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A Systematic Review of Mental Health Literacy Measures for Children and Adolescents

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Abstract

Mental health literacy is an essential part of preventing mental illnesses. However, the quality of mental health literacy measures remain unknown, as does its universality across various settings and populations. Few studies focus on measures aimed at assessing mental health literacy of children and adolescents that covers knowledge about mental health and mental disorders, strategies to decrease stigma, and enhancement of help-seeking efficacy. The present study aimed to conduct a systematic search to find available measures of mental health literacy of children and adolescents under the age of 19 years. The following databases were searched: Web of Science, PubMed, PsycINFO, MEDLINE, ERIC and CINAHL Plus. COSMIN checklist was applied to assess the methodological quality of each study. Twenty-one mental health literacy measures were identified in 18 studies. The quality of the studies ranged between very good and inadequate. Sixteen measures were universal, implying that they were not diagnostic specific. Two measures scored a full score of four on mental health literacy comprehensiveness. This review revealed that the overall quality of the measurement properties was mixed, that there are limited measures available to evaluate non-diagnostic-specific mental health literacy in universal populations of children and adolescents, and that measures fail to cover key mental health literacy components of knowledge of mental health, illness, stigma, and help-seeking. New measures should be developed to cover this gap in the field of child and adolescent mental health.

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Funding

This project is supported by EEA and Norway Funds Project: SUPREME Strengthening Universal Prevention, Resources, and Evaluation of Mental Health in Education, funded via the grant “Monitoring a posilování duševního zdraví dětí a adolescent,” grant number ZD-ZDOVA1-025. The funding bodies had no role whatsoever in the design of our program or study, methodology used, data collection, data analysis, data interpretation, or writing of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

MK participated in the design and study quality assessment, interpretation of the data, and helped draft the manuscript; HT participated in the study design, data management and extraction, and helped draft the manuscript; MS participated in data management and extraction and reviewed the manuscript; AK conceived the study, participated in its design and interpretation of the data, and helped draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Matej Kucera.

Ethics declarations

Conflict of interest

The authors report no conflict of interests.

Preregistration

This systematic review was registered in International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), Registration number: INPLASY202290054, DOI number: https://doi.org/10.37766/inplasy2022.9.005.

Additional information

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Appendices

Appendix I

Search strategy applied across the databases

Concept 1 (population) < 19)

Concept 2 (assessment tool)

Concept 3 (mental health)

Concept 4 (literacy)

Concept 5 (study type)

“Child*” OR “adolescen*” OR “youth”

“Assessment*” OR “evaluat*” OR “measur*” OR “test*” OR “scale*” OR “assessment*” OR “psychometrics” OR “questionnaire*”

“Mental health” OR “mental well-being”

“literacy” OR “knowledge” OR “awareness” OR “attitudes” OR “stigma”

Reliability OR effective* OR efficac* OR program evaluation OR validity

Appendix II

Standards and measurement properties and its taxonomy based on COSMIN

Content validity

 

 Box 1. PROM development

 

 Box 2. Content validity

The degree to which the content of a PROM is an adequate reflection of the construct to be measured.

Internal structure

 

 Box 3. Structural validity

The degree to which the scores of a PROM are an adequate reflection of the dimensionality of the construct to be measured.

 Box 4. Internal consistency

The degree of the interrelatedness among the items.

 Box 5. Cross-cultural validity\measurement invariance

The degree to which the performance of the items on a translated or culturally adapted PROM are an adequate reflection of the performance of the items of the original version of the PROM

Remaining measurement properties

 

 Box 6. Reliability

The proportion of the total variance in the measurements which is due to ‘true’ differences between patients

 Box 7. Measurement error

The systematic and random error of a patient’s score that is not attributed to true changes in the construct to be measured

 Box 8. Criterion validity

The degree to which the scores of a PROM are an adequate reflection of a ‘gold standard’

 Box 9. Hypotheses testing for construct validity

Hypotheses testing for construct validity refers to the degree to which the scores of a PROM are consistent with hypotheses based on the assumption that the PROM validly measures the construct to be measured.

 Box 10. Responsiveness

The ability of a PROM to detect change over time in the construct to be measured

Appendix III

Updated criteria for good measurement properties

Measurement property

Rating

Criteria

Structural validity

+

CTT: CFA: CFI or TLI or comparable measure > 0.95 OR RMSEA < 0.06 OR SRMR < 0.08

IRT/Rasch: No violation of unidimensionality: CFI or TLI or comparable measure > 0.95 OR RMSEA < 0.06 OR SRMR < 0.08 AND no violation of local independence: residual correlations among the items after controlling for the dominant factor < 0.20 OR Q3’s < 0.37 AND no violation of monotonicity: adequate looking graphs OR item scalability > 0.30 AND adequate model fit: IRT: χ2 > 0.01 Rasch: infit and outfit mean squares ≥ 0.5 and ≤ 1.5 OR Z-standardized values > -2 and < 2

?

