MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Mental health literacy and psychological distress
as predictors of psychological well-being in
Sriwijaya University students
Sayang Ajeng Mardhiyah
Psychology Department, Medical Faculty University Sriwijaya
Abstract
Introduction. This research focused on answering questions: how mental health literacy and
psychological distress act as predictors of psychological well-being in Sriwijaya University students.
Methodology.This research used quantitative method, by conducting instrument preparation,
data collection, and analysis of data results to see the role of the independent variables on the
dependent variable. Psychological well-being was measured using an instrument in a form of
psychological scale referred to Psychological Scale by Ryff & Keyes (1995). Meanwhile,
psychological distress was measured using WHO Self-Reporting Questionnaire 20 (SRQ-20)
Indonesian version, and Mental Health Literacy measurement was adapted from O’Connor and
Casey (2015). The participants of this research were consisted of 418 college students.
Results.The analysis results show that there is a role of mental health literacy and psychological
distress together on psychological well-being, thus the hypothesis is accepted. Major hypothesis
test was done using multiple linear regression which shows a correlation value (R) of 0.586 and a
significance of 0.001 (p<0.05). For the results of minor hypothesis test, it is known that the beta
value is 0.143 and the P value is 0.022 (p>0.05), this indicates that there is a role for mental health
literacy on psychological well-being, thus the hypothesis is accepted. In addition, it is known that
psychological well-being and psychological distress show a beta value of -1.945 and a P value
of 0.001 (p>0.05), this indicates that there is a role for psychological distress on psychological
well-being thus the hypothesis is accepted.
Conclusions.The percentage of mental health literacy and psychological pressure influences on
psychological well-being (R adjusted) is 0.343, this also shows that the contribution of mental
health literacy and psychological distress together on psychological well-being is 34.3%, while
the rest is the contribution of other variables not examined in this study.
Keywords
mental health literacy, psychological distress, psychological well being
Address for correspondence:
Sayang Ajeng Mardhiyah, Psychology Departement, Medical Faculty University
Sriwijaya. email : ajeng_mardhiyah.psi@fk.unsri.ac.id
This work is licensed under a Creative Commons Attribution-
NonCommercial 4.0 International License (CC BY-NC 4.0).
©Copyright: Sayang Ajeng Mardhiyah, 2021
Licensee NDSAN (MFC- Coordinator of the NDSAN), Italy
doi: https://doi.org/10.32437/mhgcj.v4i1.114
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Introduction
The World Health Organization (WHO),
describes mental health as a state in which a
person realizes their abilities, able to deal with
normal stressors, able to work productively and
pleasantly, and able to contribute to the
community (WHO, 2005). It can be said that, if
there are obstacles in carrying out these functions,
the individual may have problems with their
mental health.
The increase in mental disorders obtained from
Basic Health Research Indonesian Ministry of
Health (riskesdas) in 2018, shows a significant
increase compared to Riskesdas in 2013, which
increase from 1.3% to 7% (Indonesian Ministry of
Health, 2018). This increase was revealed from the
increase in the prevalence of households with
people with mental disorders (ODGJ) in Indonesia.
Johanna Jarcho, Ph.D., a postdoctoral at
National Institute of Mental Health, said that most
mental health disorders appear in their teens or
early 20s. The symptoms usually begin in
childhood or adolescence and will continue into
adulthood. Most people don’t realize that they
had an anxiety disorder when they were
teenagers, and realize it as an adult. Teenagers
have the potential to experience mental health
problems such as school problems, college, lack
of sleep, and romance, so it is not uncommon for
them to choose drugs and alcohol to forget about
those problems (Women’s Brain Health Initiative,
2015) .
It is estimated that mental disorders in children
and adolescents will become one of the five
problems that cause disability, morbidity, or even
mortality in the next 20 years (WHO, 2013). Mental
health problems in children and adolescents can
affect their functioning in important domains in
their lives now and the future, such as functioning
at school, at home, with friends, and in the
community (Jaycox et al., 2009).
