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Predictors of Mental Health Literacy Among Graduating University
Students
Azni Syafena Andin Salamat
1
, Anis-Farahwahida M.K.
2*
1,2
Faculty of Administrative Science and Policy Studies, Universiti Teknologi MARA Cawangan Kedah,
Kampus Sungai Petani, 08400 Merbok, Kedah, Malaysia
*Corresponding Author
DOI:
https://doi.org/10.47772/IJRISS.2025.91100328
Received: 29 November 2025; Accepted: 06 December 2025; Published: 10 December 2025
ABSTRACT
Mental Health Literacy (MHL) is increasingly recognised as a critical foundation for promoting psychological
well-being among young adults, yet its predictors remain insufficiently examined among graduating university
students in Malaysia. This conceptual paper synthesises current empirical evidence and theoretical perspectives
to position MHL as a multidimensional construct shaped by individual knowledge, attitudes toward help-seeking,
stigma, social support, and institutional accessibility to mental health resources. Existing literature indicates that
while students may recognise mental health problems, gaps persist in procedural literacy and confidence to
navigate available support systems, particularly within cultural contexts where stigma and confidentiality
concerns remain prevalent. Drawing on contemporary help-seeking and behavioural models, this paper argues
that MHL develops through the interaction of cognitive, emotional, and contextual determinants rather than
isolated informational factors. Despite growing research interest, major gaps remain, including limited focus on
final-year students, insufficient multivariable predictive analyses, and the absence of longitudinal evidence
tracking changes in MHL during the transition to the workforce. This paper proposes a refined conceptual
understanding of the predictors of MHL and highlights theoretical and practical implications for Malaysian
higher education institutions. Strengthening institutional support systems, integrating stigma-reduction
initiatives, and improving the clarity of service pathways are vital for enhancing help-seeking behaviour among
graduating students. The paper concludes with recommendations for future research to explore mediating and
moderating mechanisms, adopt mixed-method or longitudinal designs, and evaluate integrated mental health
interventions tailored to culturally specific needs.
Keywords: Mental Health Literacy (MHL), Predictors, Graduating Students, Stigma, Help-seeking behaviour.
INTRODUCTION
Mental Health Literacy (MHL) is broadly defined as the knowledge and beliefs that enable recognition,
management and prevention of mental disorders, as it is a foundational determinant of help-seeking, early
intervention and overall mental health outcomes. The construct was introduced to highlight gaps in public
recognition of mental disorders and has since been expanded to include positive mental-health knowledge,
stigma reduction, and the practical skills needed to obtain appropriate care. (Jorm et al., 1997; Sampaio et al.,
2022).
University students are a population of particular concern because the transition to higher education coincides
with the peak age of onset for many common mental disorders and with unique academic, social and
developmental stressors that increase vulnerability to psychological distress. Recent systematic reviews indicate
that MHL among tertiary students varies widely across settings and is influenced by sociodemographic,
psychosocial, cultural and experiential factors, with stigma and limited awareness repeatedly identified as central
barriers to recognition and help-seeking (Martínez Líbano et al., 2024; Sampaio et al., 2022). Improving MHL,
therefore, represents an important channel for reducing unmet need and for promoting timely access to mental-
health services among young adults.
Empirical research has identified several recurring predictors of MHL in student populations. Personal exposure
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XI November 2025
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to mental illness (either personal history or contact with someone who has experienced mental illness), attitudes
towards help-seeking, perceived social support, and stigma (both public and self-stigma) are consistently
associated with levels of MHL and with subsequent help-seeking intentions and behaviour (Martínez Líbano et
al., 2024; Yang et al., 2024). In addition, institutional and contextual resources, including availability of campus
mental-health programmes, mental-health education, and accessible online information, support shaping
students’ practical ability to recognise problems and to navigate services (Sampaio et al., 2022; Martínez Líbano
et al., 2024). Recent empirical models suggest that MHL encourages help-seeking indirectly, for example, by
reducing stigma and increasing perceived social support, pathways which relevant when designing interventions
targeted at university cohorts (Yang et al., 2024).
