# Changes in mental health stigma and well-being: knowledge, attitudes and behavioural intentions among Hong Kong residents between 2021 and 2023

## TL;DR

This study found that mental health stigma increased in Hong Kong from 2021 to 2023, with attitudes mediating the link between knowledge and behavior, and reduced willingness to disclose mental illness despite its benefits for well-being.

## Contribution

The study reveals worsening mental health stigma in Hong Kong and identifies attitudes as mediators between knowledge and behavioral intentions during the pandemic.

## Key findings

- Mental health stigma measures increased in severity from 2021 to 2023 in Hong Kong.
- Attitudes partially or fully mediated the relationship between knowledge and behavioral intentions.
- Mental illness disclosure was linked to higher well-being, but willingness to disclose decreased in 2023.

## Abstract

Previous research has demonstrated that the COVID-19 pandemic led to a global increase in mental distress. However, few studies have examined the impact of the pandemic on mental health stigma.

To investigate changes in measures of mental health stigma, including knowledge, attitudes and behavioural intentions, in 2021 and 2023 in Hong Kong; to examine the mediating role of attitudes on the relationship between knowledge and behavioural intentions; and to explore how disclosure of mental illness contributes to enhanced overall well-being.

Data were collected as part of a larger research project focusing on mental well-being in Hong Kong. A total of 1010 and 1014 participants were surveyed in 2021 and 2023, respectively. The participants were Hong Kong residents aged 18 years and above.

Our findings demonstrate that all measures of mental health stigma showed increases in severity between 2021 and 2023. In addition, our mediation analyses observed both full and partial mediation effects of attitudes on the relationship between knowledge and behavioural intentions. The results also showed that mental illness disclosure was associated with higher well-being; however, despite these benefits, there was a decrease in willingness to disclose in 2023 compared with 2021.

This study highlights the ongoing issue of mental health stigma in Hong Kong. Future mental health programmes and interventions should aim to address various facets of mental health knowledge, including symptom recognition, access to support resources and the deleterious consequences of mental health stigma.