A Correlational Study to Assess Mental Health Literacy and Positive Mental Health among adolescents of selected schools in Thiruvalla Taluk
Anu Mathew1*, Jisha Mary George2, Arjun Krishna2, Hananya Ann Sabu2,
Reshma Xavier2, Jiya Elizabeth Sajeev2, Deol Joy2, Josna George2, Aiswarya R. Pillai2,
Adithya. A. 2, Athira. B. 2, Arya. G. Krishna2, Mariya Jose2, Harshana Ashraf2
1Vice Principal, Department of Mental Health Nursing, Believers College of Nursing, Kuttapuzha,
Thiruvalla 689103, Kerala, India.
2Assistant Professor, Department of Mental Health Nursing, Believers College of Nursing, Kuttapuzha, Thiruvalla 689103, Kerala, India.
*Corresponding Author Email: Cherukathra@gmail.com
ABSTRACT:
Background: Adolescence is a formative period marked by rapid physical and psychological changes, making mental health support a critical focus. Mental health literacy (MHL) is essential for recognizing disorders and accessing help, which contributes to positive mental health (PMH) and effective coping. Objectives: This study aimed to assess the level of mental health literacy and positive mental health among adolescents and evaluate the correlation between these two variables in selected schools in Thiruvalla Taluk, Kerala. Materials and Methods: A quantitative correlational research design was employed. A total of 114 adolescents aged 10–19 years were selected using a convenient sampling technique. Data were collected via a structured questionnaire consisting of a socio-demographic sheet, a modified 29-item Mental Health Literacy Scale, and a 9-item standardized Positive Mental Health Scale. Statistical analysis was performed using descriptive measures, Chi-square exact tests, and Pearson’s correlation coefficient. Results: The findings revealed that 86.80% of participants had a moderate level of MHL, while 11.40% had high and 1.70% had low levels. Regarding PMH, 48.20% exhibited high levels, 42.10% moderate, and 9.64% low levels. A weak yet positive correlation was found between MHL and PMH (r = 0.0111). MHL showed significant associations with age, gender, and previous exposure to mental health information. PMH was significantly associated with age, gender, and educational level. No significant associations were found with religion or family type. Conclusion: While most adolescents possess moderate mental health literacy, the weak correlation with positive mental health suggests that knowledge alone does not guarantee emotional resilience. There is a need to incorporate practical mental health education into school curriculums to foster self-esteem and emotional regulation.
KEYWORDS: Adolescents, Mental Health Literacy, Positive Mental Health.
INTRODUCTION:
Mental health literacy (MHL) refers to knowledge and beliefs about mental disorders that aid in their recognition, management, and prevention¹. It includes awareness of symptoms, risk factors, self-help strategies, and professional help- seeking options.
Positive mental health (PMH) is the ability to maintain emotional balance, cope with stress, and function effectively in daily life². MHL and PMH are interrelated constructs that significantly influence overall well-being³.
Globally, approximately 25% of children and adolescents experience mental health problems, with about 10% meeting diagnostic criteria for mental disorders⁴. Many of these conditions begin before the age of 14, highlighting the need for ear ly intervention⁵.
Adolescents are particularly vulnerable due to rapid developmental changes and limited understanding of mental health concepts⁶. In India, which has a large adolescent population, mental health issues remain under-recognized and inadequately addressed⁷.
Previous studies have shown that adolescents often have moderate levels of mental health literacy, with variations based on demographic factors such as gender, education, and socio-economic status⁸.
The World Health Organization emphasizes mental health promotion as a key component of public health through initiatives like the Mental Health Action Plan⁹.
Mental health literacy among adolescents encompasses the knowledge and attitudes required to recognize and manage psychological challenges, such as social anxiety and depression16. Research indicates that structured educational interventions can significantly improve an adolescent's understanding of these conditions, as seen in studies where teaching programs effectively addressed social anxiety in school settings.12 Furthermore, literacy extends to recognizing the correlation between external life events and the manifestation of depressive symptoms, which is crucial for early identification and support in school environments17.
A vital component of positive mental health literacy involves understanding the impact of lifestyle choices and substance use on long-term well-being. Comparative studies between urban and rural adolescents highlight varying levels of knowledge and attitudes regarding the hazards of alcoholism and tobacco use11,20. Addressing these literacy gaps through information booklets and descriptive assessments helps shift the focus toward preventative care and the development of healthy attitudes, reducing the risk of substance-related harm during the formative teenage years13,19.