In Malaysia, concern about student mental health has grown in parallel with international trends. National
surveys and institutional studies report elevated rates of anxiety, depression and stress among youth and tertiary
students, and many Malaysian studies emphasise gaps between awareness and effective help-seeking despite
widespread exposure to mental-health information (Ghazali et al., 2024). Qualitative research conducted with
Malaysian university students and educators points to a complex picture: students often recognise mental-health
concepts but experience barriers to help-seeking that include stigma, family expectations, limited campus
resources and variable quality of mental-health education (Soo, 2024). These findings indicate the need for
contextually grounded research into which factors most strongly predict MHL among Malaysian students, and
how those predictors interact with cultural and institutional variables.
Overall, international evidence and emerging Malaysian literature indicate that MHL among graduating students
is shaped by multilevel determinants that consist of individual, interpersonal and institutional, which have direct
implications for help-seeking and wellbeing. The present study, therefore, seeks to identify and quantify
predictors of MHL among final-year university students in Malaysia, intending to inform targeted campus
interventions and policy measures that can strengthen early recognition and appropriate help-seeking as students
prepare to enter the workforce.
Although MHL (MHL) has gained international research attention, Malaysian studies remain limited, largely
descriptive, and insufficient in identifying multilevel predictors among university students (Ghazali et al., 2024;
Soo, 2024). Existing findings rarely integrate individual, social, and institutional factors into a comprehensive
predictive model, despite international evidence demonstrating the importance of these multidimensional
determinants (Martínez Líbano et al., 2024; Yang et al., 2024). Accordingly, there is a critical need for empirical
research that rigorously examines predictors of MHL among graduating Malaysian university students to inform
targeted interventions and policy responses.
LITERATURE REVIEW
Mental Health Literacy (MHL) among graduating university students: Predictors
Mental Health Literacy (MHL) is broadly defined as knowledge and beliefs about mental disorders that assist in
their recognition, management, and prevention; the construct also encompasses knowledge of where and how to
seek information or professional help and attitudes that promote early help-seeking (Jorm et al., 1997; Chua,
2022). In student populations, MHL is not a single attribute, but a composite outcome shaped by multiple,
interacting predictors. International systematic reviews and empirical studies identify several recurring predictor
domains: (a) individual-level characteristics (e.g., prior contact with mental illness, personal experience of
symptoms, mental-health knowledge and educational attainment), (b) psychosocial factors (e.g., stigma
including public and self-stigma as well as attitudes toward help-seeking, perceived social support), (c)
informational orenvironmental exposures (e.g., digital information seeking, media literacy, participation in MHL
programs), and (d) institutional or structural resources (e.g., availability and visibility of campus mental-health
services, curriculum integration of mental-health education) (Martínez Líbano et al., 2024; Suwanwong et al.,
2024; Yang et al., 2024). Studies that treat these variables jointly demonstrate that each group contributes
uniquely to MHL: for example, contact with people with mental illness and prior help-seeking experience are
robust correlates of better recognition and reduced stigma, while institutional investments (campaigns,
counselling availability) raise practical literacy that is the ability to navigate services and act on knowledge
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(Suwanwong et al., 2024; Yang et al., 2024).
In Malaysia, emerging evidence echoes this multidimensional profile but also emphasises contextual modifiers.
