{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T18:11:58Z","timestamp":1775067118667,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CESPU, CRL and iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU","award":["GI2-CESPU 2023"],"award-info":[{"award-number":["GI2-CESPU 2023"]}]},{"award":["GI2-CESPU 2023"],"award-info":[{"award-number":["GI2-CESPU 2023"]}],"id":[{"id":"https:\/\/ror.org\/00w7bj245","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background: It is well known that the university period is an important stage for young adults, involving significant academic and psychosocial adjustments. Students with greater Mental Health Literacy (MHL), which is defined as the knowledge, beliefs, and skills individuals have regarding mental health and mental illness, are better able to identify difficulties, seek help, and adopt healthier coping strategies. This study aims to describe the MHL levels of undergraduate health students and identify associated factors related to academic life, mental health and psychological state. Methods: A cross-sectional, self-administered, web-based survey was conducted using a non-probability sampling strategy among undergraduate students in health-related degrees at a Portuguese higher-education institution. Data was collected using a general characterization questionnaire and the following instruments: MHL Questionnaire, Academic Life Satisfaction, Subjective Happiness Scale, Psychological Well-Being Scale (PWBS), and Depression Anxiety Stress Scale. Bivariate and linear regression analyses were employed to identify factors associated with MHL. Results: A total of 306 students (79% female, mean age = 21.6 years; 59% nursing students) participated. The median MHL score was 70 (range: 30\u201380). The linear regression model explained 17.5% of the variance in MHL. Higher MHL levels were associated with having the course as a first choice, holding a previous degree, reporting taking psychotropic medication use (which may reflect previous mental health service utilization), and higher levels of psychological well-being. Conclusions: This study provides evidence on factors associated with MHL among undergraduate health students, suggesting that higher MHL is associated with greater psychological well-being, highlighting the potential importance of integrating strategies to promote MHL and psychological well-being in health and nursing education. However, these findings should be interpreted with caution due to the single-institution convenience sample, potential self-selection and reporting biases, and cross-sectional design, which limits causal inferences.<\/jats:p>","DOI":"10.3390\/nursrep16040109","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:45:53Z","timestamp":1774615553000},"page":"109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Mental Health Literacy Among Undergraduate Health Students in Portuguese Higher Education: The Role of Psychological Well-Being"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-9311","authenticated-orcid":false,"given":"Ana Isabel","family":"Teixeira","sequence":"first","affiliation":[{"name":"Nursing School of Vale do Ave, IPSN-CESPU, 4760-409 Vila Nova de Famalic\u00e3o, Portugal"},{"name":"RISE-Health, Nursing School of the University of Porto (ESEP), 4200-072 Porto, Portugal"},{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"UCIBIO\u2014Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-8913","authenticated-orcid":false,"given":"S\u00f3nia","family":"Martins","sequence":"additional","affiliation":[{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"RISE\u2014Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"ISSSP\u2014Higher Institute of Social Services of Porto, 4460-362 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3421-4854","authenticated-orcid":false,"given":"Sara","family":"Lima","sequence":"additional","affiliation":[{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"UCIBIO\u2014Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal"},{"name":"Nursing School of T\u00e2mega e Sousa, IPSN-CESPU, 4560-485 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-7545","authenticated-orcid":false,"given":"Francisca","family":"Pinto","sequence":"additional","affiliation":[{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"Nursing School of T\u00e2mega e Sousa, IPSN-CESPU, 4560-485 Penafiel, Portugal"}]},{"given":"T\u00e2nia","family":"Morgado","sequence":"additional","affiliation":[{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3045-043 Coimbra, Portugal"},{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2900-3972","authenticated-orcid":false,"given":"Olga","family":"Valentim","sequence":"additional","affiliation":[{"name":"RISE-Health, Nursing School of the University of Porto (ESEP), 4200-072 Porto, Portugal"},{"name":"Nursing School, University of Lisbon (ESEL), 1600-096 Lisboa, Portugal"},{"name":"Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8423-4653","authenticated-orcid":false,"given":"H\u00e9lder","family":"Alves","sequence":"additional","affiliation":[{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"ISSSP\u2014Higher Institute of Social Services of Porto, 4460-362 Porto, Portugal"},{"name":"INESC TEC, 4200-465 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Elkin, N., Mohammed, A.K., K\u0131l\u0131n\u00e7el, \u015e., Soydan, A.M., Tanr\u0131ver, S.