INTRODUCTION

Abrupt global changes have heightened vulnerability, anxiety, and stress, leading to emotional instability, unhealthy behaviors, and depression [1]. Tran et al. [2] observed a 14.6% prevalence of depression among 27 216 individuals during the pandemic, with health workers experiencing higher rates. Similarly, Pham et al. [3] reported a 15.2% incidence of depression among medical students, attributing it to factors such as financial burdens and inactivity, with 7.7% of them having suicidal thoughts. Depression rates were even higher among Thai university students, at 23.3%, as noted by Angkapanichkit and Rochanahastin [4] noted, driven by the challenges young adults face in adapting to changes. Helping behavior, which includes both emotional and substantial support, can significantly reduce depression and serve as a valuable preventive strategy. The term “helping behavior” refers to actions aimed at assisting another person or alleviating their problems, such as depression [5]. The propensity of adolescents to engage in help-giving may be influenced by their mental health literacy (MHL), which impacts their ability to recognize when a peer needs support [6].

This research explores the impact of MHL on the helping behaviors of health science students, with a focus on 2 primary dimensions: (1) causal/substantial helping, which involves providing tangible assistance, and (2) emotional/mental helping, which involves offering emotional support [7]. The helping behavior is guided by cognitive processes triggered by the helper’s emotional desire to improve another individual’s mood or alleviate their pain. Assistance can be direct, often taking the form of advice, or indirect, such as seeking expert help on behalf of the individual. Conversely, people may refrain from providing help due to fears of potential negative consequences [8]. To assess the factors influencing helping behavior, it is crucial to first understand the role of MHL. However, the impact of MHL on helping behaviors among health science students in Vietnam and Thailand has not been extensively studied.

MHL comprises the knowledge and beliefs an individual may possess about mental disorders, which can guide them in recognizing, managing, or preventing these conditions. Jorm et al. [9] describe MHL as the knowledge and beliefs concerning mental disorders that aid in their recognition and prevention, suggesting that the ability to recognize mental disorders is indicative of MHL. Another definition posits that MHL is “the knowledge, attitudes, and habits developed by individuals to promote their own mental health and that of others, and to cope with mental illnesses in themselves and others” [10]. In the realm of athletics, Duffy et al. [11] found that MHL directly influences coaches’ perceptions and their provision of mental health support behaviors, including prevention and early intervention for athletes experiencing mental health issues. Based on this empirical and theoretical foundation, we can hypothesize that MHL impacts helping behavior.

This research is grounded in Andersen and Newman [12]’s Health Care Utilization Model, which identifies 3 primary categories of factors that explain how helping behavior impacts individuals at risk of depression. The study organizes the factors influencing helping behavior into 3 groups: (1) Predisposing factors, which include socio-cultural and demographic elements such as attitudes, age, and education. Positive attitudes toward mental health support are crucial for fostering helping behavior. (2) Enabling factors, encompassing resources and logistical support. Having access to social support and health services facilitates assistance, enhancing understanding and proactive support. (3) Need factors, which cover immediate health concerns and the ability to recognize mental health issues in oneself and others. Awareness of others’ needs for help increases the likelihood of providing support. Analyzing these 3 categories allows for a structured examination of helping behavior, potentially leading to targeted interventions that improve MHL, attitudes, and support. This, in turn, fosters a more supportive environment for individuals vulnerable to depression.

The model suggests that MHL supports the link between helping behavior and population characteristics. When social support is available, it can help individuals learn how to seek information and access high-quality mental health support online through platforms designed to increase awareness and promote existing mental health services [13]. According to Liu et al. [14] and Jung et al. [15], social support enhances MHL by influencing self-efficacy and fostering positive attitudes toward seeking help. Lo et al. [16] have also confirmed the direct effects of social support on MHL. Based on this evidence, a second hypothesis is proposed: Social support directly influences MHL and also has an indirect effect through self-efficacy and attitudes toward help-seeking behavior.

Positive attitudes toward mental helping behavior are strong predictors of MHL, as evidenced by multiple studies [17,18]. These attitudes can forecast future MHL levels and the effectiveness of help-seeking behaviors [19]. Based on these findings and theories, we propose our third hypothesis: Attitude toward mental help influences MHL directly and also has an indirect effect on MHL through self-efficacy.

Furthermore, self-efficacy in mental health is also a key determinant of MHL, with higher self-efficacy associated with improved MHL, especially in seeking help [20]. Furthermore, the study by Beasley et al. [21] explored the attitudes, self-efficacy, and MHL of primary care physicians in practice. Based on these findings, we propose our fourth hypothesis: Mental health self-efficacy influences MHL.

