Description of participants' characteristics
The participants’ social-demographic characteristics are presented in Table 1. The current participants were aged between 65 and 96 years, with a mean age of 73.40 (SD = 6.59) years. The average length of education was 5.63 (SD = 3.43) years. Among the 443 participants, 58.7% were females and the majority (88.7%) were living with their relatives or caregivers. In terms of the frequency of participating in community elderly activities, nearly one-third (31.4%) never attended, and the majority attended the activities sometimes (48.5%) or always (20.1%).
Table 1
Social-demographic characteristics of the participants (N = 443).
Characteristics
|
|
n/Mean
|
%/SD
|
Sex (n & %)
|
Male
|
182
|
41.1
|
|
Female
|
260
|
58.7
|
Age (year, mean & SD)
|
|
73.40
|
6.59
|
Length of education (year, mean & SD)
|
|
5.63
|
3.43
|
Living alone status (n & %)
|
Yes
|
49
|
11.1
|
|
No
|
393
|
88.7
|
Frequency of participating in the elderly activities (n & %)
|
Never
|
139
|
31.4
|
Sometimes
|
215
|
48.5
|
Always
|
89
|
20.1
|
PHQ-9 (score, mean & SD)
|
|
1.47
|
2.93
|
GAD-7 (score, mean & SD)
|
|
0.47
|
1.60
|
AD-8 (score, mean & SD)
|
|
1.74
|
2.28
|
Mental health literacy profiles and univariate analysis
As shown in Fig. 1A, 115 (26.3%) older adults reported a lack of knowledge of the importance of mental health. Approximately one-third (34.7%) of the participants were unaware of the preventability and treatability of mental illnesses, and 26.5% did not know the means of preventing dementia.
Table 2 shows the results of MHL profiles at different demographic and mental health status groups that were examined using univariate analysis. Participants who were unaware of the preventability and treatability of mental illnesses and the means of preventing dementia were more likely to be older (t = 2.818, p = 0.005 for the preventability and treatability of mental illnesses, t = 2.574, p = 0.011 for the means of preventing dementia) and with lower education levels (t = -3.309, p = 0.001 for the preventability and treatability of mental illnesses, t = -2.767, p = 0.006 for the means of preventing dementia). Participants who never or merely sometimes participated in the community’s elderly activities appeared to lack MHL in three dimensions (χ2 = 13.192, p = 0.001 for the knowledge of the importance of mental health, χ2 = 13.927, p = 0.001 for the preventability and treatability of mental illnesses, and χ2 = 15.450, p < 0.001 for the means of preventing dementia). Moreover, the older adults who were lack of the knowledge of preventability and treatability of mental illnesses and the means of preventing dementia were likely to report more depressive symptoms (t = 1.997, p = 0.047 for preventability and treatability of mental illnesses, t = 2.142, p = 0.034 for means of preventing dementia) but not anxiety symptoms (t = 1.341, p = 0.181 for preventability and treatability of mental illnesses). In addition, participants who had insufficient MHL in three dimensions tended to report higher cognitive impairment (t = 2.741, p = 0.006 for the knowledge of the importance of mental health, t = 2.693, p = 0.007 for the preventability and treatability of mental illnesses, and t = 2.645, p = 0.008 for the means of preventing dementia).
Profiles of demand and willingness for mental health services and univariate analysis
As shown in Fig. 1B, 62.0% of the older adults reported the demand for mental health services, among which 16.2% expressed a strong need. Over two-thirds (69.6%) of the participants expressed that they would be willing to receive mental health services if they felt emotionally distressed.
Table 2 indicates the results of demand and willingness for mental health services at different demographic and mental health status groups that were examined using univariate analysis. Compared with participants who expressed negative or neutral attitudes toward the necessity of mental health services, those who indicated a need for mental health services contained higher proportions of older adults who were living alone (13.3% vs. 1.8% vs. 9.9%; χ2 = 6.456, p = 0.040) and more percentages of participants who always participated in the elderly activities (23.5% vs. 21.4% vs. 11.7%; χ2 = 10.060, p = 0.039). Additionally, participants who were willing to receive mental health services showed higher scores on the scores of PHQ-9, GAD-7, and AD-8.
Logistic regression analysis
As shown in Table 3, after adjusting for other variables, those who always participated in the elderly activities were more likely to aware the importance of mental health (odds ratio (OR) = 3.70, 95% confidence interval (CI) = [1.72, 7.95]), preventability and treatability of mental illnesses (OR = 2.92, 95% CI = [1.50, 5.68]), and means of preventing dementia (OR = 4.18, 95% CI = [1.88, 9.28]), compared with those who never took part in the activities.