Likewise, when teenagers enter university,
students’ mental health issues become a very
common discussion (Blanco C. et al., 2008). In
general, it is known that every individual has the
potential to experience mental health disorders,
from children to adults. In children, it is too early for
them to understand mental health, so research
has focused more on adolescents. This is because
in adolescence, the cognitive development has
finally able to receive information abstractly and
rationally, it also can process this information in
everyday life. Furthermore, for early prevention
before mental disorders occur in adulthood,
adolescents also need to understand about
mental health itself. In this context, many students
experience the onset of mental health problems
or even worsen initial conditions that students have
experienced before entering university (Burns &
Rapee, 2006; Pedrelli et al., 2014;).
Screening results on 147 Unsri students
conducted by researcher at the time of
community service in 2019, found 56.5% of the
students experienced mild symptoms of
psychological distress, 40.1% experienced
symptoms of high psychological distress (needs to
be wary of), and only 3.4% did not show symptoms
of psychological distress, such as depression,
anxiety and somatic complaints (Mardhiyah,
2019).
Low mental health literacy and psychological
distress are considered predictors of low
psychological well-being (Farrer, Leach, Griffiths,
Christensen, & Jorm, 2008; Burns & Rapee, 2006)
and even dropping out of college (NAMI, 2012).
Mental health literacy is knowledge and beliefs
about mental disorders related to recognition,
management, or prevention (Jorm, 2000). This
means that individuals with mental health literacy
have knowledge about mental disorders, their
causes, symptoms, and treatments. Mental health
literacy (Jorm, 2000) consists of several
components including: 1) the ability to recognize
specific disorders or differences in types of
psychological distress, 2) knowledge and beliefs
about risk factors and causes, 3) knowledge and
understanding of self-help interventions, 4)
knowledge and beliefs about mental health
disorders.
Based on the background of the study, the
researcher was interested to analyze mental
health literacy and psychological distress as
predictors for psychological well-being of collage
students in Sriwijaya University.
Purpose
This research focused on answering questions
as below:
1. Is there a role of mental health literacy and
psychological distress on the psychological well-
being of collage students in Sriwijaya University?
2. Is there a role of mental health literacy on
the psychological well-being of collage students in
Sriwijaya University?
3. Is there a role of psychological stress on
the psychological well-being of collage students in
Sriwijaya University?
Design/Methodology/Approach
This research used quantitative method, by
conducting instrument preparation, data
collection, and analysis of data results to see the
role of the independent variables on the
dependent variable.
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Research Population and Sample
The population in this study are active students
in Sriwijaya University. The sampling technique used
is the incidental sampling which is a sampling
technique based on respondents who are met
and meet the criteria. In this study, samples were
taken based on individual’s willingness to fill out the
research scale.
The selection of the number of samples in this
study refers to Roscoe’s theory (Sugiyono, 2016).
Roscoe suggested a suitable sample size for
research ranging from 30 to 500 (Sugiyono, 2016).
In this study, the participants were 418 college
students.
Data collecting methods
Psychological well-being was measured using
an instrument in a form of psychological scale
referred to the psychological concept proposed
by Ryff and Keyes (1995), which describes
individual functioning to be independent, realize
their potential, able to master their environment,
able to accept themselves, have a purpose in life,
and able to have a positive relationship with
others. The Indonesian version of the Ryff and
Keyes (1995) psychological well-being scale
developed by Rachmayani and Rachmadani
(2014) was modified and a try out was carried out
to 50 respondents before being distributed. This
was done to measure the validity and reliability of
the measuring instrument. The reliability before try-
out with 86 items was 0.871 and after try-out with
43 items was 0.923 (data attached).
