1. Introduction

Early adolescence marks a crucial period for the development and onset of mental health problems [1]. A mental disorder, also referred to as a mental illness [2], a mental health condition [3], a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning [4]. Mental illness refers to all diagnosable mental health disorders [5] involving depression, schizophrenia, substance abuse, eating disorders, and other anxiety and mood disorders [6]. A survey of students reported that 43.2% of them suffered from symptoms of depression, 40.0% from anxiety, 24.7% from adjustment problems, and 12.2% from relationship crises. Moreover, 2.4% suffered from posttraumatic stress disorder, 14.3% from suicidal crises, 13% from alcohol problems, and 1.6% had attempted suicide. However, very few were less likely to seek help [7]. Globally, one in seven 10–19 year olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group and this is while these cases remain largely undiagnosed and untreated [8]. In recent years, mental health disorders have been gaining attention from researchers, health professionals, and policymakers [9]. Mental health is a state of mental wellbeing that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community [10]. Multiple factors affect mental health. The more risk factors the adolescents are exposed to, the greater the potential impact on their mental health. Factors that can contribute to stress during adolescence include exposure to adversity, pressure to conform with peers, violence (especially sexual violence and bullying), harsh parenting, as well as severe socioeconomic problems [11]. Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services [12]. Recognizing the symptoms of mental disorders in students is essential for early intervention and support. Teachers, parents, and peers play a vital role in recognizing the signs and symptoms of mental health issues and supporting those who need it [13]. The most common symptoms of mental distress include changes in behavior, mood swings, withdrawal from social activities, concentration problems, and decreased academic performance [14]. Various studies have shown that mental health literacy (MHL) is a good predictor of adolescent’s mental health [15, 16]. MHL refers to knowledge and beliefs about mental health disorders, including their symptoms, risk factors, and available treatments. It also refers to the ability to recognize a mental illness when someone is experiencing a mental health problem and seek appropriate help or support [17].

Comprehensive mental health education for students is very important to improve MHL. Students are required to become aware of common mental disorders, their symptoms, and how to seek help. By increasing MHL, we can empower students to seek help and support when needed [18].

Schools play an important role in promoting student mental health and wellbeing. Incorporating mental health education into the curriculum enables students to develop a better understanding of mental health, acquire coping strategies, and cultivate empathy for their peers [19]. Educators and caregivers are crucial in providing mental health support for students and fostering a safe space for open discussions [20]. Due to a notable deficiency in mental health knowledge, particularly among students, a large number of students do not possess the essential knowledge and abilities to recognize and address mental health problems, resulting in a rise in social harm. Enhancing students’ knowledge of mental health enables them to take preventive measures to improve their mental well-being and thrive in a supportive setting. The World Mental Health Report (2022) emphasizes the need for all stakeholders to come together to alter the environments influencing mental health and bolster mental health care systems [10]. Despite the increasing mental health issues among students, researchers in Iran have not paid attention to the issue of mental health knowledge and attitudes toward mental disorders in students. Therefore, this study examines the relationship between mental health knowledge and attitudes toward mental disorders with MHL and its dimensions in students.

Therefore, I decided to examine the components of MHL, including the ability to recognize specific disorders, knowledge of available professional help, knowing how to search for mental health information, self-treatment knowledge, awareness of risk factors and causes, and attitudes that facilitate appropriate recognition and help-seeking. Since mental health knowledge and attitudes regarding mental disorders were weak in the components of the MHL questionnaire, knowledge and attitudes were also examined.

2. Methods

2.2. Study Design

Initially, a list of secondary schools was compiled in conjunction with the Education Department of Sirjan, followed by the random selection of five schools from each district and one class (comprising 28 students) from the four educational districts of Sirjan. In this study, using the effect size and primary data from the study by Nguyen et al. [21], considering the type 1 error at the level of 0.05 and the power of 0.80, the sample size was 562 male and female students. Inclusion criteria were public school designation, willingness to participate, and consent from the school and class principal, and exclusion criteria were exceptional schools (adolescents with learning disabilities or behavioral problems) and incomplete completion of the questionnaire. The researcher obtained written consent from both students as well as their parents, ensuring them that their responses would be used solely for research purposes and kept confidential. Data were gathered using a MHL questionnaire, a Mental Health Knowledge Questionnaire (MHKQ), and an attitude to mental illnesses with demographic information included. Figure 1 shows the research process.

3. Results

A total of 562 students, aged between 13 and 15 years, participated in the study. Of these, 411 people (73.3%) were female and 151 people (26.87%) were male. A total of 456 people (81%) had two children, 21 people (3.7%) had a history of mental illness, and 69 people (12.3%) had visited a psychiatrist.

In this study, the items of history of mental illness and visits to a psychiatrist had some missing data. The overall rate of missing data was 0.7%. According to Kim, Yu, and Kim [6], biases and missing data are not significant if the amount of missing data is low (less than 5%). The demographic characteristics of study participants are presented in Table 1.

Table 2 illustrates the mean and SD of scores for variables of MHL and its components, mental health knowledge, as well as the attitudes to mental illness questionnaire in sex-disaggregated format. The mean scores for all variables were almost the same for boys and girls.

The complete pattern of relationships between variables is illustrated in the structural equation model shown in Figure 2.

The model’s findings reveal that having a knowledge of mental health impacts both MHL and attitudes to mental illness. Also, MHL has a significant impact on all aspects of MHL except the ability to recognize disorders.

Jaccard [26] argued to include at least one indicator from each processing group in our report. A model fit can be considered acceptable when at least three indicators show satisfactory values [27].