CTT: Not all information for ‘+’ reported

IRT/Rasch: Model fit not reported

Criteria for ‘+’ not met

Internal consistency

+

At least low evidence for sufficient structural validity AND Cronbach’s alpha(s) ≥ 0.70 for each unidimensional scale or subscale

?

Criteria for “At least low evidence for sufficient structural validity” not met

At least low evidence for sufficient structural validity AND Cronbach’s alpha(s) < 0.70 for each unidimensional scale or subscale

Reliability

+

ICC or weighted Kappa ≥ 0.70

?

ICC or weighted Kappa not reported

ICC or weighted Kappa < 0.70

Measurement error

+

SDC or LoA < MIC

?

MIC not defined

SDC or LoA > MIC

Hypotheses testing for construct validity

+

The result is in accordance with the hypothesis

?

No hypothesis defined (by the review team)

The result is not in accordance with the hypothesis

Cross-cultural validity/measurement invariance

+

No important differences found between group factors (such as age, gender, language) in multiple group factor analysis OR no important DIF for group factors (McFadden’s R2 < 0.02)

?

No multiple group factor analysis OR DIF analysis performed

Important differences between group factors OR DIF was found

Criterion validity

+

Correlation with gold standard ≥ 0.70 OR AUC ≥ 0.70

?

Not all information for ‘+’ reported

Correlation with gold standard < 0.70 OR AUC < 0.70

Responsiveness

+

The result is in accordance with the hypothesis7 OR AUC ≥ 0.70

?

No hypothesis defined (by the review team)

The result is not in accordance with the hypothesis OR AUC < 0.70

Appendix IV

Methodological quality of each study on a measurement properties

PROM

Tool

Content validity

Internal structure

Remaining measurement properties

  

Tool development

Content validity

Structural Validity

Internal Consistency

Cross-cultural validity

Reliability

Measurement error

Criterion validity

Hypotheses testing

Responsiveness

PROM A Riebschleger et al. (2019)

(K-MIR)

D

NR

V

V

NR

NR

NR

NR

NR

NR

PROM B (Ochoa et al. (2016)

(CAMI - Spanish version)

D

NR

NR

V

NR

V

A

NR

NR

NR

PROM C McKeague et al. (2015)

Peer mental health stigmatization scale

D

D

NR

D

NR

V

V

NR

V

V

PROM D Kellison et al. (2010)

(ASQ)

D

D

V

V

NR

V

V

 

V

V

PROM E Pinto et al. (2012)

(r-AQ)

I

NR

V

V

A

NR

NR

NR

NR

 

PROM F Hart et al. (2014)

ADKQ

I

NR

V

V

V

NR

NR

NR

NR

V

PROM G Burns and Rapee (2006)

Friend in need questionnaire

I

NR

NR

 

NR

NR

NR

NR

NR

NR

PROM H Campos et al. (2016)

(MHLq)

V

V

NR

V

NR

V

V

NR

NR

NR

PROM I Zenas et al. (2020)

Danish MeHLA questionnaire

V

V

V

V

NR

NR

NR

NR

NR

NR

PROM J Castellvi et al. (2020)

EspaiJove.net

V

V

NR

V

NR

V

V

NR

V

V

PROM K Kaushik et al. (2017)

Paediatric (PaedS)

V

V

V

V

NR

NR

NR

NR

V

V

PROM L Darraj et al. (2016)

(D-lit)

V

V

V

V

NR

A

V

NR

NR

NR

PROM M Rosa et al. (2016)

MentalHLis-AA

V

V

A

V

NR

NR

NR

NR

NR

NR

PROM N Serra et al. (2013)

Knowledge of mental disorders

I

NR

V

NR

NR

NR

NR

NR

NR

NR

PROM O Jackson and Heatherington (2006)

Social contact scale

D

NR

NR

A

NR

NR

NR

NR

NR

NR

PROM P Jackson and Heatherington (2006)

(OMI)

D

NR

NR

NR

NR

NR

NR

NR

NR

NR

PROM Q Mansfield et al. (2020)

(RIBS)

D

NR

V

V

NR

NR

NR

NR

V

V

PROM R Schmeelk-Cone et al. (2012)

(HSA)

D

V

V

V

NR

NR

NR

NR

V

V

PROM S (Schmeelk-COne et al. (2012)

(RCS)

D

V

V

V

NR

NR

NR

NR

V

V

PROM T Schmeelk-Cone et al. (2012)

(AHSY)

D

V

V

V

NR

NR

NR

NR

V

V

PROM U Watson et al. (2005)

(ATSMI-AV)

I

NR

NR

NR

NR

NR

NR

NR

NR

NR

  1. V very good, A  adequate, D  doubtful, I inadequate

Appendix V

Rating of results in each study on measurement properties against the updated criteria for good measurement properties

PROM

Tool

Content validity

Internal structure

Remaining measurement properties

  

Relevance rating

Comprehensiveness rating

Comprehensibility rating

Structurl validity

Internal consistency

Cross-cultural validity

Reliability

Measurement error

Criterion validity

Hypotheses testing

Responsiveness

PROM A Riebschleger et al. (2019)

(K-MIR)

NR

NR

NR

+

+

NR

NR

NR

NR

NR

NR

PROM B Ochoa et al. (2016)

(CAMI - Spanish version)

NR

NR

NR

NR

+

NR

+

?

