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Questionnaire for Assessment of Mental Health Literacy – QuALiSMental:

study of psychometric properties

Article  in  Revista de Enfermagem Referência · March 2015

DOI: 10.12707/RIV14031

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 ISSNe: 2182.2883 | ISSNp: 0874.0283
Disponível em: http://dx.doi.org/10.12707/RIV14031
RESEARCH PAPER

Questionnaire for Assessment of Mental Health Literacy

– QuALiSMental: study of psychometric properties
Questionário de Avaliação da Literacia em Saúde Mental – QuALiSMental: estudo das
propriedades psicométricas
Cuestionario de Evaluación de la Alfabetización en la Salud Mental – QuALiSMental:
estudio de las propiedades psicométricas
Luís Manuel de Jesus Loureiro*

Abstract
Theoretical framework: The assessment of mental health literacy is a key aspect in the design and implementation of mental
health education and awareness programmes, specifically in school settings, given the high prevalence of mental disorders in
adolescents and young people and the need for interventions adjusted to specific settings and target groups.
Objectives: To describe the assessment of the psychometric properties of the Questionnaire for Assessment of Mental Health
Literacy (QuALiSMental).
Methodology: Administration of the questionnaire to a random and representative sample of 4.938 Portuguese adolescents and
young people attending schools in the area of coverage of the Regional Directorate of Education - Centre.
Results: The QuALiSMental has acceptable levels of reliability and a factor structure which is consistent with the theoretical
components of mental health literacy.
Conclusion: The questionnaire may be applied both as a screening measure of literacy and as a measure for assessing the impact
of interventions on the promotion of mental health among adolescents and young people.

Keywords: mental health; questionnaires; mental health literacy; adolescent.

Resumo
Enquadramento: A avaliação da literacia em saúde mental é
um aspeto fundamental para a concepção e implementação
de programas de educação e sensibilização para a saúde
mental, especificamente no contexto escolar, dado a elevada
prevalência de perturbações mentais em adolescentes e jovens
e a necessidade de intervenções ajustadas aos contextos e
públicos-alvo.
Objectivos: Apresentar a avaliação das propriedades
psicométricas do Questionário de Avaliação da Literacia em
Saúde Mental (QuALiSMental).
Metodologia: Estudo realizado com a aplicação do
questionário a uma amostra aleatória e representativa de 4.938
adolescentes e jovens portugueses, que frequentam as escolas
da região de Abrangência da Direcção Regional de Educação
do Centro.
Resultados: O QuaLiSMental apresenta índices de fiabilidade
aceitáveis e uma estrutura fatorial que é consistente com as
componentes teóricas da literacia em saúde mental.
Conclusão: O questionário poderá ser aplicado, quer como
medida de rastreio da literacia, quer ainda como medida
de avaliação do impacto das intervenções no domínio da
promoção da saúde mental de adolescentes e jovens.
Palavras-chave: saúde mental; questionários; literacia em
saúde mental; adolescente.
Resumen
Marco contextual: La evaluación de la alfabetización en la
salud mental es un aspecto fundamental para el diseño y la
implementación de programas de educación y sensibilización
para la salud mental, especialmente en el contexto escolar,
dada la alta prevalencia de trastornos mentales en los
adolescentes y jóvenes y la necesidad de intervenciones
ajustadas a los contextos y al público objetivo.
Objetivos: Presentar la evaluación de las propiedades
psicométricas del Cuestionario de Evaluación de la
Alfabetización en Salud Mental (QuaLiSMental).
Metodología: Estudio realizado con la aplicación del
cuestionario a una muestra aleatoria y representativa de 4.938
adolescentes y jóvenes portugueses que asisten a escuelas en
el ámbito de la Dirección Regional de Educación del Centro.
Resultados: El QuaLiSMental tiene niveles de fiabilidad
aceptables y una estructura factorial que es consistente con los
componentes teóricos de la alfabetización en la salud mental.
Conclusión: El cuestionario se puede aplicar tanto como
medida de detección de la alfabetización como medida para
evaluar el impacto de las intervenciones en la promoción de la
salud mental de los adolescentes y jóvenes.
Palabras clave: salud mental; cuestionarios; alfabetización
en salud mental; adolescente.

