# Development and validation of the mental health service demand and utilization questionnaire

## TL;DR

This paper introduces a new questionnaire to assess mental health service needs and usage, validated in a large Chinese study involving adolescents and older adults.

## Contribution

The study presents a novel, culturally relevant questionnaire validated for assessing mental health service demand and utilization.

## Key findings

- The Service Needs subscale showed high internal consistency (Cronbach’s α = 0.975).
- Exploratory factor analysis identified three key factors explaining 82.716% of the variance.
- The questionnaire demonstrated strong validity and reliability in its target populations.

## Abstract

As the global burden of mental health issues continues to grow, significant gaps persist in assessing the demand for and utilization of mental health services, particularly among vulnerable populations such as adolescents and older adults. Existing assessment tools often lack cultural and policy relevance, limiting their applicability across diverse social, political, and medical contexts. Guided by a revised Demand and Utilization Framework for Mental Health Services (R-MUSDU), this study aimed to develop and validate a comprehensive Mental Health Service Demand and Utilization Questionnaire (MHSDUQ). The instrument incorporates contextual, individual, and service-related factors to provide a more accurate evaluation of both service needs and patterns of utilization.

The questionnaire was developed based on the R-MUSDU framework. Initial items were generated through literature clustering analysis (n = 4,864), policy document analysis (n = 8), and qualitative interviews (n = 17), and were subsequently refined via transparent expert consultation (n = 18) and a pilot survey (n = 60). This study was conducted from May to August 2025 across general hospitals, specialized hospitals, communities, and secondary schools in six provincial-level regions in China. Due to limited data variability in the service utilization section, reliability and validity were assessed specifically for the Service Needs subscale using data from the final sample of 755 participants.

The Service Needs subscale demonstrated high internal consistency (Cronbach’s α = 0.975). All items showed significant discriminant values (CR > 3.000, p < 0.01) and strong item-total correlations (ranging from 0.765 to 0.914). The exploratory factor analysis (EFA) yielded three factors (attitudinal characteristics, enabling factors, and need factors) comprising 22 items, which collectively accounted for 82.716% of the total variance. Confirmatory factor analysis (CFA) indicated that the modified model fit the data well.

The MHSDUQ demonstrated high validity, internal consistency, and reliability. It is a theory-based and empirically validated tool that can be used to evaluate the mental health service needs and utilization patterns of adolescents and the older adult, demonstrating its potential for application in specific social, cultural, and policy contexts analogous to the study setting.