Promoting positive mental health also requires a holistic approach that integrates physical wellness and behavioral management. Practices such as Yoga (e.g., Vajrasana) have been shown to be effective in enhancing both physical and mental health outcomes among college-aged adolescents15. By fostering high mental health literacy, adolescents are better equipped to handle academic pressures, mitigate suicide risks, and understand the psychological ill effects of modern stressors like excessive cellphone usage, ultimately leading to better academic performance and overall life stability14,18,21.
Assess the mental health literacy among adolescents. Assess the positive mental health among adolescents.
Assess the correlation between mental health literacy and positive mental health among adolescents.
To find out the association between mental health literacy and sociodemographic variables. To find out the association between positive mental health and sociodemographic variables.
The present study is carried out to assess the correlation between mental health literacy and positive mental health among adolescents in selected schools of Thiruvalla Taluk.
A quantitative research approach was used for the study, in view of the nature of the problem and to accomplish the objective. The research design chosen is a correlational study. This study was conducted in selected schools at Thiruvalla Taluk. In this study students aged between 10-19 years in selected schools of Thiruvalla Taluk was selected.. Convenient sampling technique was used in this study.
1. Adolescents of age range from 10 to 19 years.
2. Adolescents who can read and write Malayalam or English.
3. Adolescents studying in selected schools at Thiruvalla Taluk.
1. Adolescents those who were not available at the time of data collection
2. Adolescents who are having developmental delays.
The socio-demographic data consists of age, gender, area of residence, class of studying, type of family, education of father and mother, occupation of father and mother, religion, number of siblings, family history of mental illness, awareness about mental health and source of knowledge about mental health.
The modified standardized mental health literacy scale of O’ Connor, M, Casey L (2015) is used to assess the Mental Health Literacy among adolescents of age 10-19 years. It consists of 29 questions. The knowledge was measured in terms of ability to recognize specific mental disorders or different types of psychological distress, knowledge and belief about causes and risk factors, attitude which facilitate recognition and appropriate help seeking, knowledge and belief about self-help intervention, knowledge of how to seek mental health information, knowledge and belief about professional help available. It is measured in terms of knowledge scores of multiple option items (questions) 5 options in each item. Each option have scores to measure the knowledge. Scoring is from 1 to 5.
According to bloom’s cut off knowledge score, Low mental health literacy 29-87(20%-59%) Moderate mental health literacy 88-115(60%-79%) High mental health literacy 116-145(80%-100%)
A 9-item positive mental health scale questionnaire is to assess the positive mental health among adolescents of age 10-19. It consists of standardized items about adaptability to the environment, managing emotions, personal satisfaction, confidence, attitude, autonomy, problem solving. It consists of 9 questions and it is measured in terms of scores of multiple option items, 5 options in each item and each option have scores. Scoring is from 0 to 4.
• Low Positive Mental Health: 0-16(0-59%)
• Moderate Positive Mental Health:17-27(60%-79%)
• High Positive Mental Health: 28-36(80%-100%)
The reliability of Tool-2 was checked using split-half method and the reliability of the tool was r = 0.90. The reliability of Tool-3 was already established =0.8
• In age the majority come between 13-15 years (37.70%)
• In gender the majority belongs to female (67.70%)
• In terms of education most of them were High school (40.30%)
• In occupation most of the fathers were employed (61.40%)
• In occupation most of the mothers were employed (50.80%)
• In terms of father’s education most of them belonged to postgraduate (60.50%)
• In terms mother’s education most of them had belonged to postgraduate (59.60%)
• In terms of residence majority belongs to Urban area (58.70%)
• In terms of family majority belongs to nuclear family (58.77%)
• In religion most of them belongs to Christian (75.40%)
• In terms of number of siblings most of them have one (60.50%)
• In terms of family history of mental illness majority belongs to no family history of mental illness (98.24%)
• In terms of awareness about mental health most of them have knowledge about mental health (87.70%)
• Most of them heard about mental health through Media (44.70%)
Figure 1: Distribution of the subject according to the level of mental health literacy n=114
Figure 1 shows the mental health literacy among adolescents. Out of 114 participants 20(17.5%) belongs to low mental health literacy, 82(71.5%) belongs to moderate mental health literacy and remaining 12(10.5%) belongs to high mental health literacy.