*Ph.D., Adjunct Professor, Nursing School of Coimbra, 3046-851, Coimbra, Portugal

[luis.loureiro@esenfc.pt]. Address for correspondence: Urbanização Vale do Rosal, Received for publication: 20.03.14
Lote 17, 2º Dtº., 3040-339 Coimbra, Portugal. Accepted for publication: 09.09.14

Revista de Enfermagem Referência Série IV - n.° 4 - jan./fev./mar. 2015

pp.79-88
Introduction
Mental health literacy may be defined as the knowledge
and beliefs about mental problems and disorders
which allow for their recognition, management (in
the sense of self-care) and prevention (Jorm, 2012;
Loureiro & Abrantes, 2014; Jorm, 2014). This is a core
concept that has been occupying a leading position in
the most diverse areas of knowledge and professional
intervention, such as  Nursing (Loureiro, Mendes et
al., 2012).
Since 1997, when both the concept and the results of
the first study conducted in Australia were presented
(Jorm, Korten, Rodgers et al., 1997), many studies have
been developed in several countries and continents,
in different situational, economic, social and cultural
contexts (Jorm, 2012; Jorm, 2014).  mental health literacy for different types of disorders.
With regard to data collection instruments and as
proposed by Jorm, Korten, Jacomb et  al. (1997),
almost all published studies assessing mental health
literacy use the Survey of Mental Health Literacy
in Young People - Interview Version  (Jorm, Korten,
Rodgers et al., 1997). This instrument allows assessing
the components of mental health literacy in relation
to different disorders. It has different versions, which
maintain the key structure and, therefore, allow
studying, with the necessary adaptations, samples
of  adolescents, young people and adults (Jorm,
Korten, Rodgers et al., 1997; Jorm et al., 2000; Jorm,
Mackinnon, Christensen, & Griffiths, 2005).
In Portugal, there is only one instrument to assess
mental health literacy – the Questionário de Avali­
ação da Literacia em Saúde Mental (QuALiSMental)
(Questionnaire for Assessment of Mental Health
Literacy) (Loureiro, Pedreiro, & Correia, 2012). This
questionnaire is an adapted version of the Survey of
Mental Health Literacy in Young People - Interview
Version for both adolescents and young people. The
QuALiSMental has been recurrently used to assess
mental health literacy in portuguese adolescents and
young people (Loureiro, Jorm et al., 2013; Loureiro,
Barroso et al., 2013; Loureiro, Jorm et al., 2014).
The aim of this paper is to describe the assessment
of the psychometric properties of the version for
adolescents and young people of the QuALiSMental
regarding their level of depression. It also aims to
assess the predictive ability  of the questionnaire
concerning mental health help-seeking intentions.
Revista de Enfermagem Referência - IV - n.° 4 - 2015
80
Background
The concept of mental health literacy, as defined in
the introduction, involves a set of components, such
as: (a) the recognition of mental disorders in order
to promote and facilitate help-seeking; (b) knowledge
about the professionals and treatments available; (c)
knowledge of the effectiveness of self-help strategies;
(d) knowledge and skills to provide support and first
aid to others; (e) knowledge of how to prevent mental
disorders (Jorm, 2012; 2014).
Although there are instruments in the literature to
assess, even if indirectly, some components of mental
health literacy, only the Survey of Mental Health
Literacy in Young People - Interview Version was
designed to simultaneously assess all components of
The generalised use of this instrument has
several positive aspects, namely the fact that it
allows comparing mental health literacy in different
cultural, social and economic contexts, which translates
into an added value in terms of the intervention needs
and challenges in this field (Jorm, 2014).
As for the study and assessment of the psychometric
qualities of the original instrument, the published
studies  relate only to  some components (Jorm,
Korten, Rodgers et al., 1997; Jorm et al., 2000; Jorm et
al., 2005). For example, there are no validation studies
of the recognition of disorders component, although
dozens of  studies assess this specific component of
literacy.
In 1997, the authors published an analysis concerning
the items of the knowledge about the professionals
and treatments available component (Jorm,
Korten, Rodgers et  al., 1997), using a sample of
2031 Australians aged between 18 and 74 years. The
factor analysis showed a 3-factor structure, which the
authors designated as Medical (including items
related to prescribed medication), Psychological
(items related to professional help and therapies)
and Lifestyle (items related to non-professional help,
e.g. teas, vitamins, close friends, family members or
physical activity). 
Later on, the results of another analysis on the
same items were also published, though applying
a Confirmatory Factor Analysis (Jorm  et al., 2000).
The sample was composed of 3.109 australian adults
(Jorm et al., 2000). Results were similar to those
obtained in the previous study, and the designations
Questionnaire for Assessment of Mental Health Literacy – QuALiSMental:
study of psychometric properties
of the factors remained the same in comparison to the
former study.  literacy. A vignette reporting a case of depression is
In 2005, the same authors  published another
study (sample of 3.998 Australian adults), except that
now they added the items of the effectiveness of self-
help strategies component to the knowledge about the
professionals and treatments available component
(Jorm et al., 2005). Items were subjected to exploratory
factor analyses and a 4-factor structure was obtained:
lifestyle, psychological, medical and information
seeking actions. The last factor included items relating
to the search for mental health information, such
as  looking up a website giving information about
the problem and reading a self-help book.
Methodology
Type of study
This  is a quantitative methodological study, which
mainly fits into the type and assumptions of the work
carried out.
 