NR

NR

NR

PROM C McKeague et al. (2015)

Peer mental health stigmatization scale

±

NR

+

NR

?

?

NR

?

+

PROM D

(Kellison et al., 2010)

(ASQ)

+

+

+

+

+

NR

+

?

NR

+

+

PROM E Pinto et al., (2012)

(r-AQ)

NR

NR

NR

+

+

?

NR

NR

NR

NR

NR

PROM F Hart et al. (2014)

(ADKQ)

NR

NR

NR

+

+

?

NR

NR

NR

NR

?

PROM G Burns and Rapee (2006)

Friend in need questionnaire

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

PROM H Campos et al. (2016)

(MHLq)

+

+

+

NR

+

NR

+

?

NR

NR

NR

PROM I Zenas et al. (2020)

Danish MeHLA questionnaire

+

+

+

+

NR

NR

NR

NR

NR

NR

PROM J Castellvi et al. (2020)

EspaiJove.net

+

+

+

NR

+

NR

?

NR

?

?

PROM K Kaushik et al. (2017)

Paediatric (PaedS)

+

+

+

+

+

NR

NR

NR

NR

?

?

PROM L Darraj et al. (2016)

(D-lit)

+

+

+

?

+

NR

?

?

NR

NR

NR

PROM M Rosa et al. (2016)

MentalHLis-AA

+

+

+

?

NR

NR

NR

NR

NR

NR

PROM N Serra et al. (2013)

Knowledge of mental disorders

NR

NR

NR

?

NR

NR

NR

NR

NR

NR

NR

PROM O Jackson and Heatherington (2006)

Social contact scale

NR

NR

NR

NR

+

NR

NR

NR

NR

NR

NR

PROM P Jackson and Heatherington (2006)

(OMI)

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

PROM Q Mansfield et al. (2020)

(RIBS)

NR

NR

NR

+

+

NR

NR

NR

NR

?

?

PROM R Schmeelk-Cone et al. (2012)

(HSA)

+

+

+

?

+

NR

NR

NR

NR

?

?

PROM S Schmeelk-Cone et al. (2012)

(RCS)

+

+

+

?

NR

NR

NR

NR

?

?

PROM T Schmeelk-Cone et al. (2012)

(AHSY)

+

+

+

?

NR

NR

NR

NR

?

?

PROM U Watson et al. (2005)

(ATSMI-AV)

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

  1. + sufficient, ? indeterminate”, – insufficient, ± inconsistent

Appendix VI

MHL comprehensiveness across the scales

Name of the scales

Authors

MHL 1

MHL 2

MHL 3

MHL 4

Knowledge of mental illness and recovery scale (K-MIR)

Riebschleger et al. (2019)

0

1

1

0

Community attitudes towards mental illness (CAMI) (Spanish version)

Ochoa et al. (2016)

0

1

1

0

Peer mental health stigmatization scale

McKeague et al. (2015)

0

0

1

0

Revised attribution questionnaire (r-AQ)

Pinto et al. (2012)

0

0

1

0

Friend in need questionnaire

Burns and Rapee (2006)

0

1

0

1

Mental health literacy questionnaire (MHLq)

Campos et al. (2016)

1

1

0

1

Danish MeHLA questionnaire

Zenas et al. (2020)

1

1

1

1

EspaiJove.net

Castellvi et al. (2020)

1

1

1

1

Depression literacy questionnaire (D-lit)

Darraj et al. (2016)

0

1

1

0

Knowledge of mental disorders

Serra et al. (2013)

0

1

0

0

Social contact scale

Jackson and Heatherington (2006)

0

0

1

0

Reported and intended behaviour scale (RIBS)

Mansfield et al. (2020)

0

0

1

0

Help-seeking acceptability (HSA) at school scale

Schmeelk-Cone et al. (2012)

0

0

0

1

Attitudes toward serious mental illness scale - Adolescent version (ATSMI-AV)

Watson et al. (2005)

0

1

1

0

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Kucera, M., Tomaskova, H., Stodola, M. et al. A Systematic Review of Mental Health Literacy Measures for Children and Adolescents. Adolescent Res Rev 8, 339–358 (2023). https://doi.org/10.1007/s40894-022-00202-8

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