Zhang Yamin, Zhou Meng, Liang Rong, Chen Jingyuan, Shi Puyu, Zheng Yanghao, Luo Xing, Wu Yuejing, Yu Xueli, Wu You, Liang Sugai, Deng Wei, Bueber Marlys Ann, Phillips Michael Robert, Li Tao
Affiliated Mental Health Centre, Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Lancet Reg Health West Pac. 2025 Aug 1;61:101642. doi: 10.1016/j.lanwpc.2025.101642. eCollection 2025 Aug.
Low mental health literacy (MHL) could contribute to misconceptions about mental illnesses and reinforce various forms of stigma (public, personal, and associative), leading to discrimination, reduced help-seeking, and poorer mental health outcomes. To summarise the current state of the literature on MHL, stigma, and discrimination, this scoping review identified 387 studies published from 2000 to 2024 in five English and three Chinese databases: 60.7% focused on stigma, 31.8% on MHL, and only 7.5% on discrimination. Most studies (84.8%) were descriptive cross-sectional studies, 14.5% evaluated interventions, and 0.7% were non-intervention longitudinal studies. Methodological quality was generally low: reports about 88.4% of the cross-sectional studies, 75.6% of the randomised controlled trials, and 83.4% of the quasi-experimental studies lacked descriptions of key methodological or statistical details. After excluding researcher-developed tools only reported in a single study, 125 assessment tools remained, 26.4% of which were developed in China. Although 21 different mental health conditions were studied, 91.0% of the studies focused on a single condition. Study locations were geographically skewed (one-third of all studies were conducted in Guangdong, Beijing, and Shanghai), and study participants were not representative of the target cohort. The number of publications increased substantially after 2010. Most of the 56 intervention studies, which primarily used psychoeducational interventions, reported improved MHL and decreased stigma. Recommendations for future studies include: 1) Develop standardised instruments to improve comparability. 2) Ensure detailed statistical analyses and clearly defined sample characteristics. 3) Assess variations in MHL, stigmatisation, and discrimination across different mental health conditions. 4) Increase research in underserved regions and conduct nationwide longitudinal studies. 5) Include a broader range of participants in intervention studies and consider new intervention strategies (i.e., other than psychoeducation interventions). 6) Align research objectives with national mental health policies to enhance their relevance and impact.
低心理健康素养（MHL）可能导致对精神疾病的误解，并强化各种形式的污名化（公众污名、个人污名和关联污名），进而导致歧视、求助行为减少以及心理健康状况恶化。为了总结关于MHL、污名化和歧视的文献现状，本范围综述在五个英文数据库和三个中文数据库中检索了2000年至2024年发表的387项研究：60.7%的研究聚焦于污名化，31.8%聚焦于MHL，而仅7.5%聚焦于歧视。大多数研究（84.8%）为描述性横断面研究，14.5%评估了干预措施，0.7%为非干预性纵向研究。方法学质量总体较低：约88.4%的横断面研究、75.6%的随机对照试验和83.4%的准实验研究报告缺乏关键方法学或统计学细节的描述。在排除仅在一项研究中报告的研究者自行开发的工具后，仍有125种评估工具，其中26.4%是在中国开发的。尽管研究了21种不同的心理健康状况，但91.0%的研究仅聚焦于一种状况。研究地点在地理上分布不均（所有研究的三分之一在广东、北京和上海进行），研究参与者不具有目标人群的代表性。2010年后出版物数量大幅增加。56项干预研究中的大多数主要采用心理教育干预措施，报告显示MHL有所改善，污名化有所减少。对未来研究的建议包括：1）开发标准化工具以提高可比性。2）确保进行详细的统计分析并明确界定样本特征。3）评估不同心理健康状况下MHL、污名化和歧视的差异。4）增加在服务不足地区的研究并开展全国性纵向研究。5）在干预研究中纳入更广泛的参与者，并考虑新的干预策略（即除心理教育干预之外的策略）。6）使研究目标与国家心理健康政策保持一致，以增强其相关性和影响力。