Sample
Data were collected  in the central region of
mainland Portugal, using a representative sample of
adolescents and young people aged between 14 and
24 years. Participants attended the 3rd cycle of basic
and secondary education in 50 schools belonging to
the area of coverage of the Regional Directorate of
Education - Centre (DREC).
Both schools and classes were selected through
a multistage cluster sampling using the Random
Sequence Generator. The sample consisted of 4.938
portuguese adolescents and young people: 43.3%
were males and 56.7% were females, with a mean age
of 16.75 years and a standard deviation of 1.62 years.  minutes.
Data collection instrument
The data collection instrument (QuALiSMental)
consists of a set of items aimed at assessing the five
components of mental health literacy, using different
response formats, as detailed in the description of the
instrument in the presentation results.
The  1st part of the questionnaire includes
instructions for completion and questions on socio-
demographic characteristics (gender, age, place
of residence, district and parents’ academic
qualifications). The 2nd part is composed of different
LUÍS MANUEL DE JESUS LOUREIRO
81
sections relating to each component of mental health
previously presented according to the DSM-IV-TR
diagnostic criteria for alcohol abuse (Associação
Americana de Psiquiatria, 2006).
The recognition of disorders component is composed
of  several expressions that individuals can choose
from using a multiple choice format. In addition to the
expressions (e.g.: depression, burnout), it also includes
response options: there is nothing wrong with him/
her, I don’t know, he/she has a problem and other, in
which the problem should be specified.
The  knowledge about the professionals and
treatments available  component consists of  16
items in total and has the following response format:
helpful, harmful and neither. 
Both components - knowledge of the  effectiveness
of self-help strategies and knowledge and skills
needed to provide support and first aid to others -
are composed of 12 and 10 items, respectively, with
the following response format:  useful, harmful and
neither. 
The last component of mental health literacy in the
QuALiSMental (the knowledge of how to prevent
mental disorders) is composed of 8 items, with the
following response format: yes, no and I don’t know.
The content of the items of all dimensions are shown
in the tables of results.
Methodological procedures 
Data were collected between November 2011 and
May 2012, using a cluster sampling approach. The
questionnaire was administered in classroom settings,
in collective sessions, under the supervision of a
member of the research team and a teacher of the
class. The time of response was between 40 and 50
Ethical-legal considerations
The QuALiSMental was submitted to the Directorate-
General for Innovation and Curriculum Development
of the Ministry of Education of the Portuguese
Government (process no. 0252500001) and the Ethics
Committee of the Health Sciences Research Unit -
Nursing (UICISA: E) of the Nursing School of Coimbra
(No.: P58-12/ 2011). Both entities approved the use
of the questionnaire and allowed for its application.
Given the characteristics of the sample (mostly
composed of underage students), an informed
Revista de Enfermagem Referência - IV - n.° 4 - 2015
consent form was added to the instrument to be
signed by parents/tutors or, in case young people
were aged ≥ 18 years, a specific consent form was
added to be signed by participants .
Data were inserted and analysed using the IBM-SPSS
software, 22.0 version. The appropriate summary
statistics and both the absolute and percentage
frequencies were calculated whenever necessary. The
construct validity study was performed for the items
of all components using Exploratory Factor Analyses
based on the matrix of Spearman’s correlations,
phi coefficient (j) and Cramer’s V , given the items’
response format, with factor extraction using the
principal components analysis (PCA)  followed by
orthogonal Varimax rotation  (Maroco, 2011).
The decision on the number of factors to be retained
in the analysis was based on the eigenvalue-greater-
than-one rule, supported by the  scree test  and the
percentage of variance explained by  factor. Prior to
the EFA, the KMO measure was obtained and the
Bartlett’s test of sphericity was performed.  factor includes the items Schizophrenia, Psychosis,
The reliability analysis was performed using the
Cronbach’s alpha coefficients for each factor that
emerged from the analysis.
Subsequently, the scores of the factors that emerged
from the analysis  of all components were subjected
to a (binary) Logistic Regression Analysis.
Table 1
Factor loadings of each item  (expression)  in the  five retained  factors, including eigenvalues and % of
explained variance, after the EFA with factor extraction using the Principal Components Analysis followed
by Varimax rotation
Results
As regards the recognition of disorders
component,  the matrix of phi  coefficients (j) was
calculated and an EFA was performed based on the
matrix with extraction of the factors using the PCA
method  followed by Varimax rotation. The KMO
measure was 0.65 (a low value for recommendation
of FA). Still,  the test of sphericity showed statistical
significance (p<.001), thus we continued with the
analysis. 
As can be seen (Table 1), the solution found points to
five factors with eigenvalues greater than 1.00, which
explained 46.84% of the variance. 
The 1st  factor includes the following labels with
loadings  >.40: Depression,  Stress,  Nervous break-
down and Psychological/emotional/mental problems,
and explained 9.72% of the variance. The 2nd factor
includes the items Alcoholism and Substance abuse,
and explained a total of 9.69% of the variance. The 3rd
Mental illness and  Cancer, and explained 9.36%
of the variance. The 4th factor  corresponds to the
labels  Bulimia and Anorexia and explained 9.27%
of the variance. The last factor (5th) includes the
items He/she has a problem, Age crisis and Stress, and
explained 8.79% of the variance.