Furthermore, the concept of psychological
distress is used as an indicator of mental health
which is defined as a multifactorial and
unpleasant emotional experience of
psychological (cognitive, behavioral, emotional),
social, and spiritual traits that may interfere with the
ability to effectively cope with illness, physical
symptoms, and treatments (Reis et al., 2014). In
this case, the researcher measured psychological
distress using the Indonesian version of the WHO
Self-Reporting Questionnaire 20 (SRQ-20), with a
scoring scale of Yes (1) and No (0). This instrument
has been used in Basic Health Research (Riskesda)
of Indonesian population, which aims to
determine mental health status. One of the
reasons is because this questionnaire has good
validity in terms of sensitivity of 88%, and specificity
of 81% (Hartono, 1995).
Meanwhile, mental health literacy concept is
defined as knowledge and beliefs about mental
disorders that aid in the recognition,
management, or prevention. Mental health
literacy includes the ability to recognize specific
disorders; knowing how to seek mental health
information; knowledge of risk factors and causes;
knowledge of self-treatments; knowledge of
professional help available; and attitudes that
promote recognition and appropriate help-
seeking (O’Connor & Casey, 2014). To measure
mental health literacy, a standardized scale was
adapted from O’Connor and Casey (2015) which
was translated into Bahasa, with permission and
guidance from O’Connor.
Results
Description of Participants
The number of participants in this study were
418 college students.
Based on the gender data, it is known that there
are 129 male participants (30.9%) and 289
female participants (69.1%). Meanwhile for the
age data, there are 150 adolescent participants
(35.9%) and 268 young adult participants (64,1%)
Individual Characteristics
Frequen
cy
Percentage
Gender
Male
129
30,9%
Female
289
69,1%
Age
Adolescence
150
35,9%
Early
adulthood
268
64,1%
Participate in Non-
Academic Activities
Yes
264
63,4%
No
154
36,6%
Semester
2
153
36,6%
4
85
20,3%
6
108
25,8%
8
52
12,5%
10
16
3,8%
12
2
0,5%
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Description of Research Data
This study was analyzed descriptively on each
variable. The following is a description of each
variable
Variable
Hypothetical Data
Empirical Data
Max
Min
Mean
SD
Max
Min
Mean
SD
Mental
Health
Literacy
175
35
105
23,3
137
77
109,775
9,478
Psychological
Distress
20
6
13
2,3
20
0
7,175
4,401
Psychological
Well-Being
172
43
107,5
21,5
163
82
123,077
14,867
Description: Min: Minimum Total Score; Max: Maximum Total Score; Mean: Mean Score; SD:Standard
Deviation.
Besides that, researcher also classified the
participants into certain categories for variable of
mental health literacy and psychological well-
being. This categorization serves a purpose to
place individuals into groups in which positions are
tiered according to a continuum based on the
measured attributes. Classification of participants
was done through three kinds of categories,
namely: low, average, and high.
Meanwhile, for psychological distress, the
Indonesian version of WHO Self-Reporting
Questionnaire 20 (SRQ-20) was used. Specifically,
the interpretation of SRQ-20 total score is (Medhin,
Hanlon, Dewey, Alem, Tesfaye, Lakew, et al, 2010):
Table of SRQ-20 Total Score Categorization
SRQ-20 Total Score
Categorization
0
No symptoms of psychological distress, such as depression, anxiety and
somatic complaints
1 – 5
There are mild symptoms of psychological distress
6 or above
Experiencing symptoms of high psychological distress (needs to be
wary of)
Based on the formula above, the categorization for
each variable is as follows:
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Table of Categorization of Participants’: Mental Health Literacy, Psychological Distress and Psychological Well-Bein
Categorization
Frequen
cy
Percentage
Mental Health
Literacy
X < 81,7
Low
2
0,5%
81,7 ≤ X <
128,3
Average
402
96,2%
X ≥ 128,3
High
14
3,3%
Psychological
Distress
X < 1
No symptoms of
psychological distress
21
5,0%
1 ≤ X < 6
Showing mild
symptoms of
psychological distress
140
33,5%
X ≥ 6
Showing symptoms of
high psychological
distress
257
61,5%
Psychological Well-
Being
X < 86
Low
4
1%
86 ≤ X < 129
Average
263
62,9%
X ≥ 129
High
151
36,1%
Results
Data analysis results
Assumption test
1) Normality test
Before testing the hypothesis, the researcher
conducted a normality test first, because to test
the hypothesis, the data are required to be
normally distributed. Normality of a data can be
recognized or detected by looking at the
distribution of data (dots) on the diagonal axis of
the plot graph and its residuals. Data can be said
to be normally distributed if the dots spread
around the diagonal line and follow the direction
of the diagonal line.