Table 3
Results of logistic regression analysis of factors associated with mental health literacy.
Variables
|
|
Importance of mental health (ref: No)
|
Preventability and treatability of mental illnesses (ref: No)
|
Means of preventing dementia (ref: No)
|
|
Overall
|
Living alone
|
Non-living alone
|
Overall
|
Living alone
|
Non-living alone
|
Overall
|
Living alone
|
Non-living alone
|
|
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
|
Sex (ref: Male)
|
Female
|
1.17 (0.72, 1.91)
|
0.66 (0.08, 5.80)
|
1.14 (0.68, 1.90)
|
0.99 (0.62, 1.56)
|
0.17 (0.02, 1.52)
|
0.99 (0.61, 1.60)
|
0.98 (0.60, 1.61)
|
0.66 (0.07, 6.14)
|
0.91 (0.54, 1.53)
|
|
Age
|
|
1.00 (0.97, 1.04)
|
1.05 (0.91, 1.21)
|
1.00 (0.96, 1.04)
|
0.98 (0.94, 1.01)
|
0.99 (0.86, 1.14)
|
0.97 (0.93, 1.01)
|
0.98 (0.94, 1.02)
|
1.00 (0.87, 1.16)
|
0.97 (0.93, 1.02)
|
|
Length of education
|
|
1.02 (0.94, 1.10)
|
1.28 (0.87, 1.87)
|
0.99 (0.91, 1.08)
|
1.07 (1.00, 1.16)
|
1.37 (0.94, 2.01)
|
1.04 (0.96, 1.13)
|
1.06 (0.97, 1.15)
|
1.19 (0.81, 1.75)
|
1.05 (0.96, 1.14)
|
|
Frequency of participating in the elderly activities (ref: Never)
|
Sometimes
|
1.14 (0.70, 1.85)
|
6.74 (0.84, 53.79)
|
0.92 (0.55, 1.55)
|
0.92 (0.58, 1.46)
|
3.95 (0.52, 30.07)
|
0.79 (0.48, 1.29)
|
1.03 (0.63, 1.67)
|
2.52 (0.27, 23.9)
|
0.96 (0.58, 1.61)
|
|
Always
|
3.70 (1.72, 7.95) ***
|
3.93 (0.42, 36.59)
|
3.57 (1.54, 8.28) **
|
2.92 (1.50, 5.68) **
|
1.87 (0.19, 18.36) **
|
3.10 (1.48, 6.50) **
|
4.18 (1.88, 9.28)***
|
0.79 (0.09, 7.23)
|
5.51 (2.16, 14.02)***
|
|
PHQ-9
|
|
1.00 (0.90, 1.13)
|
1.08 (0.83, 1.42)
|
0.98 (0.86, 1.12)
|
0.95 (0.86, 1.05)
|
1.30 (0.95, 1.79)
|
0.88 (0.78, 1.00) *
|
0.92 (0.82, 1.02)
|
0.97 (0.75, 1.26)
|
0.89 (0.79, 1.02)
|
|
GAD-7
|
|
1.06 (0.86, 1.31)
|
1.01 (0.62, 1.65)
|
1.01 (0.78, 1.31)
|
1.12 (0.91, 1.36)
|
0.76 (0.49, 1.19)
|
1.19 (0.92, 1.54)
|
1.09 (0.88, 1.35)
|
1.00 (0.62, 1.59)
|
1.08 (0.83, 1.41)
|
|
AD-8
|
|
0.88 (0.79, 0.97) *
|
0.87 (0.61, 1.24)
|
0.87 (0.78, 0.97) *
|
0.93 (0.84, 1.03)
|
0.92 (0.66, 1.27)
|
0.92 (0.82, 1.03)
|
0.94 (0.84, 1.05)
|
0.79 (0.54, 1.15)
|
0.94 (0.84, 1.06)
|
|
OR = odds ratio, CI = confidence interval. |
*p < .05, **p < .01, ***p < .001. |
The results of ordinal logistic regression examining the factors associated with demand and willingness for mental health services are shown in Table 4. Compared to the older adults who never participated in the elderly activities, those who always attended activities had higher levels of demand for mental health services (OR = 2.16, 95% CI = [1.22, 3.79]) and willingness for mental health services (OR = 2.24, 95% CI = [1.19, 4.20]).
