Following the PRISMA-Protocol and using meta-analytic techniques, this study examines the effects of interventions for mental health literacy among Chinese people, with knowledge of mental health stigma and help-seeking as outcome variables. The study also explores the influences of five moderator variables (types of intervention, types of contact, types of intervention staff, types of region, and types of experiment) on the intervention effects in order to identify the active ingredients of the intervention. Another purpose of this study is to clarify the relationships among knowledge, stigma, and help-seeking in intervention, in order to provide some theoretical references for more effective improvement of mental health literacy.
Studies were identified by searching six foreign databases (PubMed, PsycARTICLES, PsycINFO, Elsevier Web of Science and Cochrane Controlled Trials Register) and three Chinese databases (CNKI, Wanfang, VIP). The search terms consisted of subject headings such as mental illness, mental health, mental disorder; outcome measures such as attitude, knowledge, help-seeking; intervention methods such as health education, health promotion, curriculum; regions such as Mainland China, Hongkong, Taiwan, Macao; and these groups of search terms were paired and combined. Selection criteria included: (1) Participants: Chinese people living in Mainland China, Hongkong, Taiwan and Macao; (2) Study design: the study provided a control group, including randomized and non-randomized trials, examining the mental health literacy at pre and post intervention; (3) Outcome measure: using knowledge, stigma, or help-seeking to measure mental health literacy; (4) Intervention: education and contact to improve mental health literacy; (5) The included studies are peer-reviewed papers and include master's and doctoral thesis. Excluding criteria were (1) participants with psychological disorders; (2) non-Chinese and non-English literature.
A total of 38 studies were included in the meta-analysis. Results: (1) The immediate effect of the intervention on knowledge, stigma and help-seeking was significant and medium-to-large (knowledge: g = 0.70, stigma: g = -0.52, help-seeking: g = 1.18). At a 6-month follow-up, only the effect of intervention on knowledge was significant (g = 0.67); at longer follow-ups (> 6 month), the effect of intervention on knowledge was still significant (g = 0.74), and the effect of intervention on stigma was significant (g = -0.34). (2) Results of the subgroup analysis: In terms of knowledge, the subgroup analysis indicated the types of region, the types of participants, the types of interaction and contact in intervention, and the types of experiment were significant. With respect to the help-seeking, only the types of region and the types of interaction and contact in intervention were significant. (3) Results of regression analysis: In terms of knowledge, the moderating effect of regions was significant after controlling other variables. In terms of stigma, the moderating effect of the types of experiment was not significant. Studies have shown that mental health literacy interventions have obvious cultural differences. Intervention effects on knowledge are stable in time, while the intervention effects on stigma are unstable. The intervention of interaction on knowledge is effective, but not conducive to stigma. The role of contact in intervention on knowledge and stigma is unclear.
Implications for future studies: (1) Improve the conceptual framework of mental health literacy. (2) Further explore the moderating variables of mental health literacy and develop individualized intervention programs. (3) Cultural factors should be considered when developing an intervention plan. (4) Explore new methods to improve mental health literacy.