Based on the plot graph output, the dots follow
and approach the diagonal line thus it can be
concluded that the data are normally distributed.
2) Linearity test
One of the other requirements before testing
the hypothesis is that there is a linear relationship
between variables. To find out whether there is a
linear relationship or not between each variables,
a linearity test was carried out. The results of the
linearity test are as follows:
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Table of Linearity Test Results
Variables
Linearity
Description
Pearson’s r
p-value.
Psychological Well-
Being -- Mental Health
Literacy
0,110
0,025
Linear
Psychological Well-
Being -- Psychological
Distress
-0,578
< 0,001
Linear
Based on the linearity test, the significance
value of psychological well-being and mental
health literacy variables is 0.025; while
psychological distress is 0.001 (p<0.05), thus it can
be concluded that the variables have a linear
relationship.
3) Multicollinearity test
Multicollinearity test is used to see whether the
independent variables have a perfect or near
perfect linear relationship, because a good
regression model should not have a perfect
correlation between the independent variables.
Multicollinearity test was carried out by looking at
the Variance Inflation Factor (VIF).
According to Ghozali (in Purnomo, 2016), if the
VIF value is <10 then there is no symptom of
multicollinearity among the independent
variables, and if the VIF value is >10 then
multicollinearity occur among the independent
variables. The results of the multicollinearity test
can be seen in the following table:
Table of Multicollinearity Test Results Summary
Variables
Collinearity Statistics
Description
Tollerance
VIF
Psychological Well-
Being -- Mental Health
Literacy
0,999
1,001
No multicollinearity
Psychological Well-
Being -- Psychological
Distress
0,999
1,001
No multicollinearity
From these results, it can bee seen that the
variable of mental health literacy and
psychological well-being has a VIF of 1.001,
meaning that the VIF value is smalled than 10
(1.001<10), thus it can be conclude that there is
no symptom of multicollinearity among the
independent variables.
4) Heteroscedasticity test
This test is carried out to see whether the variance
of the variables is not the same for all observation,
because heteroscedasticity should not occur in a
good regression. In this study, to see whether there
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
is heteroscedasticity, the researcher used
scatterplots; namely by looking at the pattern of
dots on the regression scatterplots. The method is
to create a plot or scatter graph between
Standardized Predicted Value (ZPRED) and
Studentized Residual (SRESID). Whether or not there
is a certain pattern on the scatterplot graph
between SRESID and ZPRED can be seen from the
Y axis which has been predicted and the X axis
which is the residual (predicted Y – true Y).
From the results of heteroscedasticity test, it
can be seen that the dots spread above and
below the number 0 on the Y axis, which means
that there is no symptom of heteroscedasticity.
Hypothesis testing
To test the hypothesis, the researcher used
regression analysis. In this study, multiple regression
analysis is used to determine the role of mental
health literacy and psychological distress on
psychological well-being. The result of the
regression analysis is as follows:
Table of Major Hypothesis Testing Results
Variables
R
R Square
F
Sig
Description
Mental Health
Literacy -
Psychological
Distress -
Psychological
Well-Being
0,586
0,343
108,416
< 0,001
Significant
Based on the table, it is known that the significance
value of psychological well-being, mental health
literacy, and psychological distress is 0.001
(p<0.05) with a correlation coefficient (R) of 0.586.
These results show that there is a role of mental
health literacy and psychological distress together
on psychological well-being, thus the hypothesis is
accepted.
