Mental health literacy moderates the association between anxiety and depressive symptoms among Chinese young adults: a population-based cross-sectional study

Abstract

Mental health literacy (MHL) plays an important role in the recognition, prevention, and management of mental disorders, but its current status among Chinese young adults and its potential moderating role in the association between anxiety and depression remain underexplored. This study examined MHL among young adults in China, identified its influencing factors, and tested whether MHL moderates the relationship between anxiety and depressive symptoms. A cross-sectional survey was conducted in Fujian Province, China, using multistage stratified cluster random sampling. A total of 2,164 young adults aged 18–35 years were included in the analysis. Measurement instruments comprised a study-developed sociodemographic questionnaire, the National Mental Health Literacy Questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7). Multivariable logistic regression was used to identify factors associated with MHL, and Model 1 of the PROCESS macro for SPSS (with 5,000 bootstrap resamples) was used to test the moderating effect of MHL on the anxiety–depression association. Only 22.4% of young adults had MHL attainment. Compared with participants without depressive or anxiety symptoms, those with such symptoms were less likely to have good MHL (both p < 0.05). Anxiety and depressive symptoms were strongly comorbid and positively correlated, and MHL significantly moderated this association (β = 2.04, p = 0.043). At low anxiety levels, the risk of depression was lower in the good MHL group than in the poor MHL group; at high anxiety levels, however, the rate of depression was higher in the good MHL group, suggesting that individuals with good MHL may identify their psychological issues earlier, resulting in a higher detection rate of depression during screening. MHL among Chinese young adults remains low and is closely linked to depressive and anxiety symptoms. For young adults with good MHL, early-screening pathways should be established to translate symptom awareness into timely professional assessment and intervention. For those without good MHL, public-health efforts should focus on improving symptom recognition and correcting cognitive biases that lead to underestimation of mental health risks and delays in help-seeking. however, this explanation remains speculative and requires further validation through longitudinal studies.