The study developed a health promotion model tailored for Thai and Vietnamese populations, where depression rates exceed the global average. Standardized tools were used to assess helping behavior and MHL, with MHL serving as a mediator in comparing health science students from both countries. The model’s goal is to improve MHL, thereby translating increased awareness into improved helping behavior. The results indicate no significant differences in the causal models between Thai and Vietnamese students, likely attributable to shared cultural, educational, and social factors. Both countries have comparable health science curricula, which may account for the consistent levels of MHL and helping behaviors observed. In both nations, cultural values emphasize family bonds and collectivism, leading families to address mental health issues within the family context to avoid public stigma. Nonetheless, public health initiatives are in progress to increase awareness and encourage help-seeking behaviors.

METHODS

Study Population

A cross-sectional study was conducted with health science students in years 3-6 at universities in Bangkok, Thailand, and Ho Chi Minh City, Vietnam. The sample size was calculated based on the structural equation model and the observed variable-per-subject ratio of 1:20 suggested by Hair et al. [22]. With 12 observed variables, the required sample size ranged from 100 to 200; therefore, the researchers decided on 200 participants per university and distributed the questionnaires accordingly. The participants were undergraduate health professional students who had received some psychiatric training, ensuring a consistent level of MHL regarding depression. Students who either did not fully complete their questionnaires or had severe health issues were excluded from the study. The final sample consisted of 422 students, with 211 from each university. The majority of the participants were female, 22 years old, psychology majors, in their third year, living with family, and generally reported good mental health.

The study utilized a stratified random sampling approach. Initially, the sample was divided according to the field of study, and proportional allocation was carried out within each stratum. Subsequently, a simple random sampling method was used to select participants from each field. The Registrar’s Office of Health Science Universities supplied the sampling units.

Instrument

Following the guidelines established by Geisinger [23], the scales were first adapted and translated into Vietnamese. This process began with an initial translation from Thai to Vietnamese, followed by a back-translation to Thai performed by the same bilingual translator. The back-translated version was then compared with the original to assess its accuracy. Subsequently, the quality of the Vietnamese translation was evaluated by a panel of bilingual experts to ensure both accuracy and cultural appropriateness. Based on their feedback, further revisions were made to the translation. Data collection commenced in 2023 at both universities. In the final step, a multiple group invariance analysis was conducted to ensure consistency across the 2 languages, enabling both Thai and Vietnamese participants to understand the scale structures equivalently.

Helping Behavior

The scale developed by Chuenphitthayavut et al. [7] comprises 17 items, categorized into 2 components: casual/substantial helping and emotional/mental helping. It utilizes a 5-point Likert scale where higher scores signify more pronounced helping behavior. The scale demonstrated a content validity index ranging from 0.67 to 1.00, a total-item correlation between 0.24 and 0.62, and a reliability score of 0.86.

Mental Health Literacy

The 15-item Mental Health Literacy Scale (MHLS), which is based on the concepts outlined by Jorm et al. [9] and O’Connor and Casey [24], includes 5 components: information-seeking, knowledge of risk factors/causes, self-help strategies, profes-sional help, and attitudes toward help-seeking. It utilizes a 5-point Likert scale where higher scores reflect better MHL. The MHLS had a content validity index (CVI) ranging from 0.67 to 1.00, a total-item correlation between 0.25 and 0.83, and a reliability score of 0.84.

Attitudes Toward Mental Helping Behavior

This 9-item scale, adapted from Abolfotouh et al. [25], assesses attitudes toward mental helping behavior using a 5-point Likert scale. Higher scores reflect more positive attitudes. The scale demonstrated a CVI ranging from 0.67 to 1.00, a total-item correlation between 0.27 and 0.62, and a reliability coefficient of 0.74.

Mental Health Self-efficacy

The 8-item scale, developed by Frank et al. [26], evaluates mental health self-efficacy, with higher scores reflecting greater self-efficacy. This scale had a CVI ranging from 0.67 to 1.00, a total-item correlation between 0.412 and 0.759, and a reliability score of 0.85.

Social Support

This 10-item scale, developed by Grey et al. [27], assesses informational, emotional, and tangible support using a 5-point Likert scale. Higher scores reflect greater social support. The scale demonstrated a CVI ranging from 0.67 to 1.00, a total-item correlation between 0.412 and 0.759, and a reliability score of 0.85.

Data Collection Procedure

To conduct the survey, researchers sought faculty participation and permission to gather data, which was followed by onsite meetings to present the project and secure anonymous consent. Data collection was carried out using questionnaires, and the responses were recorded in Microsoft Excel (Microsoft, Redmond, WA, USA). Typically, completing the questionnaire took about 30 minutes.