The percentage of mental health literacy and
psychological distress influences on psychological
well-being (R adjusted) is 0.343, this also shows that
the role of mental health literacy and
psychological distress together on psychological
well-being is 34.3%, while the rest is the
contribution of other variables not examined in this
study.
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Table of Minor Hypothesis Testing Results
Variables
Beta
p
Significance
Mental Health Literacy -
Psychological Well-Being
0,143
0,022
Significant
Psychological Distress -
Psychological Well-Being
-1,945
< 0,001
Significant
Based on the table above, it can be seen that
psychological well-being and mental health
literacy show a beta value of 0.143 and a P value
of 0.022 (p<0.05), this indicates that there is a role
for mental health literacy on psychological well-
being, thus the hypothesis is accepted.
It can also be seen that psychological well-
being and psychological distress show a beta
value of -1.945 and a P value of 0.001 (p<0.05),
this indicates that there is a role for psychological
distress on psychological well-being, thus the
hypothesis is accepted.
To determine how big the role of mental health
literacy and psychological distress on
psychological well-being, the researcher
conducted an analysis to find the effective
contribution of the variables. By using the following
formula:
Thus it is known that the effective contribution of
mental health literacy is 1.001% and
psychological distress is 33.35% on mental health.
Table of Effective Contribution Data of Mental Health Literacy and Psychological Distress on
Psychological Well-Being
Variable
Beta
Zero Order
Mental Health
Literacy
0,091
0,110
Psychological Distress
-0,576
-0,579
Table of Effective Contribution Summary
Variables
Effective Contribution
Mental Health Literacy
- Psychological Well-
Being
(0,091) x (0,110) x 100%
1,001%
Psychological Distress -
Psychological Well-
Being
(-0,576) x (-0,579) x 100%
33,35%
Discussion
In this study, the major hypothesis testing was
carried out using multiple linear regression which
showed correlation value (R) of 0.586 and a
significance of 0.001 (p<0.05). These results show
that there is a role of mental health literacy and
psychological distress together on psychological
well-being, thus the hypothesis is accepted.
Meanwhile, the percentage of mental health
literacy and psychological distress influences on
psychological well-being (R adjusted) is 0.343, this
also shows that the role of mental health literacy
and psychological distress together on
psychological well-being is 34.3%, while the rest is
the contribution of other variables not examined in
this study. According to Ryff (1995), several factors
that may affect psychological well-being are age,
gender, and culture. Then Ryff et al. (2002) also
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
added several more factors including educational
status and personality.
For the results of the minor hypothesis testing, it
is known that the beta value is 0.143 and the P
value is 0.022 (p>0.05), this indicates that there is
a role for mental health literacy on psychological
well-being, thus the hypothesis is accepted.
In addition, psychological well-being and
psychological distress show a beta value of -1.945
and a P value of 0.001 (p<0.05), this indicates that
there is a role for psychological distress on
psychological well-being, thus the hypothesis is
accepted. Specifically, the effective contribution
of mental health literacy is 1.001% and
psychological distress is 33.35% on mental health.
Several previous researches indicate that
university should planning intervention and
promotion of psychological well-being, to
increase awareness and ability to conceptualize
mental and emotional health for collage students
(Vazquez, 2016). Learning and adopting
knowledge related to health promotion and
behavior during adolescence can improve
healthy decision making and health literacy in
collage, including mental health literacy, which in
particular also has a component of knowledge
around mental health itself (Bjørnsen et al., 2019).
Therefore, mental health literacy interventions are
suggested in promoting psychological well-being
as the result itself rather than focusing solely on
curative mental disorders (Vazquesz, 2016).
Adolescence is also a period when individuals
are vulnerable to psychological distress, and so
this period is an important time to promote
psychological well-being and early intervention for
mental health, as an effort to avoid the
occurrence of mental health problems (Pengpid,
& Peltzer, 2020). One of the interventions that can
be done is mental health literacy intervention as
described above. Research on mental health
literacy will lead to planning for mental health
promotion in order to reduce the occurrence and
severity of mental disorders, so the promotion of
mental health literacy becoming important to
promote psychological well-being and prevent
mental health problems (Inchaithep, Punsawat, &
Nuntana, 2018).
