over 3 years ago

Mental health symptoms can be subtle, resulting in delaying treatment. A prompt identification of mental signs and symptoms is important for preventing mental disorders in the public. This study examined whether local public have adequate knowledge to identify mental health symptoms and the need to get timely professional help.

Methods The population-based telephone surveys were conducted in 2015 and 2018. It involved a random sample of 4033 respondents aged 12–75 years. Mental health knowledge and help seeking attitude were assessed using six vignettes depicting subtle and obvious symptoms of anxiety disorders, mixed anxiety and depressive disorders, and dementia. Logistic regression models were performed to examine association between mental health knowledge and help-seeking attitude.

Results Individuals with poor knowledge in subtle symptoms were more likely to be males (t =  − 5.0, p < .001), younger (F = 15.0, p < .001), have tertiary education (F = 15.0, p < .001), and employed (t =  − 2.1, p = .037). The knowledge scores of subtle and obvious symptoms were 1.5 and 2.3 respectively. Binary logistic regression found that poor knowledge of subtle symptoms was associated with reluctance to professional help seeking.

Conclusions Poorly identified subtle mental health symptoms is a major barrier to early professional help in highly educated working males. Future research should explore specific interventions to increase knowledge and professional help seeking in this group.

Background The Hong Kong Mental Morbidity Survey 2010–2013 reported that 13.3% of the population aged between 16 and 75 struggled with some types of common mental disorders, which is comparable to the global prevalence of 13% [1, 2]. A recent population-based survey further revealed that the proportion of people experiencing stress and anxiety symptoms has increased by 42.3%, and depressive symptoms and unhappiness have doubled compared to 2016 [3]. It is certain that subtle mental health symptoms are more common now than before, but they are not getting easier to be identified. Longitudinal evidence demonstrated that delaying treatment of up to 23 years could be resulted for any mood disorders [4]. Therefore, a prompt and accurate identification of mental signs and symptoms could be beneficial to the mental health in the public.

However, mental health literacy studies still found inaccurate labelling of mental disorders and low willingness to use mental health service in some developed countries [5,6,7,8]. Cross-cultural studies further revealed that identification of mental disorders in Asian populations is relatively low [9,10,11]. It is mainly due to inability to use psychiatric terms for subtle mental health symptoms and lack of knowledge in symptomatology [9]. Interestingly, a recent study comparing three cultural groups found that Hong Kong Chinese adults were comparable to British in terms of familiarity with mental illness terms compared to Malaysians, but the endorsement of the same population to professional help is still low. This reflects fair awareness but lack of knowledge in mental health disorders and associated burdens in local population [10].

There have been many studies on public awareness of mental health problems, but investigation on knowledge in symptomatology remained rudimentary and mostly focused on schizophrenia and depression in adolescences or young adults [12,13,14,15,16]. It is both timely and relevant to assess if the public have adequate knowledge to identify other common mental health disorders and the need to get professional help. We specifically looked at the level of knowledge in obvious and subtle symptoms of three common mental disorders, namely anxiety disorders, mixed anxiety and depressive disorder (MADD), and dementia, in a local population-based sample. We postulated that poor knowledge of subtle symptoms in these selected mental health disorders might be a major barrier to early professional help. We aimed to examine the extent of knowledge of mental health symptoms and to evaluate its association with help seeking attitude. Our study might provide a more comprehensive understanding of public mental health knowledge and advice effective delivery of public health education in the prevention of mental disorders under the current mental health crisis.

Methods Study design and participants A telephone survey was conducted with Computer Assisted Telephone Interview (CATI) at the Centre for Communication and Public Opinion Survey (CCPOS) of the Chinese University of Hong Kong (CUHK) in 2015 and 2018 respectively. A random sample of telephone numbers was drawn from a sampling frame generated from 2005, 2007 and 2009 Hong Kong residential number directory. The target respondents were land-based non-institutional Hong Kong residents aged 12–75 years, who spoke Cantonese, Putonghua or English. A random sample of 4033 respondents were successfully interviewed by trained CCPOS interviewers using a trilingual (Cantonese, Chinese and English) questionnaire. Foreign domestic helpers and those who were institutionalized were excluded from the study, as their daily activity pattern might be different and not be generalizable with the other Hong Kong residents. Verbal consent for all respondents and parental consent for those aged below 18 years were obtained over phone before interview.

