Development and validation of the Espaijove.net mental health literacy (EMHL) test for Spanish adolescents

Abstract Background There is evidence of the effectiveness of implementing Mental Health Literacy (MHL) programs in improving mental health knowledge and reducing the stigma. However, there are substantial limitations in the instruments of measurement of mental health literacy. This study aimed to develop and validate the EspaiJove.net MHL test (EMHL) for Spanish adolescents assessing its psychometric properties.Methods The development of the EMHL as a maximum performance test was conducted using item pool generation and pilot study. Content generation was assessed according item relevance by mental health professionals’ and comprehensive and non-offensiveness by adolescents’ focus groups. A convenience sample of high school students aged 13-15y (n=355) participated in the validity study. Reliability was assessed with internal consistency and test-retest. Convergent validity was evaluated comparing effect size among known groups with different levels of mental health knowledge, correlation with mental health-related instruments, and item discrimination index.Results A final version of 35-item EMHL test was obtained with two parts: (i) 1st part consist of binary choice format (yes/no) for the identification of mental disorders; (ii) The part 2 has multiple choice questions with four possible answer options based on the thematic contents of the EspaiJove.net program. Internal consistency was acceptable in the 1st part (Cronbach’s alpha=0.744; Guttman’s lambda 2=0.773) and almost acceptable in the 2nd part (Cronbach’s alpha=0.615; Guttman’s lambda 2=0.643). The test-retest evaluation supported the stability of the test (1st part, ICC= 0.578; 2nd part, ICC= 0.422), no ceiling and floor effects were found. The EMHL test scores discriminated known groups with different levels of mental health knowledge, it is associated with a reduction of related-stigma, emotional symptoms, conduct problems and bullying behaviours and anxiety/depression and self-care quality of life (p<0.05), and it shows a strong discrimination index in almost all items (D≥0.40).Conclusions The EMHL test is a relevant measure for mental health prevention and promotion adapted to Spanish context taking into account the opinion of adolescents, using a non-offensive and adolescent-adapted vocabulary with acceptable validity and stability for assessing MHL levels in adolescents.