The Role of Mental Health Literacy in Promoting Help-Seeking Attitudes: A Propensity Score Matching Approach

Background and Purpose:

Many individuals who need mental health services do not seek care. Untreated mental illness can result in significant psychological and social burdens for both individuals and their families, making its societal impact impossible to ignore. While previous research has examined the relationship between mental health literacy and help-seeking attitudes, much of that work has been used primarily to establish correlations, limiting the ability to draw causal conclusions. This study aims to address this gap by using propensity score matching to estimate the causal impact of mental health literacy on help-seeking attitudes. We hypothesize that individuals with higher mental health literacy will be more likely to endorse positive attitudes toward seeking mental health support compared to those with lower literacy levels. Specifically, this study investigates whether higher mental health literacy leads to more favorable help-seeking attitudes.

Methods:

Data were drawn from the 2018 General Social Survey, which employed a vignette-based strategy to elicit respondents’ views on mental illness. Using these vignettes, we assessed respondents’ levels of mental health literacy by summing their responses related to both the recognition of mental illness and causal attributions regarding the issue depicted. These scores were then recoded into a binary variable indicating either high or low mental health literacy.

The outcome variable, attitudes toward help-seeking, was measured by summing responses to 10 items assessing beliefs about the recovery process, as well as openness to mental health professionals and psychiatric medications.

Potential confounding variables included age, sex, race, income, education level, contact with someone with mental illness, physical health status, depression diagnosis, and stigma-related beliefs.

Propensity score matching was performed using 1:1 nearest neighbor matching with a caliper of .03.

Results

Before matching, significant differences were observed between individuals with high and low mental health literacy on all confounding variables except age, sex, and physical health status at the p < .05 level.

After matching, 310 participants were retained. Balance diagnostics indicated substantial improvement: the average standardized bias was reduced from 12.9% to 8.3%, and the likelihood ratio test for covariate imbalance was no longer statistically significant (p = .539).

A weighted linear regression model was used to estimate the treatment effect on help-seeking attitudes. Results showed that individuals with high mental health literacy scored significantly higher on help-seeking attitude measures compared to those with low literacy (b = .48, 95% CI [0.16, 0.79]). This suggests that higher mental health literacy is positively associated with more favorable attitudes toward seeking mental health support, even after adjusting for key confounders.

Conclusions and Implications:

Findings highlight the critical role of mental health literacy in shaping positive attitudes towards seeking mental health support. Integrating mental health literacy into broader mental health education initiatives can be a viable strategy for reducing barriers to care and encouraging help-seeking behavior. Additionally, social workers can develop tailored interventions that prioritize mental health literacy as a key factor in enhancing help-seeking behaviors while recognizing that different communities face unique needs and barriers in accessing mental health care.