Vignettes Six vignettes (V1–V6) were constructed to depict anxiety disorders in adolescents, MADD in adults and dementia in older adults. For each mental health condition, two scenarios were presented at two levels of difficulty with symptom descriptions. One case depicted more obvious mental symptoms with more constant intense feelings affecting daily function, while the other case described subtle symptoms of the same mental disorder that is either contextual or intermittent. Respondents were asked to identify symptoms as mental illnesses and recommend treatment for all vignettes. Please refer to Appendix or vignette’s description.

Measurement Knowledge of mental health symptoms Knowledge of mental health symptoms was evaluated using the six vignettes. After the presentation of each vignette, respondents were asked to identify the vignette as 1 = Yes, he/she is likely to suffer from mental health disorders or 0 = No, he/she is not likely to suffer from mental health disorder/Do not know. A summary knowledge score ranges from 0 to 6, with higher score indicating higher level of knowledge.

Help seeking attitude on common mental health disorders Help seeking attitude was explored based on the six vignettes described above. For each vignette, respondents were asked to opt for the most preferred help seeking methods: (i) nothing needs to be done; (ii) talking to family and friends; or (iii) consult a doctor or seek help from a professional. A total score for each help seeking attitude was calculated by summing the number of each methods chosen in all six vignettes. Each help seeking methods would score from 0 to 6, with higher score indicating higher preference towards a particular help seeking method.

Potential confounders Mental health status was adjusted, as it could modulate the association between knowledge and help seeking attitude. It was assessed by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) and the Kessler Psychological Distress Scale (K6). K6 is a six-item questionnaire that measures psychological distress in the past 1 month anchoring on items: (i) feeling nervous, (ii) feeling hopeless, (iii) feeling restless or fidgety, (iv) feeling so depressed that nothing could cheer you up, (v) feeling everything was an effort, and (vi) feeling worthless. Each item is scored on a five-point Likert scale ranging from: (i) none of the time, (ii) a little of the time, (iii) some of the time, (iv) most of the time, and (v) all of the time. Higher scores, on a range of 0–24, indicate higher level of psychological distress. The K6 scale has a cut-off score at 13 to indicate severe psychological distress, with an internal reliability coefficient (Cronbach’s alpha) of 0.84 [17]. SWEMWBS is a validated seven-item instrument. It assessed the mental well-being status based on the frequency of experiencing seven positive feelings over the past two weeks: (i) feeling optimistic about the future, (ii) feeling useful, (iii) feeling relaxed, (iv) dealing with problems well, (v) thinking clearly, (vi) feeling close to other people, and (vii) able to make up own mind about things [18]. It is rated on a five-point Likert scale spanning from (i) none of the time, (ii) a little of the time, (iii) some of the time, (iv) most of the time, and (v) all of the time. It has a total score ranging from 7 to 35, with an internal reliability coefficient (Cronbach’s alpha) of 0.89. Higher scores indicate better mental well-being [18].

Sociodemographic information on age, gender, educational attainment, marital status, employment status, experience of mental health problems, and knowing someone with mental health problems were also obtained.

Statistical analysis Descriptive statistics summarized the sociodemographic and mental health profiles of respondents. The overall knowledge of mental symptoms was determined by counting the number of vignettes successfully identified as mental illnesses. Similarly, knowledge on different types of symptoms (subtle and obvious) was determined by counting the number of vignettes successfully identified at each level. The demographic characteristics of those who could and could not identify mental health symptoms were compared to explore factors that might have associated with level of knowledge. Logistic regression models were performed to assess the association between help-seeking attitude and correct identification of mental health symptoms with adjustment for potential confounders. All data analyses were performed using IBM SPSS 23.0 for Windows. A p-value of < 0.05 was considered statistically significant.

Results Sample characteristics A total of 4033 respondents (42% males and 58% females) with a mean age of 46.1 (SD = 17.3) years. Table 1 displays the basic sociodemographic profile of the respondents. In terms of mental health status, the respondents had an average score of 5.6 (SD = 4.0) and 18.8 (SD = 4.4) on K6 and SWEMWBS respectively. 5.9% of the respondents experienced severe psychological distress (above K6 cut-off) during the past 2 weeks. There were 10.4% of the respondent with personal experience of mental health problem, and more than half (56.9%) of the respondents reported knowing Someone with mental health problems.