Table 4
Results of logistic regression of factors associated with demand a and willingness for mental health services.
Variables
|
|
Demand for mental health services
(ref: Not need)
|
Willingness for mental health services
(ref: Unwilling)
|
|
Overall
|
Living alone
|
Non-living alone
|
Overall
|
Living alone
|
Non-living alone
|
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
OR (95% CI)
|
Sex (ref: Male)
|
Female
|
1.16 (0.76, 1.76)
|
0.40 (0.04, 3.90)
|
1.15 (0.74, 1.77)
|
0.93 (0.59, 1.48)
|
1.37 (0.12, 15.99)
|
0.89 (0.56, 1.44)
|
Age
|
|
1.00 (0.97, 1.04)
|
1.10 (0.95, 1.27)
|
0.99 (0.96, 1.03)
|
0.99 (0.96, 1.03)
|
0.97 (0.84, 1.12)
|
0.99 (0.95, 1.03)
|
Length of education
|
|
0.99 (0.93, 1.06)
|
1.36 (0.97, 1.91)
|
0.98 (0.91, 1.05)
|
0.97 (0.90, 1.05)
|
1.14 (0.84, 1.54)
|
0.96 (0.89, 1.04)
|
Frequency of participating in the elderly activities
(ref: Never)
|
Sometimes
|
1.45 (0.94, 2.24)
|
0.47 (0.05, 4.51)
|
1.37 (0.87, 2.17)
|
1.29 (0.81, 2.06)
|
1.88 (0.16, 22.35)
|
1.22 (0.74, 1.99)
|
Always
|
2.16 (1.22, 3.79) **
|
1.25 (0.11, 13.92)
|
1.98 (1.10, 3.59)*
|
2.24 (1.19, 4.20)*
|
7.54 (0.33, 173.84)
|
2.03 (1.05, 3.91)*
|
PHQ-9
|
|
1.02 (0.91, 1.13)
|
1.28 (0.70, 2.35)
|
1.02 (0.90, 1.14)
|
1.04 (0.92, 1.17)
|
0.92 (0.47, 1.82)
|
1.04 (0.91, 1.19)
|
GAD-7
|
|
1.09 (0.87, 1.35)
|
6865.29 (0.00, -)
|
0.96 (0.75, 1.23)
|
1.13 (0.87, 1.46)
|
9142.13 (0.00, -)
|
1.00 (0.76, 1.33)
|
AD-8
|
|
1.06 (0.96, 1.18)
|
0.81 (0.52, 1.27)
|
1.07 (0.96, 1.19)
|
1.05 (0.94, 1.17)
|
1.06 (0.66, 1.69)
|
1.06 (0.94, 1.19)
|
a Using the “Not need” answer as a response to establish ordinal logistic regression of demand for mental health services. |
OR = odds ratio, CI = confidence interval. |
*p < .05, **p < .01, ***p < .001. |
Stratified analysis in living alone and non-living alone
The frequency of participating in the elderly activities was significantly correlated with the MHL among non-living alone (OR = 3.57, 95% CI = [1.54, 8.28] for the knowledge of importance of mental health, OR = 3.10, 95% CI = [1.48, 6.50] for the preventability and treatability of mental illnesses, and OR = 5.51, 95% CI = [2.16, 14.02] for the means of preventing dementia) but not living alone (OR = 3.93, 95% CI = [0.42, 36.59] for the knowledge of importance of mental health, OR = 1.87, 95% CI = [0.19, 18.36] for the preventability and treatability of mental illnesses, and OR = 0.79, 95% CI = [0.09, 7.23] for the means of preventing dementia). More frequent participation in the elderly activities consistently enhanced the awareness of all three dimensions of MHL. Additionally, the lower score of AD-8 was associated with the awareness of the importance of mental health among non-living alone (OR = 0.87, 95% CI = [0.78, 0.97]). Similarly, lower scores of PHQ-9 contributed to the awareness of the preventability and treatability of mental illnesses among non-living alone (OR = 0.88, 95% CI = [0.78, 1.00]). Furthermore, no factors showed a significant effect on MHL among those living alone (see Table 3).
More frequent participation in the elderly activities was significantly associated with a stronger demand (OR = 1.98, 95% CI = [1.10, 3.59]) and willingness (OR = 2.03, 95% CI = [1.05, 3.91]) for mental health services among non-living alone. However, no variables showed a significant effect on demand and willingness for mental health services among those living alone (see Table 4).