Ashfield and Smith (Male Suicide Prevention
Australia, 2018) through their discussion of suicide
prevention, also explained that it is not only
important to reach an approach on how to
respond to psychological distress and mental
health disorders, but also to be involved in
preventive promotion (in this case suicide
prevention), improvement on psychological well-
being, and mental health literacy. Moreover, one
of the components of mental health literacy
mentioned by Jorm (2000) is the ability to
recognize specific disorders or differences in
various psychological distresses. Thus, both mental
health literacy and psychological distress are
considered having a role in improving
psychological well-being.
The results and discussion above indicate that
the hypothesis which states there is a role of
mental health literacy and psychological distress
on psychological well-being can be accepted.
Given that there are still 65.7% of other factors
unidentified in this study, for further research, other
variables can be added as predictors of
psychological well-being, including adjustment,
emotion, personality type, stress management,
social support, and others.
The results also show that 61.5% students have
high psychological distress, 33.5% on average
level, and another 5% on low level of
psychological distress. This is in line with what
Jarcho (Womens Brain Health Initiative (2015) said
that most adolescents in university experience
psychological distress.
Psychological distress is a state of emotional
distress that affects psychological well-being, this
condition is characterized by symptoms of
depression (e.g. loss of interest, sadness,
hopelessness) and anxiety (e.g. restlessness,
feeling tense) (Mirowsky & Ross, 2003). The level of
psychological distress can be caused by two
influences, namely: intrapersonal, such as
personality traits; and situational influences, such
as life events (Matthews, 2000). Situational factors
from the environment that encourage
psychological distress include traumatic events,
physical factors, social factors, and poor health
(Matthews, 2000). Therefore, there should be
preventative efforts that universities can come up
with in this regard.
In this study, the researcher also conducted
additional analysis by conducting difference tests
on variables of psychological well-being, mental
health literacy, and psychological distress based
on gender, age, participation in non-academic
activities and semester of lectures. From those
tests, differences are found in age for all variables
and both in gender and semester for the variables
of mental health literacy and psychological
distress. The difference in gender and mental
health literacy variables is in line with several
previous studies (Dias et al., 2018; Cotton et al.,
2006), where women have higher mental health
literacy scores than men. Gender differences
found in psychological distress variable are also in
line with several previous studies (Campbell, Bann,
& Patalay, 2021; Tian et al., 2021), where women
have higher mental health problems than men,
and the biggest difference is in life satisfaction and
MHGCJ – 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
psychological distress (Campbell, Bann, &
Patalay, 2021).
Limitations of the study
In this study, the researcher limits the scope of
the research so that the research objectives can
be achieved properly:
1) This research was conducted on active
Sriwijaya University students
2) Individual characterisrics data was
obtained from personal data of students involved
as participants in this research
Conclusions (and Future Work)
The percentage of mental health literacy and
psychological pressure influences on
psychological well-being (R adjusted) is 0.343, this
also shows that the contribution of mental health
literacy and psychological distress together on
psychological well-being is 34.3%, while the rest is
the contribution of other variables not examined in
this study.
Future work, it is important that university
planning an intervention and promotion of
psychological well-being, to increase awareness
and ability to conceptualize mental and
emotional health for collage students. Learning
and adopting knowledge related to health
promotion and behavior during in collage; can
improve healthy decision making and health
literacy in adolescents, including mental health
literacy, which in particular also has a component
of knowledge around mental health itself.
Research on mental health literacy will lead to
planning for mental health promotion in order to
reduce the occurrence and severity of mental
disorders.
Acknowledgments
This research is expected to be able to
contribute to the development of knowledge in
the field of mental health regarding mental health
literacy, psychological distress, and psychological
well-being of collage students in Sriwijaya
University.
Conflict of interest
Author declares that she has no conflict of
interests
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