Several institution-based studies and reviews report relatively high levels of psychological distress among
university students, accompanied by mixed levels of MHL: students may be able to name common disorders in
abstract but lack procedural knowledge (how to access services) and face cultural and familial barriers to help-
seeking (Azizan et al., 2024; Nahas et al., 2024; Soo, 2024). Local reviews highlight school- and campus-based
interventions as promising but unevenly implemented, and Malaysian qualitative work points to the salience of
family expectations, religious and cultural understandings, and confidentiality concerns as predictors that operate
differently than in many Western settings (Muniandy, 2024; Soo, 2024). Taken together, the literature indicates
that predicting MHL among graduating students in Malaysia requires simultaneous attention to individual
exposure and knowledge, stigma and social norms, digital or informational practices, and institutional readiness
and to how these predictors are shaped by Malaysian cultural and educational contexts (Martínez Líbano et al.,
2024; Suwanwong et al., 2024; Azizan et al., 2024).
Theoretical and Conceptual Models Relevant to Mental Health Literacy Predictors
The literature uses several complementary theoretical frameworks to organise predictors of MHL and to explain
how they lead to help-seeking and service use. First, the original conceptualisation of MHL by Jorm et al. (1997)
provides a foundational taxonomy (recognition, knowledge of causes and risk factors, knowledge of self-help
interventions and professional help, and attitudes that promote recognition and help-seeking) that maps directly
on the predictor domains described above. Second, help-seeking theories notably Rickwood and Thomas’s
measurement framework and related models, which emphasise help-seeking as a multi-stage process (problem
recognition, deciding to seek help, selecting a source, and service use) in which knowledge, perceived need, and
social norms operate at different decision points (Rickwood & Thomas, 2012). These stages explain why MHL
improvements in recognition do not always translate to service use: stigma and perceived barriers often block
later stages even when early recognition is present.
Third, behavioural theories commonly used in MHL intervention research, such as the Health Belief Model
(HBM) and the Theory of Planned Behaviour (TPB) that specify cognitive and social determinants that predict
intentions and actions. The HBM highlights perceived susceptibility, severity, benefits, barriers, self-efficacy
and cues to action; applied to MHL, HBM helps explain why students who perceive higher susceptibility or
greater benefits of treatment are more receptive to mental-health information and help-seeking (Alyafei et al.,
2024). The TPB foregrounds attitudes, subjective norms and perceived behavioural control as predictors of help-
seeking intentions and mechanisms that mediate the effect of knowledge and stigma on actual behaviour
(Tomczyk et al., 2020). Empirical work using these models shows consistent mediation pathways where MHL
affects help-seeking intentions by changing attitudes and perceived norms, while stigma and social support
moderate these relationships (Yang et al., 2024; Tomczyk et al., 2020). Finally, socio-ecological and multilevel
frameworks integrate individual and contextual layers (family, peers, campus, policy environment) and are
increasingly recommended for understanding MHL among students because they accommodate institutional
predictors (services, curricula) alongside personal and social variables (Zhao et al., 2022; Suwanwong et al.,
2024). These theoretical lenses together make clear that predictors operate through both cognitive (knowledge,
beliefs) and social or structural (norms, availability) pathways; robust empirical models therefore measure
multiple domains and test mediation and moderation effects rather than relying on bivariate associations alone.
Research Gaps and Synergy Among Predictors
Although international research has advanced knowledge about individual predictors of MHL, three important
gaps remain, especially for Malaysia. First, most Malaysian studies are descriptive, qualitative, or limited to
single-institution samples; few have applied multivariable modelling to estimate the relative and interacting
contributions of individual, social and institutional predictors among graduating students (Muniandy, 2024;
Nahas et al., 2024). Second, the mediation and moderation pathways that link MHL to help-seeking (for example,
MHL → reduced self-stigma → stronger help-seeking intentions) have been demonstrated in several non-
Malaysian samples but are under-tested in Malaysian higher education contexts where family, religion, and
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
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confidentiality concerns may produce different patterns (Yang et al., 2024; Soo, 2024). Third, there is insufficient
evaluation of modifiable predictors (digital literacy, campus programmes, peer-led interventions) using rigorous
designs; recent reviews call for studies that target and measure changeable factors in the education setting
(Suwanwong et al., 2024).