1 2 3 4 5
Depression .65
Schizophrenia .68
Psychosis .55
Mental illness .57
Bulimia .79
Stress .48 .45
Nervous breakdown .71
Substance abuse .76
Age crisis .66
Psychological/mental/emotional problems .43
Anorexia .80
Has a problem .69
Alcoholism .79
Cancer .36
Eigenvalues 1.36 1.36 1.31 1.30 1.23
% of Explained variance 9.72 9.69 9.36 9.27 8.79
Kuder-Richardon (K-20) .50 .45 .40 .49 .36
KMO Measure =.65; Bartlett’s Test of Sphericity: c(2)(91)= 2504.73; p<.001

Questionnaire for Assessment of Mental Health Literacy – QuALiSMental:

Revista de Enfermagem Referência - IV - n.° 4 - 2015 study of psychometric properties

82
The items related to the knowledge about
the professionals and treatments available
and  knowledge of self-help strategies components
were analysed according to the original validity studies
(Jorm, Korten, Rodgers et al., 1997; Jorm et al., 2000;
Jorm et al., 2005). Thus, the items were subjected to an
EFA based on the matrix of Spearman’s correlations,
given the response format, with factor extraction
using the PCA followed by Varimax rotation.
The KMO  value was  acceptable (0.77) and the
Bartlett’s test was statistically significant (p<.001). As
can be seen (Table 2), the 5-factor solution explained
approximately 40.00% of the variance.
The 1st factor - professionals and professional help
-  explained  8.83% of the variance. It includes the
items  Family physician,  Psychologist, Nurse,  Social
worker and Psychiatrist, as well as the items Joining
a support group of people with similar problems
and Going to a specialised mental health service.
The 2nd factor - harmful strategies - explained 8.07%
of the variance. It includes the following items: Solving
problems on his/her own, Using alcohol to relax and
Smoking cigarettes to relax.
The 3rd factor – medication – explained 8.06% of the
variance. It includes the items relating to prescribed
medication, such as Tranquilisers/Sedatives, Anti­
depressants, Antipsychotics and Sleeping pills.
The 4th factor – self-help strategies - explained 7.85%
of the variance. It includes the items relating to non-
medical products, that is, over-the-counter drugs
such as Vitamins and Teas, and items relating to self-
help strategies such as Becoming more physically
active, Getting relaxation training,  Practicing
meditation,  Getting acupuncture and  Getting up
early and getting out in the sunlight.
The last factor (5) - informal help - explained 6.32%
of the variance. It includes two items relating to
informal help, namely talking to a Close family
member and  Close friend, and the items relating
to seeking information and support (Telephonic
helpline,  Looking up a website giving information
about the problem or Reading a self-help book on the
problem). 
Despite being low in some factors, the values obtained
in the reliability analysis were acceptable. 

