Based on a new conceptual frame of mental health literacy (MHL), which refers to two structural dimensions including “coping with mental illness-mental health promotion” and “self-others” and three aspects including knowledge, attitude, and behavior tendency, a systematic nationwide sampling survey was conducted for the purpose of understanding the mental health literacy profile of the Chinese. This study further explored the influences of four group variables (geographical and gross domestic product (GDP) distribution, basic demographic variables, socio-economic status, and mental health background) on mental health literacy. Another aim of this study was to provide some strategies for improving mental health literacy more effectively.

The Chinese Mental Health Literacy Questionnaire and Basic Background Information Questionnaire were used to assess the mental health literacy levels of the Chinese and their influencing factors. The Chinese Mental Health Literacy Questionnaire contains six sub-scales (knowledge and concepts related to mental health, knowledge and concepts related to mental illness, attitudes and behavior tendency to maintain and promote one’s mental health, attitudes and behavior tendency to cope with one's mental illness, attitudes and behavior tendency to maintain and promote the mental health of others, and attitudes and behavior tendency to cope with the mental illness of others). The questionnaires were administered to 8866 Chinese adults in nine cities (Beijing, Wuhan, Chengdu, Lishui, Kaifeng, Guilin, Zhangye, Baoding, and Linfen), which covered the well-developed, developing, and less-developed regions in China.

With a balanced development considering geographical and GDP distribution, the results indicated that the mental health literacy levels among adults in different cities were low to moderate. Their influences on mental health literacy were small but significant with respect to geographical distribution, gender, age, familiarity with professional mental health service, and the frequency of contact with psychiatric patients. Regarding the structure of mental health literacy, the results of the development of national mental health literacy demonstrated that mental health maintenance and promotion literacy was better than mental illness coping literacy, and self-help literacy was better than helping others literacy. The survey found that the knowledge had relatively high individual differences, whereas attitudes and behaviors had relatively low individual differences concerning the contents of the mental health literacy. In addition, among the social influencing factors of mental health literacy this research tested, the socio-economic status was the most effective one, which showed large effect size in the knowledge and small to medium effect size in the attitudes and behavior tendency.

These findings implicate that (1) improving mental health literacy is an arduous task; (2) improving the literacy of coping with mental illness should be the focus and breakthrough point of the current practice of mental health literacy promotion; (3) socio-ecological perspective should be adopted when developing a mental health literacy promotion policy; and (4) the mechanism of the attitude and behavior tendency change needs to be explored and clarified.

Keywords： mental health literacy ; prevalence survey ; group difference