Background: The recent adoption of China's new national mental health law provides a good opportunity to obtain baseline information about community mental health literacy in the country.
Aim: Assess knowledge and attitudes about mental disorders among residents in Shanghai.
Methods: A total of 1953 residents aged 15 or above selected from all 19 districts in Shanghai completed two self-report questionnaires - the Mental Health Knowledge Questionnaire (MHKQ) and the Case Assessment Questionnaire (CAQ). MHKQ total scores range from 0 to 20 (higher scores indicate better mental health literacy). The CAQ presents respondents with five case vignettes and possesses nine questions after each vignette measuring respondents' knowledge and attitudes towards these mental illnesses.
Results: Correct response rates for the 20 MHKQ items ranged from 26 to 98%, with a mean rate of 72%. The internal consistency (alpha) of the 20 items on the MHKQ was 0.69, but this decreased to 0.59 after removing four items about mental health promotion. A 5-factor model for the 20 items in the MHKQ was identified using exploratory factor analysis on one-half of the surveys, but the model was only partially validated in the confirmatory factor analysis using the second half of the surveys. On the CAQ, rates of correct recognition of mania, depression, schizophrenia with positive symptoms, schizophrenia with negative symptoms and anxiety were 42%, 35%, 30%, 19% and 21%, respectively. Work stress (37.3%), problems with thinking (30.0%) and negative life events (24.4%) were reported to be the three main causes of mental disorders. Seeing a counselor (34.2%) or a psychiatrist (33.3%) were the two most common suggestions for help-seeking. Higher education and younger age were related with better mental health literacy and higher rates of recognition of common mental disorders.
Conclusions: Mental health literacy in Shanghai appears to be increasing, but the reliability and validity of the instruments used to assess mental health literacy (MHKQ and CAQ) have not been adequately assessed so this result must be considered preliminary. Further work, preferably including both qualitative and quantitative components, is needed to revise these instruments before they can be used to assess the effectiveness of mental health promotion campaigns.
背景: 近期中华人民共和国精神卫生法的实施是了解中国社区居民精神卫生知识知晓度基线数据的契机。
目的: 了解上海市居民精神卫生知识和态度。
方法: 来自上海市所有的19个区县1953名15岁及以上的常住居民完成了《精神卫生与心理保健知识问卷》及《案例》部分的调查。知识问卷满分20分，得分越高，表明对相关知识的了解程度越高。案例部分包括5个案例的描述，在每个案例后提出9个相关问题以评估受访者对这些精神障碍的知识和态度。
结果: 精神卫生与心理保健知识问卷20个条目的正确回答率为26%～98%，平均72%。该问卷20个条目的内部一致性（α）为0.69，如果不纳入其中关于精神卫生健康促进的4个条目，α值则降至0.59。对一半的调查数据进行探索性因子分析，确定精神卫生与心理保健知识问卷20个条目的五因子模型，但用另一半数据进行验证性因子分析表明上述模型仅部分有效。案例相关知识调查发现，受访者对以下精神障碍的正确识别率分别为：躁狂症42%，抑郁症35%，阳性症状为主的精神分裂症30%，阴性症状为主的精神分裂症18%，焦虑症21%。工作压力太大（37.3%）、思想上的问题（30.0%）和受了打击（24.4%）被视为精神疾病的3个主要原因。找人做心理咨询（34.2%）和看精神科医生（33.3%）是建议求助的方法中2种最主要的方式。受教育程度愈高、愈年轻者对精神卫生知识的知晓率就愈高，对常见精神疾病的识别率也愈高。
结论: 调查发现上海市居民对精神卫生与心理保健知识的知晓度有所提高。由于尚未充分评估精神卫生与心理保健知识问卷及案例部分问卷的信度和效度，所以本研究结果只能视为预初性的。需要进一步的工作，如首先从质和量两方面着手修订这些工具，才能将其用于评估精神卫生促进运动的有效性。