Study design and participants
A telephone survey was conducted with Computer Assisted Telephone Interview (CATI) at the Centre for Communication and Public Opinion Survey (CCPOS) of the Chinese University of Hong Kong (CUHK) in 2015 and 2018 respectively. A random sample of 4033 Hong Kong residents aged 12 to 75 years were successfully interviewed using a trilingual (Cantonese, Chinese and English) questionnaire. Foreign domestic helpers and those who were institutionalized were excluded from the study. Verbal consent for all respondents and parental consent for those aged below 18 years were obtained over phone before interview.
Six vignettes (V1 to V6) were constructed to depict anxiety disorders in adolescents, MADD in adults and dementia in older adults. For each mental health condition, two scenarios were presented at two levels of difficulty with symptom descriptions. One case depicted more obvious mental symptoms with more constant intense feelings affecting daily function, while the other case described subtle symptoms of the same mental disorder that is either contextual or intermittent. Respondents were asked to identify symptoms as mental illnesses and recommend treatment for all vignettes.
V1 Subtle symptoms of anxiety disorders: A 14-year-old adolescent boy whose academic performance is very good. But every time when he speaks in front of his teacher and classmates, he gets blushed, hand shivering, heart pounding and the mind gone blank. He is also afraid of being teased by others.
V2 Obvious symptoms of anxiety disorders: A 16-year-old adolescent girl who studies very hard and prepares well before class. But every time before examination, she has insomnia, abdominal pain, diarrhea and sweating, and thus resulting in poor examination results.
V3 Subtle symptoms of MADD: A 34-year-old working man who recently sweat easily, has a stiff neck and shoulder pain, and does not sleep well.
V4 Obvious symptoms of MADD: A 42-year-old housewife who always worries that her son would have accidents if he goes out. Her mind is full of negative thoughts.
V5 Subtle symptoms of dementia: A 68-year-old retired person who keeps reminiscing his wife about his past in the past year. He can clearly remember events that had happened long time ago.
V6 Obvious symptoms of dementia: A 75-year-old elderly lady who has left a boiling pot on the stove at home to the point where it was almost on fire many times.
Knowledge of mental health symptoms
Knowledge of mental health symptoms was evaluated using the six vignettes. After the presentation of each vignette, respondents were asked to identify the vignette as 1 = Yes or 0 = No/Do not know. A summary knowledge score ranges from 0 to 6, with higher score indicating higher level of awareness.
Help seeking attitude on common mental health disorders
Help seeking attitude was explored based on the six vignettes described above. For each vignette, respondents were asked to opt for the most preferred help seeking methods: i) nothing needs to be done; ii) talking to family and friends; or iii) consult a doctor or seek help from a professional. Each help seeking methods would score from 0 to 6, with higher score indicating higher preference towards a particular help seeking method.
Mental health status was assessed by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) and the Kessler Psychological Distress Scale (K6). K6 is a 6-item questionnaire that measures psychological distress in the past one month anchoring on items: (i) feeling nervous, (ii) feeling hopeless, (iii) feeling restless or fidgety, (iv) feeling so depressed that nothing could cheer you up, (v) feeling everything was an effort, and (vi) feeling worthless. Each item is scored on a 5-point Likert scale ranging from: (i) none of the time, (ii) a little of the time, (iii) some of the time, (iv) most of the time, and (v) all of the time. Higher scores, on a range of 0 to 24, indicate higher level of psychological distress. The K6 scale has a cut-off score at 13 to indicate severe psychological distress (17). SWEMWBS is a validated 7-item instrument. It assessed the mental well-being status based on the frequency of experiencing seven positive feelings over the past two weeks: (i) feeling optimistic about the future, (ii) feeling useful, (iii) feeling relaxed, (iv) dealing with problems well, (v) thinking clearly, (vi) feeling close to other people, and (vii) able to make up own mind about things (18). It is rated on a 5-point Likert scale spanning from (i) none of the time, (ii) a little of the time, (iii) some of the time, (iv) most of the time, and (v) all of the time. It has a total score ranging from 7 to 35. Higher scores indicate better mental well-being (18).
Sociodemographic information on age, gender, educational attainment, marital status, employment status, experience of mental health problems, and knowing someone with mental health problems were also obtained.
Descriptive statistics summarized the sociodemographic and mental health profiles of respondents. The overall knowledge of mental symptoms was determined by counting the number of vignettes successfully identified as mental illnesses. Similarly, knowledge on different types of symptoms (subtle and obvious) was determined by counting the number of vignettes successfully identified at each level. The demographic characteristics of those who could and could not identify mental health symptoms were compared to explore factors that might have associated with level of knowledge. Logistic regression models were performed to assess the association between help-seeking attitude and correct identification of mental health symptoms with adjustment for potential confounders. All data analyses were performed using IBM SPSS 23.0 for Windows. A p-value of < 0.05 was considered statistically significant.