Table 2 
Factor loadings of each item in the five retained factors, including eigenvalues and % of explained variance,
after the EFA with factor extraction using the Principal Components Analysis followed by Varimax rotation

1 2 3 4 5
Family doctor .45
Teacher .31
Psychologist .45
Nurse .51
Social Worker .47
Psychiatrist .59
Telephonic Helpline .40
Close Family Member .38
Close Friend .37
Solving problems on his/her own .59
Vitamins .23
Teas (e.g. Camomile or hypericum) .49
Tranquilizers/Sedatives .71
Antidepressants .77
Antipsychotics .74
Sleeping pills .68
Becoming more physically active .48
Getting relaxation training .63
Practicing meditation .63
Getting acupuncture .47
Getting up early each morning and getting out in the sunlight .41

LUÍS MANUEL DE JESUS LOUREIRO Revista de Enfermagem Referência - IV - n.° 4 - 2015

83
 Receiving therapy with a specialised professional .55
Looking up a website giving information about the problem .73
Reading a self-help book on the problem .72
Joining a support group  .43
Going to a specialised mental health service .59
Using alcohol to relax .80
Smoking cigarettes to relax .79
Eigenvalues 2.47 2.26 2.26 2.20 1.77
% of Explained variance 8.83 8.07 8.06 7.85 6.32
Internal Consistency (Cronbach’s alpha) 0.68 0.72 0.72 0.55 0.52
KMO Measure =.77; Bartlett’s Test of Sphericity: c(2)(378)= 22620.65

As regards the items of the knowledge and skills
needed to provide first aid component, the KMO
value obtained was  low. However,  the result of the
Bartlett’s test  of sphericity proved to be  statistically
significant (p<.05).
As may be seen in the Table 3, the 3-factor solution
explained a total of 47.24% of the variance. Thus, the
1st factor explained 16.99% of the variance. It includes
the items perceived by the participants as  negative
strategies, namely Ask her/him whether he/she is
feeling suicidal, Suggest him/her to have a few drinks
to forget his/her troubles and Not acknowledging
his/her problem, ignoring him/her until he/she gets
over it. The item Listening to his/her problems in an
understanding way lacks transformation of identity.
The 2nd factor – non-professional self-help strategies
- explained 15.35% of the variance. It includes the
items  Talk to him/her firmly about getting his/her
act together, Rally friends to cheer him/her up, Keep
him/her busy to keep his/her mind off problems
and Encourage him/her to become more physically
active.
The 3rd factor – suggestion of professional help
-  explained 14.96% of the variance. It included the
items  Suggest him/her to seek professional help
and Make an appointment for him/her to see a GP
with his/her knowledge.
As can be seen in the Table 4, the Cronbach’s alpha
values used to assess the items’ were very low.