Statistical Analysis

The dataset underwent pre-analysis checks for missing data, outliers, and normality, with no issues identified. Descriptive demographic data were calculated, and multi-group structural equation modeling was employed to assess and compare the causal relationship model using the LISREL program. Additionally, the statistical metrics included absolute fit indices such as the chi-square (χ²) goodness-of-fit index (GFI) with a threshold of ≥0.90, root mean squared error of approximation (RMSEA) with a criterion of ≤0.05, standardized root mean residual (SRMR) with a threshold of ≤0.05, non-normed fit index (NNFI), and incremental fit index (IFI), both with a limit of ≥0.90. The adjusted goodness-of-ft index (AGFI) was also considered with a threshold of ≥0.90, and the chi-square divided by degrees of freedom (χ²/df) was evaluated with a limit of ≥5 as a parsimony fit index [28].

Ethics Statement

The study was approved by the Ethics Committee of Srinakharinwirot University (SWUEC/E 055/2566 E). Participants were informed about the objectives of the study, provided informed consent, and were assured of confidentiality.

RESULTS

The Causal Relationship of Mental Health Literacy and Helping Behavior Among Thai and Vietnamese Health Science Students (Combined Group)

The results of hypothesis testing with empirical data indicated that the influence and statistical significance of the test were not significant. The researchers adjusted the model by incorporating tolerances to assess the relationships among the variables. The testing of this adjusted model revealed a consistent causal relationship among social support, mental health self-efficacy, and attitudes toward mental health helping behavior, which influenced helping behavior through the mediation of MHL in the overall group. The model fit indices were as follows: χ²=86.10, df=35, p<0.01, χ²/df=2.46, RMSEA=0.05, SRMR=0.04, GFI=0.97, NNFI=0.98, comparative fit index=0.99, and AGFI=0.93. The factors that influenced helping behavior included MHL, self-efficacy, positive attitudes toward helping behavior, and social support, with effect sizes (ESs) of 0.91, 0.18, 0.29, and 0.77, respectively. Collectively, these factors explained 83.0% of the variance in helping behavior toward individuals at risk of depression. In contrast, the factors of self-efficacy, positive attitudes toward helping, and social support accounted for 82.0% of the variance in MHL (Figure 1 and Table 1).

Multiple Group Invariance Analysis of the Causal Relationship Model Between Mental Health Literacy and Helping Behavior Among Thai and Vietnamese Students

The results demonstrated that the causal model between variables for both groups (Thai and Vietnamese students) was identical, without the need to impose any equality constraints on the influence between the groups. The model fit indices confirmed that the structural relationship aligned with the empirical data (χ²=165.62, df=89, p<0.01, χ²/df=1.86, RMSEA=0.064, GFI =0.94). Additionally, the chi-square difference between this model and the reference mode was not statistically significant (Δχ²=2.94, Δdf=6, p=0.816), suggesting that the factor loadings were consistent across groups. This indicates that the structural relationships between variables are uniform across both groups, although the magnitude of these relationships may vary. Differences in ES and factor loading for certain paths in the causal model are shown in Figure 2.

In a comparison of the factor loadings for the causal relationship model and the effect of MHL on helping behavior, the ES was found to be 0.66, indicating no significant differences between Thai and Vietnamese students. However, variations were noted in the ESs of certain causal variables. Specifically, the ES of social support on MHL was 0.27 in the Thai group compared to 0.46 in the Vietnamese group. Additionally, the ESs of social support on positive attitudes toward helping behavior were 0.32 for the Thai group and 0.57 for the Vietnamese group, suggesting that social support has a more substantial impact on the Vietnamese participants. Moreover, while there was no observable effect of positive attitudes toward helping behavior on MHL in the Vietnamese group, the ES was 0.17 for the Thai group.

DISCUSSION

No significant differences were observed between Thai and Vietnamese health science students regarding models for helping behavior and MHL. Both countries contend with challenges related to mental health stigma, where seeking help is frequently avoided to preserve social standing. The emphasis on collectivism and strong family ties encourages families to manage problems privately, out of concern that seeking external support could result in disgrace. The similarity in health science curricula across both nations further contributes to a uniform understanding of mental health issues. Nonetheless, both countries are actively working to enhance awareness and encourage help-seeking behaviors through various public health initiatives.

Among Thai and Vietnamese health science students, MHL improves their understanding of mental health issues, encouraging them to assist individuals at risk of depression. Research conducted by Kusaka et al. [29] and Yamaguchi et al. [30] supports the effectiveness of MHL programs in improving helping behaviors. Similarly, Chuenphitthayavut et al. [7] demonstrated a 67% prediction rate for helping behaviors in their findings.