A synthetic reading of the literature suggests a clear synergy among predictors, where individual knowledge and
prior exposure increase the probability of problem recognition, but social factors (stigma, subjective norms,
perceived social support) determine whether recognition becomes intention; institutional factors (service
availability, visibility, and perceived confidentiality) transform intention into action (Rickwood & Thomas,
2012; Tomczyk et al., 2020; Yang et al., 2024). In Malaysia, cultural modifiers (family expectations, faith-based
interpretations) shape norms and perceived barriers, so interventions that address only knowledge without social
or institutional change are unlikely to produce substantial improvements in service use (Azizan et al., 2024; Soo,
2024). Consequently, research that deploys multilevel measurement and tests mediation or moderation ideally
with representative samples of final-year students and with attention to culturally salient constructs is required
to produce actionable evidence. Such work will identify which predictors are most amenable to campus policy
(e.g., confidentiality safeguards, peer programmes, curriculum integration) and which require broader social
change (e.g., stigma reduction campaigns targeted at families and communities).
In conclusion, the literature converges on the view that MHL among graduating university students is a
multidimensional outcome produced by interacting individual, social and institutional predictors. For Malaysia,
the critical next step is rigorous, multivariable, and culturally informed research that quantifies these interactions
and tests changeable levers. From here, the evidence will allow higher-education institutions to design integrated
interventions that move students from recognition to timely, appropriate help-seeking.
Table 2.0 Recent Studies Related to Mental Health Literacy among Malaysian University Students
Author(s)
Year
Title
Method
Key Findings / Predictors
Hamzah, S.
R. et al.
2022
MHL among
Malaysian Youth:
Exploring
Multidisciplinary
Perspectives
Qualitative
(interview with
7 Malaysian
mental-health
experts)
Experts identified key MHL dimensions:
ability to recognise disorders, knowledge of
how to seek information and help, self-
treatment vs professional help, attitudes,
stigma, and appropriate help-seeking
behaviour. (Hamzah et al., 2022)
Hamzah, S.
R., Musa, S.
N.,
Amiludin,
N. A., et al.
2023
Identifying
Predictors of
University
Students’ Mental
Well-Being During
the COVID-19
Pandemic
Cross-sectional
survey (199
Malaysian
university
students)
Found that physical health and social
support were strong positive predictors of
mental well-being, but MHL (MHL) had a
weak (non-significant) association with
well-being in multivariate regression.
(Hamzah et al., 2023)
Soo, Y. Y.
2024
Perceptions and
Beliefs Towards
Mental Health
Among University
Students and
Educators in
Malaysia
Qualitative
(semi-
structured
interviews)
Students and educators reported varied
understandings of “mental health” — many
students equated mental health with mental
illness; socio-environmental causes; stigma
was present; willingness to help was high,
but knowledge about accessing help was
limited. (Soo, 2024)
Mesran, N.
N.
2023
Predictors
Associated with
Mental Help-
Seeking Attitude
Among Malaysian
Cross-sectional
survey (345
foundation
students)
Found that self-stigma negatively predicted
help-seeking attitude (β = –0.59), while
MHL positively predicted it (β = 0.22); also,
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College Foundation
Students During
COVID-19
affordability of services predicted help-
seeking attitude. (Mesran, 2023)
Musa, A.,
Muazu, R.
M., Fen, B.
W., &
Cheah, K. S.
L.