Table 3 
Factor loadings of each item in the three retained factors, including eigenvalues and % of explained variance,
after the EFA with factor extraction using the Principal Components Analysis followed by Varimax rotation 

Items: knowledge to provide first aid  1 2 3

Listen to his/her problems in an understanding way* -.52
Talk to him/her firmly about getting his/her act together .50
Suggest him/her to seek professional help .80
Make an appointment with the family doctor .81
Ask whether he/she is feeling suicidal .48
Suggest him/her to have a few drinks to forget his/her troubles .77
Rally friends to cheer him/her up .61
Not acknowledging his/her problem, ignoring it until he/she gets over it .74
Keep him/her busy to keep his/her mind off problems .70
Encourage him/her to become more physically active .57
Eigenvalues 1.70 1.53 1.50
% of Explained variance 16.99 15.35 14.95
Internal Consistency (Cronbach’s alpha) .45 .44 .59
KMO Measure=.63; Bartlett’s Test of Sphericity: c(2)(45)= 3856.69; p<.001; *Transformation of identity

In relation to the last component of mental pointed to a 2-factor solution that explained 55.63% of
health literacy – knowledge of how to prevent the variance. The KMO value was acceptable; however,
mental disorders –, the results obtained by the the Bartlett’s test of sphericity was statistically
EFA  (performed based on the Cramer’s V matrix) significant (p<.05).

Questionnaire for Assessment of Mental Health Literacy – QuALiSMental:

Revista de Enfermagem Referência - IV - n.° 4 - 2015 study of psychometric properties

84
The 1st factor explained  30.76% of the variance.
It is  composed of three items that are associated
with Positive strategies focused on social support
networks, Relaxation and Exercise. The 2nd factor
Table 4 
Factor loadings of each item in the two retained factors, including eigenvalues and % of explained variance,
after the EFA with factor extraction using the Principal Components Analysis followed by Varimax rotation
Items of knowledge about prevention
Keeping physically active
Avoiding situations that might be stressful
Keeping regular contact with friends
Keeping regular contact with family
Not using drugs
Never drinking alcohol
Making regular time for relaxing activities
Eigenvalues
% of Explained variance
Internal Consistency (Cronbach’s alpha)
In order to identify the factors  that emerged from
the various factor analyses performed to mental
health literacy components (measured using the
QuALiSMental) which are predictors of mental health
help-seeking intentions, a Binary Logistic Regression
was conducted based on the answers to the question If
you were in a similar situation as Joana, would you
seek help? Two response options were possible:  yes
(value 1) and no (value 0).
As shown in Table 5, the statistical significant factors
in the recognition of disorders component were
factor 4 (B=.15; OR=1.16), composed of the
expressions Anorexia and Bulimia, and factor 5
(B=-.12;  OR=.88), composed of the expressions
Stress,  Age  crisis and  He/she has a problem. As
regards the knowledge about the professionals and
treatments available and knowledge of self-help
LUÍS MANUEL DE JESUS LOUREIRO
85
explained 24.88% of the variance. It encompasses all
strategies perceived as negative, such as alcohol and
drug use. 
The reliability values obtained were acceptable.
 
1 2
.38
.47
.88
.86
.89
.91
.45
2.15 1.74
30.76 24.88
.60 .82
strategies components, the factors Professionals and
professional help  (B=.08;  OR=1.08) and  harmful
strategies (B=-.13; OR=.88) are included in the
model. Two factors are retained by the model: the factor
referral for professional help (B=.38;  OR=1.46,
p  <.001) of the knowledge and skills to provide
support component and the factor negative strategies
(B=.07; OR=1.08; p<.01) of the knowledge on
how to prevent mental disorders component. The
model had moderate Cox & Snell (R2=.85) and
Nagelkerke (R2=.12) values. The interpretation
of Odds Ratios allows concluding that the model
adjusted with these predictors is appropriate at the
criterion variable level, as the intention to seek help
is associated with more appropriate levels of mental
health literacy.
Revista de Enfermagem Referência - IV - n.° 4 - 2015
Table 5 
Logit coefficients of the logistic regression model of the help-seeking intention variable based on the factors
that emerged from the EFA (N=4938)

B S,E, Wald OR (95% CI)

Component 1
Factor 1 .03 .03 .73 1.03 (.97-1.09)
Factor 2 -.11 .14 .56 .90 (.68-1.42)
Factor 3 .15 .11 1.90 1.16 (.94-.132)
Factor 4 .15 .06 5.44* 1.16 (1.02-1.32)
Factor 5 -.12 .04 8.70*** .88 (.81-.96)

