Objective To assess mental health literacy and its determinants among adults in Shandong province and provide a basis for the development of targeted mental health services.

Methods From November to December 2023, a combined online and on-site face-to-face survey was conducted among 10 533 residents aged 18 years and older recruited from 39 districts/counties/cities in Shandong province using stratified multistage random sampling. A general questionnaire, the National Mental Health Literacy Questionnaire (NMHLQ) developed by the Institute of Psychology, Chinese Academy of Sciences, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Insomnia Severity Index (ISI) were used in the study.

Results Of 10 489 participants with valid responses, 12.51% were assessed as having adequate mental health literacy, with 15.47%, 99.05%, and 48.87% of participants having adequate mental health knowledge, mental health skills and awareness, and the ability to identify and manage common mental disorders, respectively. Chi-squared test results showed statistically significant differences in the proportion of adults with adequate mental health literacy across regions, gender, age, marital status, education, occupation, monthly household income, smoking, chronic disease status, anxiety, and depression Logistic regression analysis showed that female gender (odds ratio OR = 0.791, 95% confidence interval 95%CI: 0.385 - 0.912), junior high school education (OR = 0.703, 95%CI: 0.576 - 0. 859), high school/vocational/technical education (OR = 0.743, 95%CI: 0.578 - 0.955), college degree or higher (OR = 0.594, 95%CI: 0.458 - 0.770), administrative/professional/technical occupation (OR = 0. 552, 95%CI: 0.442 - 0.689), other occupation (OR = 0.802, 95%CI: 0.663 - 0.968), monthly household income of 3 000 - 5 999 RMB yuan (OR = 0.630, 95%CI: 0.520 - 0.762), monthly household income of 6 000 - 9 999 RMB yuan (OR = 0.607, 95%CI: 0.494 - 0.746), and with fair/poor self-rated health (OR = 0.726, 95%CI: 0.612 - 0.860) were negatively associated with inadequate mental health literacy. Living in eastern Shandong province (OR = 1.190, 95%CI: 1.043 - 1.359), western Shandong province (OR = 1.483, 95%CI: 1.237 - 1.779), being married (OR = 1.363, 95%CI: 1.059 - 1.756), having other marital statuses (OR = 1.816, 95%CI: 1.112 - 2.964), having mild anxiety (OR = 1.408, 95%CI: 1.110 - 1.786), having moderate to severe anxiety (OR = 2.283, 95%CI: 1.183 - 4.408), having mild depression (OR = 1.443, 95%CI: 1.160 - 1.794), and having moderate to severe depression (OR = 1.819, 95%CI: 1.162 - 2.848) were positively associated with inadequate mental health literacy.

Conclusions Mental health literacy among adult residents in Shandong Province is at a relatively low level. Demographic characteristics such as place of residence, gender and marital status, and anxiety and depression status are influencing factors. Mental health services should focus on people with low levels of education, low income, and those with anxiety or depression.