2025
Predicting
Determinants of
Mental Health
Status in Malaysian
Undergraduate
Students Using
Association Rule
Mining
Quantitative;
association rule
mining on
survey data of
1,394
undergraduates
The analysis identified complex
associations: e.g., female students were
more likely to face learning problems and
uncertainty about their mental health status;
financial problems were not as strongly
predictive of mental health issues as
commonly assumed. (Musa et al., 2025)
While there is a dearth of direct studies on predictors of MHL specifically among graduating (final year)
university students in Malaysia, the above table shows adjacent and relevant research that illuminates parts of
the landscape. For instance, Hamzah et al. (2022) used expert interviews to frame what MHL means in the
Malaysian youth context which highlights recognition, help‑seeking, stigma, and self-treatment as core
components. Building on that, Hamzah et al. (2023) empirically tested how MHL, along with physical health
and social support, relates to mental well‑being in university students, but found that MHL was not a strong
predictor of well‑being once other factors were controlled. Meanwhile, Soo (2024) explored student and educator
perceptions qualitatively, revealing that although students are willing to help, their knowledge about where and
how to seek help is limited, suggesting a gap in practical literacy. Mesran’s (2023) study of foundation-level
students identified self-stigma and MHL itself as key predictors of help-seeking attitudes, showing how literacy
interacts with behavioural and attitudinal barriers. Finally, Musa et al. (2025) employed a data-mining approach
to show that common stressors like learning challenges and gender interact with mental health status;
intriguingly, financial issues were less predictive than expected, suggesting that structural stressors and identity
factors may be more important in Malaysian undergraduates’ mental health than purely economic ones.
To sum up, these studies suggest an emerging but fragmented research base where MHL is clearly relevant to
help-seeking and well-being, but its predictive power may be mediated or moderated by social support, stigma,
demographic factors, and students lived contexts. Importantly, none of these studies focus exclusively on
graduating (final year) students, which is a critical gap given that this group faces unique transitional stressors
(e.g., job seeking, graduation anxiety). This supports the need for targeted research that specifically examines
final-year university students in Malaysia, measuring predictors such as MHL, stigma, social support,
affordability, and demographic variables in a multivariate model.
DISCUSSION
The recent body of Malaysian literature, though limited, provides valuable insight into the predictors and
complexities surrounding MHL in student populations. Hamzah et al. (2022) qualitatively identified the
multifaceted dimensions of MHL that include recognition of mental disorders, pathways to professional help,
self-treatment, and stigma as perceived by mental health professionals. This foundational work underscores that
MHL in the Malaysian context is not merely about naming disorders, but also about navigating help‑seeking
behaviours and socio‑cultural beliefs.
When examined empirically, however, the strength of the relationship between MHL and mental well‑being
appears mixed. Hamzah et al. (2023) reported that, among university students during the COVID-19 pandemic,
social support and physical health were significantly associated with well‑being, but MHL itself did not emerge
as a strong predictor once other factors were controlled. This suggests that even though students may possess
some mental health knowledge, the translation of that knowledge into well‑being is contingent on supportive
environments and overall health status.
Soo’s (2024) qualitative exploration among Malaysian university students and educators further illuminates this
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
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translation gap; while students show a willingness to help peers and recognise mental health issues, they lack
procedural knowledge about where and how to access support. This procedural or “service literacy” dimension
is crucial; without it, knowledge alone may not lead to action. Soo’s findings also highlight deeply embedded
cultural and institutional challenges, such as stigma and concerns about confidentiality, which likely moderate
the effect of MHL on help-seeking.
Mesran (2023) extends these ideas through quantitative analysis: among foundation-level students, higher MHL
positively predicted help-seeking attitude, while self-stigma had a strong negative effect. This finding resonates
with broader theories of help-seeking (e.g., Rickwood & Thomas, 2012), which emphasise that attitudes and
perceived stigma are central mediators between cognition (knowledge) and behaviour. Hence, even in groups
with rising literacy, stigma remains a critical barrier that undermines willingness to reach out for help.
Finally, Musa et al. (2025) used association rule mining to uncover how demographic and structural stressors
combine to affect mental health status. Their findings that gender, learning difficulties, and uncertainty about
mental health status are more predictive of distress than purely financial problems suggest that predictors of
mental health issues are complex and context-dependent. While this study does not measure MHL directly, its
results point to the importance of considering demographic and academic stressors as part of a broader ecosystem
influencing both mental health and potentially how literacy develops or is utilised.