Components 2 and 3
Professionals and professional help .08 .01 31.54*** 1.08 (1.05-1.11)
Harmful strategies -.13 .03 17.57*** .88 (.82-.93)
Medication .03 .01 3.26 1.03 (1.00-1.06)
Self-help strategies .00 .02 .05 1.00 (.97-1.04)
Informal help .00 .02 .01 1.00 (.96-1.04)

Component 4
Negative strategies -.01 .03 .11 .99 (.94-1.05)
Non-professional help strategies -.02 .02 1.25 .98 (.94-1.02)
Referral to professional help .38 .03 119.83*** 1.46 (1.37-.157)

Component 5
Positive strategies .01 .02 .20 1.01 (.97-1.05)
Negative strategies .07 .03 7.13** 1.08 (1.02-1.13)
Constant -.75 .11 46.19*** .47
Cox & Snell R2=.85; Nagelkerke R2=,12; Hosmer-Lemeshow Test c2(8)=5.04;p=.754
*p<0,05; **p<0,01; ***p<0,001

Discussion true with all components, thus the analysis of the

As can be seen, some conclusions may be drawn from
the results obtained in these analyses.
The first conclusion relates to the purpose of the
factor analysis performed on the various expressions
of the recognition of mental disorders component.
In fact, if the aim is to assess the effective knowledge
of both adolescents and young people, that is, their
ability to properly recognise a mental disorder by
reading the expressions presented, then the factor
analysis may not be appropriate, since it provides
no information on such aspect. Therefore, it is
more appropriate to analyse the individual  answers
on the items (expressions)  marked and, eventually,
the combinations that allow concluding that the
individual is able to properly recognise the problem/
disorder (Loureiro, Jorm et al., 2013). In most cases,
the design of programmes should begin with the
analysis of the deficits in this area, thus the creation
of scores based on the loadings of each factor item
may not be appropriate; there is even the potential
to miss relevant information. This problem may be
QuALiSMental should focus on the objectives of the
study and, at the end, present the results.
However, the use of the Factor Analysis on
this component and the respective creation
of scores aimed at breaking down the items into
smaller sets of factors that allow us to observe how
adolescents and young people perceive depression
based on the expressions presented. Thus, we
concluded that there is a different prespective on the
problem raised by the vignette of depression.
The factor analysis revealed for the items of
the  knowledge about the professionals and
treatments available and knowledge of self-help
strategies components was also satisfactory, even if it
slightly differed from the results presented in other
studies (Jorm et al., 2005). 
The knowledge and skills to provide support and
first aid to others component was the one to show
the most unsatisfactory results, in terms of both the
complexity of the factor structure and the value of
the factor reliability, even if less items are included in
each factor. Still, as mentioned at the beginning of the

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86
discussion, the use of scores calculated on the basis of
the EFA results should be cautiously considered. If it is
regarded as a key component, for example, to assess
the impact of training sessions on mental health first
aid for adolescents and young people (Loureiro,
Sousa, & Gomes, 2014), then it is certainly preferable
to use the individual analysis of the items.  helpfulness of interventions for depression: Associations
Finally, the knowledge of how to prevent mental
disorders component (Jorm, 2012; 2014) showed that
adolescents and young people anticipate prevention
by both maintaining and promoting social support
networks and adopting healthy behaviours, such as
avoiding the use of alcohol and other drugs.
The results of the (binary) Logistic Regression
Analysis  suggest  that the higher levels of literacy in
its components tend to be associated with mental
health help-seeking intentions, which supports the
questionnaire findings.
Conclusion
In view of the foregoing,  it is concluded that  the
QuALiSMental is a valid (with construct validity) and
reliable (with satisfactory reliability values) instru­
ment, and may be used to assess mental health
literacy. The results found adjust to the theoretical
rationale underlying the questionnaire and the results
obtained by factor analysis.
Thus, its use in the research field and also in nursing
practice is justified, given the broad field of activity
of the professionals involved, namely in the field of
health education and promotion, for example, in
school settings or self-care management. 
It may, therefore, be used as a measure of mental
health literacy and be adapted to different disorders.
Given its nature and length, it may easily and quickly
be applied.
Future studies should include other measures
associated with mental health literacy, both related to
psychological assessment and other dimensions, such
as (personal and perceived) stigma and familiarity
with the disorders.
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