Mental Health Literacy and Help-Seeking Behavior Among Adolescents

Background and Rationale:Mental health problems among adolescents represent a significant public health burdenworldwide and in Egypt. Studies among Egyptian secondary school and university studentsshow high prevalence of depression (32.5%), anxiety (45.2%), and psychological distress(65‐70%). Despite this burden, most adolescents do not seek professional help due to lowmental health literacy, stigma, and lack of awareness of available services. ExistingEgyptian research focuses primarily on urban university students, leaving a criticalevidence gap for younger school‐aged adolescents, particularly in underserved regionslike Upper Egypt.Study Design:This is a two‐phase study combining cross‐sectional assessment and a randomizedcontrolled trial.Phase 1 ‐ Cross‐Sectional Assessment (n=270):Four preparatory/secondary schools in Assiut city will be randomly selected using clustersampling stratified by educational stage and school gender composition. All eligiblestudents aged 13‐18 years will be invited to complete validated Arabic questionnairesassessing mental health literacy (MHLS ‐ 35 items covering six domains), peerstigmatization (PMHSS ‐ 16 items), help‐seeking intentions (GHSQ), attitudes towardprofessional help (ATSPPH ‐ 10 items), and mental health difficulties (SDQ ‐ 25 items).Sociodemographic data will also be collected. This phase establishes baseline prevalenceand identifies factors associated with mental health literacy, stigma, and help‐seekingpatterns.Phase 2 ‐ Randomized Controlled Trial (n=150):Two secondary schools (one male, one female) will be selected. Within each school, 75students will be randomly assigned to the intervention group and 75 to the control group,matched for age and sex. The intervention consists of three weekly structured classroomsessions (40‐50 minutes each) delivered by trained researchers:Session 1 (Mental Health Literacy): Basic concepts of mental health and mental illness;common adolescent mental health problems including stress, anxiety, and depression; keysigns and symptoms; myths versus facts about mental health; understanding that mentalhealth problems are real, treatable conditions.Session 2 (Stigma Reduction): Definition and impact of stigma; how negative labels andstereotypes harm people with mental health problems; distinction between public stigma(others' attitudes) and self‐stigma (internalized shame); recognition of stigma inadolescent contexts (mocking, exclusion, gossip); activities promoting respectfullanguage and empathy.Session 3 (Help‐Seeking Behavior): Recognizing when problems require professional help;differences between informal sources (family, friends, religious leaders) andformal/professional sources (school counselors, physicians, psychiatrists, youth healthcenters); common barriers to help‐seeking including shame, fear, and confidentialityconcerns; information about realistic, accessible mental health resources in Assiut;role‐play exercises on approaching trusted adults and guiding peers to help.All sessions use interactive teaching methods with clear examples, group discussions, andbrief activities. The control group continues regular school activities without receivingintervention sessions during the study period. Both groups complete identicalquestionnaires at baseline and one month post‐intervention.Assessment Tools:All instruments are validated Arabic versions: Mental Health Literacy Scale (MHLS), PeerMental Health Stigmatization Scale (PMHSS), General Help‐Seeking Questionnaire (GHSQ),Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH), and Strengthsand Difficulties Questionnaire (SDQ).Expected Outcomes:This study will provide the first comprehensive data on mental health literacy, stigma,and help‐seeking among school‐aged adolescents in Assiut and Upper Egypt. It will testwhether a brief, feasible school‐based intervention can improve knowledge, reduce stigma,and promote help‐seeking behaviors, potentially informing scalable mental healthpromotion strategies for Egyptian schools.