Mediating roles of perceived stigma and mental health literacy in the relationship between school climate and help-seeking behavior in Indonesian adolescents

Objective This study aimed to investigate whether perceived stigma and mental health literacy play mediating roles in the correlation between school climate and help-seeking behavior in Indonesian adolescents. Methods We used cross-sectional study design that recruited 760 Indonesian adolescents of age 16-19 years. We used convenience sampling from July to September 2019. Bivariate analysis was used to investigate the association of demographic characteristics with help-seeking behavior. Mediation analysis was employed to explore the mediating roles of mental health literacy and perceived stigma on the relationship between school climate and help-seeking behavior. Results Findings indicated that ethnicity, family income, and father's educational level were significantly associated (p < 0.05) with help-seeking behavior in Indonesian adolescents. Furthermore, perceived stigma and mental health literacy sequentially showed partial mediating roles in the relationship between school climate and help-seeking behavior (indirect effect: 0.004; 95% CI: 0.001, 0.010). Our mediating model indicated that a high level of school climate was associated with low perceived stigma (b = -0.11, p < 0.001) and high mental health literacy (b = 0.28, p < 0.001) and higher help-seeking behavior (b = 0.14, p < 0.001). Conclusion Our study discovered novel insight of help-seeking behavior mechanism among adolescent by serial mediation test. Supportive school climate is necessary to achieve adequate help-seeking behavior. In addition, taking into account of student's perceived stigma and mental health literacy in promoting help-seeking behavior is also important.