Mental health literacy and the stigmatisation and discrimination of individuals affected by mental illnesses in China: a scoping review

Abstract

Low mental health literacy (MHL) could contribute to misconceptions about mental illnesses and reinforce various forms of stigma (public, personal, and associative), leading to discrimination, reduced help-seeking, and poorer mental health outcomes. To summarise the current state of the literature on MHL, stigma, and discrimination, this scoping review identified 387 studies published from 2000 to 2024 in five English and three Chinese databases: 60.7% focused on stigma, 31.8% on MHL, and only 7.5% on discrimination. Most studies (84.8%) were descriptive cross-sectional studies, 14.5% evaluated interventions, and 0.7% were non-intervention longitudinal studies. Methodological quality was generally low: reports about 88.4% of the cross-sectional studies, 75.6% of the randomised controlled trials, and 83.4% of the quasi-experimental studies lacked descriptions of key methodological or statistical details. After excluding researcher-developed tools only reported in a single study, 125 assessment tools remained, 26.4% of which were developed in China. Although 21 different mental health conditions were studied, 91.0% of the studies focused on a single condition. Study locations were geographically skewed (one-third of all studies were conducted in Guangdong, Beijing, and Shanghai), and study participants were not representative of the target cohort. The number of publications increased substantially after 2010. Most of the 56 intervention studies, which primarily used psychoeducational interventions, reported improved MHL and decreased stigma. Recommendations for future studies include: 1) Develop standardised instruments to improve comparability. 2) Ensure detailed statistical analyses and clearly defined sample characteristics. 3) Assess variations in MHL, stigmatisation, and discrimination across different mental health conditions. 4) Increase research in underserved regions and conduct nationwide longitudinal studies. 5) Include a broader range of participants in intervention studies and consider new intervention strategies (i.e., other than psychoeducation interventions). 6) Align research objectives with national mental health policies to enhance their relevance and impact.