The relationships among the variables in the models were similar for both countries. These factors were selected because they play a central role in illustrating how individuals perceive mental health issues and respond to them. Additionally, these factors demonstrate comparable effects across both cultures [31-33].

In both countries, MHL is influenced by social support, as both cultures emphasize strong family and community values that provide informational assistance to support the understanding and management of mental health. The cultural similarities contribute to similar effects of social support on helping behavior. Previous studies have shown that Thai and Vietnamese individuals may shun formal mental health care due to stigma, opting instead for family support. This reliance places a significant burden on families, who take on the role of caregivers for mentally ill members, often overlooking available community services [33].

Mental health self-efficacy refers to the confidence individuals have in addressing mental health concerns, and it plays a crucial role in influencing MHL. This concept affects various cultures in similar ways; notably, in Thailand and Vietnam, it significantly promotes proactive helping behaviors. Research conducted by Berens et al. [34] and Liu et al. [14] has demonstrated that self-efficacy not only directly impacts MHL but also mediates the relationship between social support and health literacy. Furthermore, Yulianti et al. [35] identified a strong correlation between self-efficacy and MHL.

However, this study revealed that attitudes toward mental helping behavior did not impact MHL among Vietnamese students, unlike their Thai counterparts. This disparity may stem from cultural differences, despite both countries’ efforts to combat mental health stigma. Attitudes are often influenced by societal and educational factors. In Thailand, increased awareness of mental health issues and a strong cultural emphasis on seeking help have led to positive attitudes toward helping behaviors, thereby improving MHL. Thai society’s openness to discussing mental health further reinforces this trend [36,37]. Conversely, in Vietnam, traditional norms and cultural pressures to maintain a positive family image discourage open discussions about mental health, which perpetuates stigma and limits engagement with services. This situation weakens the connection between attitudes and MHL, with students less inclined to prioritize helping behaviors. Additionally, limited education and a lack of mental health infrastructure, especially in rural areas, exacerbate the problem. Although social media and younger generations in Vietnam are starting to initiate conversations, these discussions are less frequent than in Thailand and often concentrate on severe mental illnesses, perpetuating fear and misunderstanding [38,39].

This research provides both theoretical and practical insights, improving our understanding of the factors that influence helping behavior and contributing to the development of MHL theories. It underscores the importance of integrating multiple theories and confirms that social support has a positive effect on MHL related to helping behavior among healthcare students. Practically, the study highlights the need for educational programs that improve MHL and support skills. It recommends that universities concentrate on training students in effective mental health support, with a focus on social support, education, self-efficacy, and helping behavior.

The present study has 2 limitations. First, the cross-sectional design restricts the analysis to data collected at a single point in time, which necessitates cautious interpretation of the findings. Future research should explore longitudinal studies. Second, the sample size was relatively small for the structural equation model; therefore, larger samples are recommended for future studies.

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

This research was funded by the Faculty of Humanities, SWU Thailand under grant no. 172/2556 and University of Social Sciences and Humanities, Vietnam National University Ho Chi Minh City under grant No. NCM2023-01.

Acknowledgements

We extend our sincere appreciation to all individuals who contributed to this research, as well as the Thai and Vietnamese students in health science for their participation in the study.

Author Contributions

Conceptualization: Jansem A, Intarakamhang U, Suwanwong C, Chuenphitthayavut K, Tuntivivat S, Prasittichok P. Formal analysis: Intarakamhang U, Prasittichok P. Funding acquisition: Jansem A. Methodology: Intarakamhang U, Prasittichok P. Project administration: Jansem A, Intarakamhang U, Le K, Lien LTM. Writing – original draft: Intarakamhang U, Le K, Lien LTM, Prasittichok P. Writing – review & editing: Jansem A, Intarakamhang U, Suwanwong C, Chuenphitthayavut K, Tuntivivat S, Le K, Lien LTM, Prasittichok P.

Figure. 1.

Causal relationship model pattern of mental health literacy affecting the helping behavior of Thai-Vietnamese students in health science. χ²=86.10, df=35, p<0.01, χ²/df=2.46, RMSEA=0.05, GFI=0.97. df, degrees of freedom; RMSEA, root mean squared error of approximation; GFI, goodness-of-ft index. *p<0.05.

Figure. 2.

Standardized coefficient estimation results, comparing the causal relationship model of mental health literacy on helping behavior between Thai and Vietnamese students in health science. χ²=165.62, df=89, p<0.01, χ²/df=1.86, RMSEA=0.064, GFI=0.94. df, degrees of freedom; RMSEA, root mean squared error of approximation; GFI, goodness-of-ft index. *p<0.05.

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Figure & Data

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