Reliability and Validity of the Mental Health Literacy Scale (MHLS) Among Malaysian Medical Students

Htay Lwin; Panjurat Laisuwannachart; Kaung  Zaw; Jayakumar  Gurusamy; Soe Moe; Htoo Htoo Kyaw Soe; Mila Nu Nu Htay

Authors

Htay Lwin Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Malaysia, Email, htay.lwin@manipal.edu.my
Panjurat Laisuwannachart Department of Master of Public Health, Sirindhorn College of Public Health, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Mueang Suphan Buri District, Thailand, Email, panjarut@phcsuphan.ac.th
Kaung Zaw Department of Family Health, Faculty of Public Health, Mahidol University, Thailand, Email, kaungzaw.1@mahidol.ac.th
Jayakumar Gurusamy Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Malaysia, Email, jayakumar.gurusamy@manipal.edu.my
Soe Moe Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Malaysia, Email, soe.moe@manipal.edu.my
Htoo Htoo Kyaw Soe Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Malaysia, Email, htoo.kyawsoe@manipal.edu.my
Mila Nu Nu Htay Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Malaysia, Email, mila.htay@um.edu.my

Keywords:

Mental health literacy, Psychometric validation, Medical students, Factor analysis, Malaysia

Abstract

Background: Mental health literacy (MHL) is critical for medical students, who encounter high rates of depression, anxiety, and burnout. No validated tool currently exists to measure MHL among Malaysian medical students. Objective: This study tested the reliability and validity of the Mental Health Literacy Scale (MHLS) in this population. Methods: A cross-sectional study was conducted at Manipal University College Malaysia (August–October 2025). A total of 273 clinical-phase medical students completed the 35-item MHLS (response rate: 89.5%; 66.3% female; mean age 22.9 years). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed, alongside reliability assessment using Cronbach's alpha and McDonald's omega. Results: After removing two poorly performing items, a five-factor, 33-item model was identified, explaining 63.41% of total variance: Mental Health Attitudes (α = 0.94), Disorder Recognition and Professional Help (α = 0.90), Help-Seeking Orientation (α = 0.91), Information-Seeking Knowledge (α = 0.88), and Self-Management and Help Knowledge (α = 0.65). CFA demonstrated acceptable fit (CFI = 0.91, RMSEA = 0.06). The five-factor model outperformed both one-factor (CFI = 0.14) and four-factor alternatives (CFI = 0.04). Overall reliability was excellent (α = 0.90, ω = 0.80), though the Self-Management subscale showed suboptimal validity (AVE = 0.41). Conclusion: The 33-item MHLS demonstrates acceptable reliability and validity for measuring MHL among Malaysian medical students. The Self-Management subscale requires further refinement. Cultural context influences the scale's factor structure, and Factor 5 scores should be interpreted cautiously. The findings point to a need for targeted curriculum interventions on self-management strategies and support multi-site replication across diverse Malaysian populations.

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