\u00c7., \u00c7elik, \u015e., and Ranganathan, M. (2025). Mental health literacy and happiness among university students: A social work perspective to promoting well-being. Front. Psychiatry, 16.","DOI":"10.3389\/fpsyt.2025.1541316"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jvb.2015.08.005","article-title":"Cognitive-motivational antecedents of career decision-making processes in Portuguese high school students: A longitudinal study","volume":"91","author":"Cordeiro","year":"2015","journal-title":"J. Vocat. Behav."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yang, Y., Miao, L., Liu, X., Su, W., and Liu, S. (2025). The impact of mental health literacy on depression, anxiety and well-being among vocational nursing students: Mediating roles of resilience. Front. Psychiatry, 16.","DOI":"10.3389\/fpsyt.2025.1585642"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., and Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: A systematic review. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13943-x"},{"key":"ref_5","first-page":"49","article-title":"Mental health literacy and psychological distress as predictors of psychological well-being in Sriwijaya University students","volume":"4","author":"Mardhiyah","year":"2021","journal-title":"Ment. Health Glob. Chall."},{"key":"ref_6","unstructured":"Thorley, C. (2017). Not by Degrees: Improving Student Mental Health in the UK\u2019s Universities, IPPR."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"116208","DOI":"10.1016\/j.psychres.2024.116208","article-title":"The prevalence of mental health conditions and effectiveness of psychological interventions among university students in Italy: A systematic literature review","volume":"342","author":"Caldarelli","year":"2024","journal-title":"Psychiatry Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1177\/10105395211055545","article-title":"Mental health of university students in Southeastern Asia: A systematic review","volume":"34","author":"Dessauvagie","year":"2022","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"106244","DOI":"10.1016\/j.neubiorev.2025.106244","article-title":"Prevalence of mental disorder symptoms among university students: An umbrella review","volume":"175","author":"Paiva","year":"2025","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5528350","DOI":"10.1155\/2024\/5528350","article-title":"Depression and anxiety of Portuguese university students: A cross-sectional study","volume":"2024","author":"Amaro","year":"2024","journal-title":"Depress. Anxiety"},{"key":"ref_11","first-page":"145","article-title":"The impact of depression on the academic productivity of university students","volume":"8","author":"Hysenbegasi","year":"2005","journal-title":"J. Ment. Health Policy Econ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2975\/26.2003.217.231","article-title":"Barriers to higher education for individuals with psychiatric disabilities","volume":"26","author":"Megivern","year":"2003","journal-title":"Psychiatr. Rehabil. J."},{"key":"ref_13","unstructured":"Hubble, S., and Bolton, P. (2020). Support for Students with Mental Health Issues in Higher Education in England, UK Parliament."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1002\/jcad.12178","article-title":"Self-stigma, mental health literacy, and attitudes toward seeking psychological help","volume":"96","author":"Cheng","year":"2018","journal-title":"J. Couns. Dev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1037\/a0025957","article-title":"Mental health literacy: Empowering the community to take action for better mental health","volume":"67","author":"Jorm","year":"2012","journal-title":"Am. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1080\/07294360.2021.1906210","article-title":"Mental health and wellbeing of postgraduate researchers","volume":"41","author":"Moss","year":"2021","journal-title":"High. Educ. Res. Dev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.12816\/0056867","article-title":"Assessment of mental health literacy of depression and suicide among undergraduate medical students","volume":"31","author":"Elsheshtawy","year":"2020","journal-title":"Arab J. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Huang, X., Wang, X., Hu, J., Xue, Y., Wei, Y., Wan, Y., Song, X., Wang, R., Zhang, B., and Fang, J. (2021). Inadequate mental health literacy and insufficient physical activity. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.753695"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102199","DOI":"10.1016\/j.pmedr.2023.102199","article-title":"Mental health literacy and psychological distress in adolescents","volume":"33","author":"Zhang","year":"2023","journal-title":"Prev. Med. Rep."},{"key":"ref_20","unstructured":"Guo, J., Xie, Y., and Wang, F. (2024). Relationship between anxiety, depression, and well-being literacy. Proceedings of the 2024 5th International Conference on Mental Health, Education and Human Development (MHEHD 2024), Kaifeng, China, 17\u201319 May 2024, Atlantis Press."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pan, J., Xu, T., and Li, D. (2025). Mental health literacy and social well-being. Behav. Sci., 15.","DOI":"10.3390\/bs15010029"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dias Lopes, L.F., Chaves, B.M., Fabr\u00edcio, A., Porto, A., de Almeida, D.M., Obregon, S.L., Lima, M.P., da Silva, W.V., Camargo, M.E., and da Veiga, C.P. (2020). Analysis of well-being and anxiety among university students. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17113874"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1891\/0889-8391.30.1.60","article-title":"Psychological flexibility, self-compassion, and emotional well-being","volume":"30","author":"Marshall","year":"2016","journal-title":"J. Cogn. Psychother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1037\/0033-2909.95.3.542","article-title":"Subjective well-being","volume":"95","author":"Diener","year":"1984","journal-title":"Psychol. Bull."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1037\/0022-3514.57.6.1069","article-title":"Happiness is everything, or is it?","volume":"57","author":"Ryff","year":"1989","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_26","first-page":"199","article-title":"Architecture of psychological well-being","volume":"63","author":"Alsinet","year":"2022","journal-title":"Scand. J. Psychol."},{"key":"ref_27","first-page":"341","article-title":"University students\u2019 mental health literacy: A systematic review","volume":"3","year":"2024","journal-title":"Health Leadersh. Qual. Life"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1146\/annurev-publhealth-090419-102529","article-title":"Understanding and responding to health literacy","volume":"42","author":"Nutbeam","year":"2021","journal-title":"Annu. Rev. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Suwanwong, C., Jansem, A., Intarakamhang, U., Prasittichok, P., Tuntivivat, S., Chuenphittayavut, K., Le, K., and Lien, L.T.M. (2024). Predictors of mental health literacy. BMC Psychol., 12.","DOI":"10.1186\/s40359-024-01878-4"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Teixeira, S., Ferr\u00e9-Grau, C., Canut, T.L., Pires, R., Carvalho, J.C., Ribeiro, I., Sequeira, C., Rodrigues, T., Sampaio, F., and Costa, T. (2022). Positive mental health in university students. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063185"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Campos, L., Dias, P., Costa, M., Rabin, L., Miles, R., Lestari, S., Feraihan, R., Pant, N., Sriwichai, N., and Boonchieng, W. (2022). Mental health literacy questionnaire-short version. BMC Psychiatry, 22.","DOI":"10.1186\/s12888-022-04308-0"},{"key":"ref_32","first-page":"000183","article-title":"Academic Life Satisfaction Scale","volume":"3","author":"Nogueira","year":"2019","journal-title":"Nurs. Healthc. Int. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1023\/A:1006824100041","article-title":"A measure of subjective happiness","volume":"46","author":"Lyubomirsky","year":"1999","journal-title":"Soc. Indic. Res."},{"key":"ref_34","first-page":"157","article-title":"Valida\u00e7\u00e3o transcultural da escala de felicidade subjectiva","volume":"13","year":"2012","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_35","first-page":"313","article-title":"Bem-estar psicol\u00f3gico em adultos","volume":"Volume V","author":"Novo","year":"1997","journal-title":"Avalia\u00e7\u00e3o Psicol\u00f3gica"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Lovibond, S.H., and Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales, Psychology Foundation. [2nd ed.].","DOI":"10.1037\/t01004-000"},{"key":"ref_37","first-page":"229","article-title":"Contribui\u00e7\u00e3o para o Estudo da Adapta\u00e7\u00e3o Portuguesa das Escalas de Ansiedade, Depress\u00e3o e Stress (EADS) de 21 itens de Lovibond","volume":"5","author":"Honrado","year":"2004","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Little, R.J.A., and Rubin, D.B. (2019). Statistical Analysis with Missing Data, Wiley. [3rd ed.].","DOI":"10.1002\/9781119482260"},{"key":"ref_39","unstructured":"Nunnally, J.C. (1994). Psychometric Theory, McGraw-Hill. [3rd ed.]