Overall, these studies support a multilevel, synergistic model of MHL predictors in Malaysian student
populations. Knowledge alone is insufficient: social support, stigma, procedural literacy (knowing how to access
services), and demographic stressors all interact to determine whether literacy leads to positive outcomes like
help-seeking or well‑being. For graduating students in particular who face academic, financial, and life-transition
stressors, this synergy may be especially salient. If final-year students are to benefit from MHL interventions,
interventions must not only deliver knowledge but also address stigma, enhance service accessibility, and
leverage peer and institutional support.
Implications for practice include the urgent need for universities in Malaysia to develop integrated mental health
programs that combine awareness sessions (to build knowledge), stigma-reduction campaigns, peer-led help
networks, and clear guidance on navigating campus services. Moreover, policymakers should emphasise
confidentiality and culturally sensitive outreach, as both stigma and procedural barriers are culturally salient
among Malaysian students (Soo, 2024).
In summary, although Malaysian research on MHL among students is emerging, it reveals a complex interplay
of knowledge, attitudes, stigma, and structural factors. To meaningfully improve MHL among graduating
university students, future work must move beyond descriptive studies to sophisticated, culturally informed
models and interventions that address synergies among predictors.
Future Directions and Research Gaps
Although emerging studies provide insights into MHL among Malaysian students, significant gaps remain,
particularly regarding graduating university students who face unique transitional stressors. Existing research is
often limited to descriptive or single-institution studies, with few employing multivariable or longitudinal
designs to establish causal pathways between predictors such as stigma, social support, demographic stressors,
and MHL outcomes (Hamzah et al., 2023; Mesran, 2023; Soo, 2024). There is also limited empirical evidence
on the mediation and moderation mechanisms that link MHL to help-seeking behaviours in culturally specific
contexts, including family expectations and confidentiality concerns.
Future research should prioritise representative, multi-institutional samples of final-year students and test
theoretically informed models that integrate individual, social, and institutional predictors. Intervention studies
are needed to evaluate the effectiveness of integrated programs combining knowledge, stigma reduction, and
procedural guidance in improving both MHL and help-seeking behaviours. Addressing these gaps will provide
actionable evidence to inform university policies, culturally sensitive interventions, and strategies that support
mental well-being during the critical transition from university to the workforce.
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CONCLUSION
This study highlights that MHL among graduating university students in Malaysia is shaped by a
multidimensional set of predictors encompassing individual knowledge, attitudes toward help-seeking, perceived
stigma, social support, and procedural awareness of mental health services. The synthesis of empirical findings
indicates that while students may possess basic knowledge of mental health issues, translating this knowledge
into action is often hindered by stigma, limited awareness of service pathways, and contextual stressors
associated with university-to-work transitions. From a theoretical standpoint, the findings reinforce help-seeking
and behavioural models that emphasise the interplay between cognitive, social, and environmental determinants,
demonstrating that MHL cannot be fully understood without considering mediating and moderating factors such
as social support, self-stigma, and cultural influences.
Practically, the study underscores the need for universities to implement holistic MHL interventions that
integrate knowledge-building, stigma-reduction components, and clear guidance on navigating mental health
resources. Enhanced peer-support structures, improved accessibility of campus services, and culturally sensitive
outreach may significantly strengthen help-seeking behaviours among graduating students. Despite these
insights, the study is constrained by limitations such as reliance on cross-sectional designs, unequal
representation across institutions, and limited examination of intervention effectiveness.
Future research should adopt longitudinal or mixed methods approaches to capture changes in MHL over time
and explore causal mechanisms more robustly. There is also a critical need for studies that specifically target
final-year students across diverse Malaysian universities and test integrative models that combine individual,
social, and institutional predictors. By addressing these gaps, future work can contribute to more effective mental
health policies and interventions that support the psychological well-being of young adults transitioning into the
workforce and broader society.
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