The present study sought to identify factors associated with mental health literacy in a diverse group of undergraduate students. Mental health literacy was quantified using multiple-choice items that assessed conceptual knowledge of specific disorders and the application of that knowledge in everyday life.
We used Discriminant Correspondence Analysis (DiCA), which is a versatile technique for analyzing multiple variables within a single model. This technique is novel and has, thus far, not been used in studies that examine the factors associated with mental health literacy. Using DiCA, we identified student groups who had higher mental health literacy scores. However, in light of the purpose of the study, which was to understand the mental health needs of college students, it was vital to also focus on those student groups with lower mental health literacy scores. In highlighting these results, we shed light on the vulnerable student groups in need of intervention for the purpose of increasing mental health literacy in a college population.
Component 1 findings
The main contributor to variation in scores between high, mid-level, and low performers was having taken a course related to clinical psychology. This finding, though correlational, suggests that formal coursework related to clinical psychology positively affects literacy of mental health. Though previous research has not specifically investigated whether clinical coursework for college students directly increases mental health literacy, there is evidence that
Mental Health First Aid/MHFA [
43], an educational training program where participants are trained to help others in crises related to mental health, improved participants’ mental health knowledge, recognition of psychological disorders, and knowledge of effective treatments [
44‐
46]. Additionally,
Transitions [
47,
48], an educational resource for post-secondary students, which addresses life-skills and mental health information, improved students’ knowledge of mental health, decreased stigma, and increased help-seeking behaviors [
49,
50]. Evidence that these programs have had a positive impact on mental health literacy of participants underscores the importance and potential benefits of education in this area.
The question of whether mental health literacy can be taught as a course is an important one. Underlying our main finding, where taking a class related to clinical psychology impacted mental health literacy, is the following question: Is the clinical psychology class in itself incorporating literacy of mental health and thus increasing students’ scores on an assessment of mental health literacy? Or, do students who have higher mental health literacy to begin with, gravitate towards these types of classes? If the former, then the argument can be made that mental health literacy could be taught, but if the latter, would taking such a course actually be effective in increasing mental health literacy? More research is needed to answer this question, specifically to assess if a college course focusing on mental health would increase the mental health literacy of students who have not taken a class related to clinical psychology.
Another factor accounting for the difference in scores between high and low performers was majoring in psychology and applied health science fields, as compared to majoring in other fields, specifically business/economics or STEM fields. This finding corresponds to a study that reported that students of psychology and medicine displayed a higher level of mental health literacy, as well as having determined that male students of natural science, economics, and law were particularly weak at recognizing symptoms of schizophrenia and depression [
18]. Further supporting this result is a finding that male STEM majors had lower mental health knowledge than students from non-STEM fields [
21]. In general, these studies have examined the relationship between overall disciplines and mental health literacy as opposed to individual majors, and our study, as well, assessed domains of study as opposed to particular majors. However, if participants would be studied more narrowly, via their specific majors, more information could be provided on how concentrated areas of study relate to mental health literacy. Thus, further research is needed to investigate whether differences observed in mental health literacy performance are associated with any individual college majors, with the purpose of directing interventions towards these specific groups.
All of the demographic variables including gender, age, and ethnicity, significantly contributed to differences in mental health literacy scores. Specifically, students who reported being female, white, and between the ages of 28–32, were more likely to earn higher scores as compared to students who reported being male, Asian/Asian American, Black/African American, or Hispanic/Latino, and between the ages of 18–22 years. Our finding that females tend to score higher than males aligns with the literature on gender and mental health literacy in college settings [
51]. These consistent findings may allude to the premise that gender socialization is at the core of the apparent gender discrepancies of mental health literacy (see [
51] for a discussion on gender socialization and how it relates to mental health literacy).
Participants in the 28–32 age group were more likely to be among the high performers, while participants in the 18–22 age group were more likely to be among the low performers. This finding seems to differ from previous research that found that individuals in the youngest age groups scored highest on identification of disorders [
7,
11]. However, there is, in fact, agreement between our results and these studies because the ages of our highest scoring group (28–32) aligns with the upper ages of the youngest groups (18–29 and 20–34) in these studies. Also noteworthy is that participants in our study who had the highest scores were older within a relatively young age group, which parallels a study addressing age and mental health literacy, where being older, albeit within a relatively young age group, was associated with higher performance in university students [
9]. However, our results are difficult to directly compare with previous studies due to the variation in age groups. For example, other studies’ oldest age groups were 60–69 [
13] and 70+ [
17] and our oldest age group was 38+, with only 7 participants above the age of 50. Similarly, it is difficult to compare the results of our lowest scoring group (18–22) with other studies, as research on this age bracket in relation to mental health literacy is scarce. This is unfortunate because the traditional age of college students falls approximately in this age bracket and based on our results these may be the students who are most in need of intervention. In future research, greater consistency in the age ranges utilized across similar samples would help reveal the true pattern of relationship between age and mental health literacy.