."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Streiner, D.L., Norman, G.R., and Cairney, J. (2024). Health Measurement Scales, Oxford University Press.","DOI":"10.1093\/med\/9780192869487.001.0001"},{"key":"ref_41","first-page":"411","article-title":"What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models","volume":"66","author":"Babyak","year":"2004","journal-title":"Psychosom. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Harrell, F.E. (2015). Regression Modeling Strategies with Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis, Springer. [2nd ed.].","DOI":"10.1007\/978-3-319-19425-7"},{"key":"ref_43","unstructured":"Cohen, J. (1998). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.apnu.2024.06.017","article-title":"Mental health literacy and resilience in nursing students","volume":"51","author":"Altun","year":"2024","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/jpm.12593","article-title":"Pathways linking mental health literacy","volume":"27","author":"Kim","year":"2020","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref_46","first-page":"511","article-title":"The Mental Health Literacy Scale","volume":"229","author":"Casey","year":"2015","journal-title":"Psychiatry Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1108\/JMHTEP-05-2016-0027","article-title":"Mental health literacy in UK university students","volume":"12","author":"Gorczynski","year":"2017","journal-title":"J. Ment. Health Train. Educ. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13690-023-01228-7","article-title":"Gender, mental health literacy and unmet need","volume":"82","author":"Blom","year":"2024","journal-title":"Arch. Public Health"},{"key":"ref_49","first-page":"e200","article-title":"Psychological burden during COVID-19","volume":"8","author":"Moura","year":"2023","journal-title":"Porto Biomed. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e13506","DOI":"10.1111\/inm.13506","article-title":"Mental health literacy and help-seeking attitudes","volume":"34","year":"2025","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"36237","DOI":"10.1038\/s41598-025-20202-7","article-title":"Mental health of university students in Qatar","volume":"15","author":"Shraim","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Miles, R., Rabin, L., Krishnan, A., Grandoit, E., and Kloskowski, K. (2020). Mental health literacy in undergraduates. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09696-0"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1007\/s11121-021-01283-y","article-title":"Impact of mental health literacy training","volume":"23","author":"Reis","year":"2022","journal-title":"Prev. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Awan, M.A., Boyce, M.A., and Lindsay, B.L. (2025). Mental health literacy and help-seeking. Front. Psychol., 16.","DOI":"10.3389\/fpsyg.2025.1589093"},{"key":"ref_55","first-page":"687","article-title":"Mental health literacy and psychological wellbeing","volume":"11","author":"Aziz","year":"2023","journal-title":"Russ. Law J."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Usenik, J., and Kranjec, E. (2025). Mental health literacy in dual-career athletes. Front. Sports Act. Living, 7.","DOI":"10.3389\/fspor.2025.1609042"},{"key":"ref_57","first-page":"e39780","article-title":"Psychological vulnerability and mental health literacy","volume":"2","author":"Nogueira","year":"2025","journal-title":"Millenium"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Vidovi\u0107, S., Kotromanovi\u0107, S., and Pogoreli\u0107, Z. (2024). Depression, anxiety, and stress in Croatia. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206240"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ahmed, I., Hazell, C.M., Edwards, B., Glazebrook, C., and Davies, E.B. (2023). Prevalence of non-specific anxiety. BMC Psychiatry, 23.","DOI":"10.1186\/s12888-023-04645-8"}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/4\/109\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:24:57Z","timestamp":1775060697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/4\/109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":59,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nursrep16040109"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16040109","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}