Figure 2: Distribution of the subject according to the level of positive mental health n=114
Figure 2 shows the distribution of participants according to positive mental health. It reveals that 11(9.64%) have low positive mental health, 48(42.10%) have moderate positive mental health, 55(48.20%) have high positive mental health.
Correlation coefficient r =0.0111Although technically a positive correlation the relationship between variables is weak (the nearer value is to zero, the weaker the relationship)
Table 1:- Association between mental health literacy with selected socio- demographic variables.
|
variables |
|
Low MHL |
Moderate MHL |
High MHL |
Chisquare |
p-value |
Significant/not |
|
Age |
10-12 |
10 |
27 |
1 |
9.9894 |
0.0406 |
Significant* |
|
13-15 |
6 |
34 |
5 |
||||
|
16-17 |
4 |
21 |
8 |
||||
|
Gender |
Male |
12 |
25 |
1 |
10.0738 |
0.006494 |
Significant* |
|
Female |
8 |
57 |
11 |
||||
|
Education |
Upper primary |
10 |
25 |
1 |
7.9903 |
0.091935 |
Not significant |
|
High school |
7 |
33 |
5 |
||||
|
Higher secondary |
3 |
24 |
6 |
||||
|
Type of family |
Nuclear |
12 |
46 |
9 |
1.5747 |
0.46118 |
Not significant |
|
Joint |
7 |
35 |
3 |
||||
|
Education of the father |
Higher secondary |
1 |
2 |
2 |
6.0625 |
0.1945 |
Not significant |
|
Graduate |
8 |
28 |
3 |
||||
|
Post graduate |
11 |
56 |
7 |
||||
|
Education of mother |
Higher secondary |
1 |
3 |
2 |
4.8825 |
0.2995 |
Not significant |
|
Graduate |
6 |
30 |
2 |
||||
|
Post graduate |
13 |
47 |
8 |
||||
|
Occupation of father |
Employed |
12 |
50 |
8 |
7.6289 |
0.1061 |
Not significant |
|
Self employed |
6 |
29 |
2 |
||||
|
Unemployed |
2 |
2 |
2 |
||||
|
Occupation of mother |
Employed |
8 |
42 |
6 |
1.4872 |
0.8289 |
Not significant |
|
Self employed |
2 |
9 |
2 |
||||
|
Unemployed |
10 |
31 |
4 |
||||
|
Area of residence |
Urban |
9 |
39 |
3 |
2.9237 |
0.2318 |
Not significant |
|
Rural |
10 |
40 |
9 |
||||
|
Number of siblings |
One |
12 |
50 |
7 |
2.7281 |
0.6042 |
Not significant |
|
Two |
7 |
18 |
3 |
||||
|
Nil |
1 |
14 |
2 |
||||
|
Religion |
Hindu |
2 |
16 |
1 |
2.9687 |
0.56307 |
Not significant |
|
Christian |
16 |
63 |
10 |
||||
|
Muslim |
2 |
2 |
1 |
||||
|
Family history of mental illness |
Yes |
1 |
1 |
0 |
1.5727 |
0.2098 |
Not significant |
|
No |
19 |
81 |
12 |
||||
|
Ever heard of mental health |
Yes |
14 |
73 |
12 |
7.8825 |
0.0050 |
Significant at p<0.01* |
|
No |
6 |
8 |
0 |
||||
|
Source of mental health knowledge |
Media |
10 |
38 |
9 |
13.3809 |
0.0003 |
Significant at p<0.01* |
|
Parents |
1 |
17 |
1 |
||||
|
Teachers |
4 |
10 |
1 |
||||
|
Peer |
0 |
0 |
1 |
||||
|
Personal experience |
1 |
2 |
0 |
||||
|
Others |
0 |
5 |
0 |
Significance at p<0.05 and p<0.01
There is an association between mental health literacy and age, gender at the level of 0.05 and there is an association between mental health literacy and knowledge of mental health, sources of mental health knowledge at the level 0.01.