In this section, four indices are used (chi-square divided by the degrees of freedom (χ²/DF); the CFI, the GFI; and RMSEA. Validating the model and documenting the results require the fit indices of the model to be acceptable. The values of the indicators used are detailed in Table 3.

Table 3 reveals that the RMSEA value is equal to 0.075 which is less than 0.08. Also, the CFI and the GFI have been calculated appropriately.

The value of the chi-square to the degree of freedom is highly dependent on the sample size, and the larger the sample size, the higher the chi-square quantity. For this matter, it cannot be attributed definitely with certainty to the wrongness of the model [32]. Therefore, based on the calculated indicators, it can be determined that the model fits optimally.

The direct, indirect, and total effects of variables and their statistical significance are shown in Table 4. MHL has a direct and significant effect on knowledge of risk factors and causes (0.28), knowledge of self-treatment (0.15), knowledge of professional help available (0.33), and knowledge of where to seek information (0.61). Moreover, MHL had a direct and inverse effect on appropriate help-seeking behavior (−0.98). As attitudes supporting proper help-seeking behavior or knowledge increase, so does MHL. In other words, the higher the MHL, the more appropriate a person’s behavior and knowledge about mental illness or disorders. Furthermore, MHL had an indirect effect on all dimensions. Also, knowledge had a direct (0.15) and indirect (0.36) effect on overall MHL. Increasing knowledge of mental health leads to a more positive influence on MHL.

4. Discussion

This study utilized a structural equation model to explore the relation between mental health knowledge and attitudes to mental illness with MHL and its dimensions. In the present study, the average MHL score of students was at a moderate level, which aligns with the findings of Fazlifar et al. [33] in high school students. In the study by Thai, Vu, and Bui [34], the MHL of high school students in Vietnam was also approximately average. In this study, the attitudes toward mental disorders were below the moderate level, while in another study, the average attitude score among students was at a moderate level. Increasing mental health knowledge among students can lead to changes in attitudes and correction of misconceptions about mental disorders; consequently, it can play a role in improving the MHL of students.

The results revealed that MHL had a direct and significant impact on the dimensions of MHL, which included all the components of MHL, including knowledge of risk factors and causes, knowledge of self-treatment, knowledge of available professional help, and knowledge of where to seek information. Mcluckie et al. examined the effect of a high-school mental health curriculum (the guide) in enhancing MHL in Canadian schools and concluded that enhancing MHL can serve as a foundation for promoting mental health, prevention, and early detection of mental disorders in students [35].

The results also showed that MHL had a direct and inverse effect on appropriate help-seeking behavior, that is, students exhibiting higher MHL scores are inclined toward having a more positive attitude toward help-seeking, consequently boosting their willingness to seek help.

Moreover, the results demonstrated a significant relationship between MHL and the likelihood of seeking help, which aligns with the conclusions drawn by Kim, Yu, and Kim [6].

The present study found that mental health knowledge significantly influences MHL. This indicates that students with greater MHL also possessed a higher level of mental health knowledge. Put simply, the higher the MHL of the students, the higher their knowledge of mental health. In other words, students who are knowledgeable about mental health are more likely to have a positive attitude toward seeking help and consulting professionals when needed [36].

The study demonstrated a direct relationship between knowledge of risk factors and causes and mental health knowledge and literacy. This study also found that students with regular access to mental health information demonstrated greater mental health knowledge and literacy. This study is consistent with the study of information access and mental health knowledge of health sciences in Indonesia by Harisa et al. [37].

The results also showed that attitudes toward mental illnesses remained unaffected by MHL. In the study by Kim, Yu, and Kim, the attitude toward seeking help was influenced by MHL in both direct and indirect ways, the latter being through stigma [6].

Due to the different aspects of MHL, no study was found concerning the influence of MHL on student’s attitudes to mental illnesses. Despite the improvements in the field of psychiatry over the past decades, the perception of psychiatry has been positively affected, but the attitudes of its patients remain unchanged [38]. However, there is a need for increased efforts to address the stigma and discrimination faced by individuals with mental illness.

The results of this study revealed a direct relationship between MHL and appropriate help-seeking behavior among students, which is consistent with other studies [39–41]. Enhancing MHL allows individuals to acquire a deeper comprehension of mental health professionals and the norms established in the field of mental health services. As a result, people become less worried about privacy infringements and gradually trust official sources [42]. In practice, this increased trust and confidence further contributes to appropriate help-seeking behavior. Conversely, improved MHL enables individuals to adopt more effective coping strategies when facing mental health challenges [43]. Therefore, individuals are more inclined to seek professional help available rather than relying solely on their solutions. In general, a strong and positive relationship was observed between MHL and appropriate help-seeking behavior.

5. Conclusion

In this study, the results indicated that general mental health knowledge affects MHL and attitudes toward mental disorders. By examining the relationship between the dimensions of MHL, the results showed that the higher the MHL, the more appropriate the individual’s behavior and understanding of mental illnesses or disorders. This increase in mental health knowledge among students can lead to changes in attitudes toward mental disorders and play a role in improving the MHL of students. In light of this, prioritizing mental health in educational programs is crucial for helping students navigate the difficulties of adolescence.

Ethics Statement

This study is taken from the thesis of a PhD student in health education and health promotion. The present study was approved by the ethics committee Yazd University of Medical Sciences (code: IR.SSU.SPH.REC.1402.089) was obtained.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

B.Z. conducted the investigation, conceptualization, methodology, data curation, analysis, data interpretation, and writing of the manuscript. M.K., R.S., and S.J. contributed to the methodology, data analysis, interpretation, and manuscript edition. All authors read and confirmed the final manuscript to be submitted to the current journal. All authors also decided to accept responsibility for all aspects of the work.

Funding

No funding was received for this research.