In terms of ethnicity, our finding corresponds to a study that found that students who were white had higher scores on depression recognition, as compared to students who were non-white [
8]. In further support, a study on college-age males found that undergraduate students who were white had higher mental health literacy than Asian and other undergraduates [
21]. It has been suggested that these results may be the effect of mental health literacy reflecting a Western conceptualization of mental health (see [
52] for a discussion on mental health literacy as it relates to cultural diversity), possibly calling into question the overall conclusion that non-whites have lower mental health literacy than whites. With this in mind, mental health assessments should incorporate more culturally aligned items in order to tap into experiences of minorities regarding knowledge, awareness, attitude, and treatment of mental health.
In our sample, students who were in their fourth year or later of their undergraduate program scored higher than students in their first, second, or third year. Though this may be the result of increased academic knowledge and life experience, it may also be that familiarity with a college campus makes it more likely for a student to access available mental health services, a factor that potentially contributes to increased mental health literacy.
Having been diagnosed and/or treated for a psychological disorder impacted mental health literacy performance in our sample. Though there is limited research on whether having been diagnosed affects mental health literacy in college students, treatment experience has been shown to impact symptom recognition of depression and schizophrenia [
18] and generalized anxiety disorder [
8]. In the general population, however, some studies have found that being diagnosed or treated for a mental health issue does influence knowledge of certain mental health disorders [
53], while others have found that it does not [
7,
11,
54]. Though research has not established a consensus, our findings were, nonetheless, statistically significant. The inconsistency in results may be related to our population of study and may suggest that being diagnosed or treated impacts mental health literacy, particularly in college students. More research is needed to determine if this is so, with the possibility that the significance of this factor varies based on the population being studied. Another possibility is that personal experience with mental health issues is broader than has been addressed in previous research. Rather than personal experience being limited to personal diagnosis and/or treatment or general use of mental health services, we also extended experience with psychological disorders to include one’s family or close friends. These items were included in a question that asked respondents to check off as many areas of experience that pertained to them. Results were statistically significant and, in fact, the more experience respondents reported to have had, the more likely they were to have higher scores.
The role of family is important for an individual’s well-being, especially in the area of mental health. Prior research has found that respondents regard family as an important source of help for mental health issues [
10,
55], though family openness to discussing mental health issues and its impact on mental health literacy does not seem to have been addressed. In an attempt to investigate the association between these two variables, we asked respondents if their immediate family was open to talking about mental health issues and those who responded in the affirmative were more likely to have higher mental health literacy scores. This finding suggests that openness to discussing mental health issues may play a role in the mental health literacy of college students. It is interesting to note that in contrast to other variables investigated in this study such as gender, age, ethnicity, year in college, and being diagnosed and/or treated for a psychological disorder, this variable, much like the clinical course previously discussed, is not immutable and can thus be incorporated into an intervention. Doing so as a community outreach initiative or family training would have the potential to increase mental health literacy in a meaningful and far-reaching manner.
The variable that did not have a significant impact on differentiating between low, mid-level, and high-performing participants was potential use of college services. Specifically, we asked respondents whether they would consider taking advantage of various campus mental health services (e.g., personal counseling, drug and alcohol counseling, and mental health awareness training) and academic services (e.g., time management, stress management, test anxiety management), to which they answered “yes” or “no”. It is possible that our non-significant findings relate to the way in which we phrased the question. As opposed to asking about willingness to access campus services, a better query might have been a measure of treatment use, such as whether participants had actually accessed any campus services, as treatment utilization behaviors have been associated with higher mental health literacy [
56].
Study limitations and future directions
Our study has the strength of assessing mental health literacy in a large and diverse sample of undergraduate college students utilizing numerous variables, which to our knowledge are more extensive than have been previously incorporated in a single study. However, due to the study design and logistical issues, we were not able to randomly select students for participation and instead used a convenience sample. In addition, as participation was voluntary, we had a higher percentage (62.0%) of women in our sample. Furthermore, all participants were from the same city and enrolled at commuter colleges, a population that is quite different from traditional undergraduates. In light of this, it is difficult to ascertain whether findings can be generalized to undergraduate students from a different geographic location and enrolled at a residential college. Also, as noted above, this study was correlational and conclusions about the directionality of the findings cannot be drawn—particularly for variables such as college major and formal coursework related to clinical psychology.
In terms of future directions, efforts should focus on addressing vulnerable students’ mental health needs by: 1) increasing awareness of, and access to, clinical services available on campus, especially to those who typically do not feel comfortable availing themselves to such services, such as males and minority groups, in a manner that is culturally accommodating and sensitive; and 2) developing an educational curriculum intended to increase mental health literacy across majors and offering a 1-credit abnormal psychology “light” course to students during their freshman and sophomore years in college. Though important in terms of its broad sweep as an educational intervention, ideally, it is the student groups with lower mental health literacy performance that would be targeted for this course, where data collected in this area could then foster a campaign geared towards these students and provide a rationale for intervention (e.g., providing psychoeducation, promoting awareness of college resources, increasing availability of treatment), all at the college level.