# The causal relationship between mental illness-related stigma and mental health knowledge among adolescents at different educational stages: a longitudinal cross-lagged study

## TL;DR

This study finds that increased mental health knowledge among adolescents may not reduce stigma and could even increase it, especially in university students.

## Contribution

The study reveals a counterintuitive causal relationship between mental health knowledge and stigma in adolescents using longitudinal data.

## Key findings

- Higher mental health knowledge at T1 predicted higher stigma at T2 across all educational stages.
- The negative effect of knowledge on future knowledge scores was significant in all groups.
- University students showed the strongest predictive pattern between knowledge and stigma.

## Abstract

The relationship between mental illness knowledge and mental illness-related stigma among adolescent and youth students remains unclear. This study aims to examine the longitudinal predictive relationship between mental illness knowledge and mental illness-related stigma among junior high school, high school, and university students in China.

A longitudinal study design was employed. Two questionnaire surveys were conducted in December 2022 (T1) and December 2023 (T2) among 5,579 adolescent and youth students (1,695 junior high, 3,120 high school, and 764 university students) in Sichuan Province. The Mental Health Knowledge Schedule (MAKS) and the Perceived Devaluation-Discrimination Scale (PDD) were used. Cross-lagged panel models were applied to analyze the mutual predictive relationships between the variables.

At baseline, significant differences were observed in demographic characteristics and scores on the MAKS and PDD among the three group students (p < 0.05). Cross-lagged model analysis revealed that across all three educational stages, the scores of MAKS at T1 significantly positively predicted the scores of PDD at T2 (p < 0.05), and significantly negatively predicted MAKS at T2 (p < 0.05). This predictive pattern was the most pronounced in the university student group.

An increase in mental health knowledge may not alleviate mental illness-related stigma among adolescent student, but might predict higher levels of stigma, particularly among university students. This suggests that educational interventions focusing solely on knowledge dissemination, without addressing emotional attitudes and social norms, may not only fail to effectively reduce stigma but could potentially produce counterproductive effects. Future anti-stigma strategies should adopt more integrated approaches and pay special attention to the psychosocial characteristics of students at different developmental stages.