Expanding a Measure of Mental Health Literacy: Development of a Multicomponent Mental Health Literacy Measure

Background and Purpose: Mental health literacy (MHL), defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention” (Jorm, 2000, p. 396) is an important factor in mental health care. It is associated with help-seeking, helping others with mental illness, and stigma. In current literature, case vignettes are the most frequently used method to measure MHL; however, it is difficult with this method to capture the breadth of MHL. Few studies examine the multiple components of MHL. A valid, reliable, and comprehensive measure of MHL is needed to adequately identify the need for mental health education. This research presents the development of a MHL measure using data collected from public housing staff who are likely to work with clients at greater risk for mental health problems.  

Methods: Extensive literature review was conducted to generate 30 items measuring knowledge, beliefs, and attitudes about mental health symptoms, treatment, cause/risk factors, and resources. Four mental health experts reviewed items for content validity. A survey questionnaire included a 30-item MHL measure, a social distance scale, and demographic questions. Survey participants (n=211) were recruited from a local public housing authority in Texas. Data analyses included an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) to test construct validity and Kuder–Richardson Formula 20 (KR20) to examine internal consistency reliability. An independent sample t-test was used to examine known-groups validity by comparing MHL scores between people who had a history of mental health treatment for self or close family members and people who had no such experiences. Concurrent validity was tested by a correlation analysis examining relationships between MHL and social distance.

Results: An EFA using WLSMV estimator and oblique rotation suggested a three factor model: knowledge-oriented MHL; beliefs/attitude-oriented MHL; resource-oriented MHL. After deleting 4 poorly functioning items, the final CFA model demonstrated a good model fit: c² (296, N=211) = 327.30, p =.10; RMSEA =.02 (0-.04); CFI =.98; and TLI =.98. All factor loadings were significant ranging from .35 to .995. KR-20 coefficient was .83. Both known-groups validity and concurrent validity were supported. Public housing staff with a history of mental health treatment (M=20.68, SD=4.00, n=111) had significantly higher MHL than their counterparts (M=17.39, SD=5.32, n=90); t (162.02) = 4.86, p <.001, two-tailed. Higher MHL was also significantly associated with lower social distance from a person with mental illness (r =.37; p< .001).

Conclusions and Implications: The findings suggest that the MHL measure is a valid and reliable tool to assess mental health literacy among public housing staff. It is worth noting that participants represented a broad range of demographics, which indicates a potential applicability of this measure to other lay community people. Social workers work with clients who are at greater risk for mental health problems. This measure may help social workers identify clients’ levels of mental health literacy, provide them adequate mental health education as an early intervention, and ultimately promote a lengthy and healthy life of clients.