Table 2:- Association between positive mental health with selected socio- demographic variables.
|
variables |
|
Low Positive mental health |
Moderate positive mental health |
High positive mental health |
Chi- square |
p-value |
Significant/ not |
|
Age |
10-12 |
1 |
16 |
21 |
11.0792 |
0.025688 |
Significant* |
|
13-15 |
3 |
23 |
17 |
||||
|
16-17 |
7 |
9 |
15 |
||||
|
Gender |
Male |
1 |
12 |
24 |
7.0927 |
0.02883 |
Significant* |
|
Female |
10 |
36 |
31 |
||||
|
Education |
Upper primary |
1 |
14 |
21 |
9.5185 |
0.049369 |
Significant* |
|
High school |
3 |
23 |
20 |
||||
|
Higher secondary |
7 |
11 |
14 |
||||
|
Type of family |
Nuclear |
7 |
30 |
30 |
11.6415 |
0.807049 |
Not significant |
|
Joint |
4 |
17 |
22 |
||||
|
Education of the father |
Higher secondary |
2 |
1 |
1 |
10.5277 |
0.032418 |
Not significant |
|
Graduate |
1 |
20 |
19 |
||||
|
Post graduate |
8 |
27 |
34 |
||||
|
Education of mother |
Higher secondary |
2 |
1 |
3 |
5.5228 |
0.237744 |
not significant |
|
Graduate |
3 |
18 |
17 |
||||
|
Post graduate |
5 |
29 |
34 |
||||
|
Occupation of father |
Employed |
7 |
34 |
29 |
6.5286 |
0.162995 |
not significant |
|
Self employed |
3 |
9 |
23 |
||||
|
Unemployed |
1 |
3 |
2 |
||||
|
Occupation of mother |
Employed |
5 |
23 |
28 |
2.2618 |
0.1336 |
Not significant |
|
Self employed |
1 |
2 |
8 |
||||
|
Unemployed |
5 |
20 |
19 |
||||
|
Area of residence |
Urban |
6 |
31 |
30 |
0.8085 |
0.3686 |
Not significant |
|
Rural |
5 |
17 |
23 |
||||
|
Number of siblings |
one |
6 |
32 |
31 |
3.1768 |
0.52868 |
Not significant |
|
Two |
4 |
8 |
16 |
||||
|
Nil |
1 |
8 |
8 |
||||
|
Religion |
Hindu |
3 |
5 |
14 |
6.2823 |
0.179055 |
Not significant |
|
Christian |
7 |
39 |
40 |
||||
|
Muslim |
1 |
4 |
1 |
||||
|
Family history of mental illness |
Yes |
1 |
0 |
1 |
4.2935 |
0.0383 |
Not significant |
|
No |
10 |
48 |
54 |
||||
|
Source of mental health knowledge |
Media |
5 |
21 |
24 |
2.5655 |
0.958606 |
Significant* |
|
Teachers |
2 |
4 |
6 |
||||
|
Parents |
2 |
7 |
11 |
||||
|
Personal experience |
1 |
2 |
1 |
||||
|
Others |
1 |
4 |
2 |
Significance at p<0.05
There is an association between positive mental literacy with the age, gender, education and source o mental health at 0.05.
The present study found moderate MHL level(71.5%) among adolescents using modified MHL scale . this result aligns with the previous studies done on adolescents using MHL scale in Indonesia (68.6%) and Portugal (79%). In contrast, studies done in Nepal and Philippines reported high MHL 82% and 83.2% respectively. The disparity could be attributed to the difference in mental health resources and education 6,7.
The current study reveals a high positive mental health (PMH) among participants (48.20%). The results align with a similar study conducted in North Angelo Portugal where majority of the samples ( 78.5%) had high PMH. The similarity may be because of the homogeneity of the samples year of study between 5th -12th class 9.
The findings of this study underscore the crucial role of mental health literacy (MHL) in fostering positive mental health (PMH) among adolescents. While the correlation between MHL and PMH was weak, it remained positive, suggesting that increased awareness and understanding of mental health can contribute to better emotional well- being. The significant associations between MHL and factors such as age, gender, ever heard of mental health and source of mental health as well as the links between PMH and variables like age, gender, educational level point to the influence of socio- demographic characteristics on adolescent mental health. These insights emphasize the importance of integrating comprehensive mental health education into school curricula to enhance awareness, reduce stigma, and promote early help-seeking behavior. Although the relationship between MHL and PMH was not strong, the data indicate that even modest improvements in mental health literacy may lead to better emotional resilience and coping abilities among young people. Future research with larger and more diverse populations is recommended to deepen understanding of these dynamics. Tailored interventions that address specific demographic needs can further strengthen adolescent mental health outcomes and contribute to the development of a more informed, emotionally resilient generation.
The authors have no conflicts of interest regarding this investigation.
Authors would like to thank the Scientific Research Committee of Believers College of Nursing.
1. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. Mental health literacy. Med J Aust. 1997; 166(4): 182–6.
2. Barry MM. Determinants of positive mental health. Int J Ment Health Promot. 2009; 11(3): 4–17.
3. Andrade C, Tavares M, Soares H, Coelho F, Tomás C. Positive mental health literacy. Int J Environ Res Public Health. 2022; 19(22): 15276.
4. World Health Organization. Adolescent mental health. Geneva: WHO; 2025.
5. World Health Organization. Promoting mental health. Geneva: WHO; 2004.
6. Teixeira S, Sequeira C, Lluch-Canut T. Positive mental health program. Lisbon; 2020.
7. Ravichandran R, Kumari S. Mental health literacy among adolescents in India. Asian J Psychiatr. 2025; 92: 103897.
8. Ahmad A, et al. Mental health literacy among adolescents. Int J Soc Psychiatry. 2022; 68(4): 791–7.
9. World Health Organization. Mental Health Action Plan 2013–2030. Geneva: WHO.
10. Bjørnsen HN, et al. Positive mental health literacy scale. BMC Public Health. 2017; 17(1): 717.
11. P. Balakrishnan. A Comparative study to assess the knowledge and attitude of adolescents (16-18 years) regarding alcoholism and its hazards between selected rural and urban Pre-University College at Bangalore. Asian J. Nur. Edu. And Research. 2011; 1(1): 31-36.
12. Vella Durai N.. A Study to Assess the Effectiveness of Teaching Programme on Social Anxiety among Adolescents in Selected Schools at Puliangudi, Thirunelveli District, Tamilnadu. Asian J. Nur. Edu. & Research. 2011; 1(2): 68-70.
13. Lissa Paul,Ramya K. R.. Knowledge and Attitude towards Alcoholism among Adolescents. Asian J. Nur. Edu. and Research. 2012; 2(4): 212-214
14. Divya Shettigar, Abu Mathew, Edweena Philip Monis, Vineesh.K.V.. Assessment of knowledge on Ill Effects of Cellphones usage among Adolescents with a View to Develop Information Booklet: An urban Community Based Study. Asian J. Nur. Edu. and Research. 2013; 3(3): 167-170.
15. Ansu K. Jose, Saraswathi K.N., Sheela Williams. A Study to Assess the Effectiveness of Vajrasana on Physical and Mental Health among Adolescents at Selected PU Colleges in Mysore. Int. J. Adv. Nur. Management. 2014; 2(1): 19-23.
16. Reeta Jebakumari, Nalini Jayavanth Santha. Adolescents – Need to be Cared!. Int. J. Adv. Nur. Management. 2014; 2(2): 112-117.
17. Paramesha, Buvaneswari. R. K., Sheela Williams, Vinay Kumar. G, Saraswathi. K.N.. A Correlation Study on Life Events and Depressive Symptoms among Adolescents Studying at Selected Schools in Mysore. Int. J. Adv. Nur. Management. 2015; 3(2): 119-123.
18. Thushara Vasukuttan. To assess and compare depression and suicide risk among residential and non residential adolescent girls. Int. J. Adv. Nur. Management. 2016; 4(3): 186-190.
19. Veerabhadrappa G. Mendagudli, Vijayalakshmi K. A Descriptive Study on Attitude and Practice Towards Alcoholism among Adolescents. Int. J. Adv. Nur. Management. 2017; 5(1): 59-64.
20. Meeha Jeganathan, Jamunarani.R, M.Arokiyamary. A Comparative Study to Assess the Level of Knowledge on Ill Effects of Tobacco use among Adolescents Residing in Urban and Rural Areas at Kanyakumari District in A View to Develop an Information Booklets. Int. J. Adv. Nur. Management. 2017; 5(2): 127-136.
21. Suvitha, S. Kamali, S. Kanimozhi, M. Kathiyayani, Kokkiligedda Madhuri. Literature Review related to Association between Mental Health and Academic Performance among Adolescents. A and V Pub International Journal of Nursing and Medical Research. 2023; 2(4): 130-2.
|
Received on 03.04.2026 Revised on 11.05.2026 Accepted on 13.06.2026 Published on 27.07.2026 Available online from August 01, 2026 Asian J. Nursing Education and Research. 2026;16(3):153-158. DOI: 10.52711/2349-2996.2026.00032 ©A and V Publications All right reserved
|
|
|
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License. |
|