Mental health literacy for public employees
Mental health literacy (MHL) refers to knowledge and beliefs about mental disorders that aid in recognizing, treating, or preventing mental health issues . It is a multidimensional construct that covers knowledge-related aspects and includes dimensions related to the ability to recognize specific disorders or different types of psychological distress and attitudes that facilitate recognition and the search for appropriate help . Currently, MHL extends to the organizational level , shifting from focusing on diagnosis and medical treatment to identifying workplace-related issues, such as team integration and access support mechanisms within and outside the work environment . The increasing incidence of mental health problems has proven to be a significant challenge for organizations. The economic impacts of this phenomenon are evident. In 2010, the costs associated with depressive disorders in the U.S. economy alone surpassed 100 billion dollars, reflecting not only absenteeism but also presenteeism — that is, the drop in productivity for employees who continue working despite mental health problems . In addition to the costs for organizations due to lost productivity and a higher incidence of accidents, mental disorders entail broad social costs. People experiencing these problems, or their family members, may experience reduced performance or even be unable to work for prolonged periods. This tends to lead to unemployment, affecting the financial capacity of individuals and families and resulting in greater dependence on social welfare programs . Incidents of distress in the workplace, although familiar, often go unnoticed. The most severe manifestation of these problems is suicide. In Brazil, there has been an increase in the number of suicides, suggesting that there is a possible epidemic on the rise. This phenomenon impacts several sectors, including agriculture, security forces, health, civil construction, transportation, storage, postal services, domestic services, education, commerce, judiciary, financial, administrative, and industrial sectors , many of which are services of public interest or provided exclusively by the State. Adverse psychosocial working conditions in the public sector, such as high demand and low levels of control over work, are associated with deterioration in mental health . When available, professional and organizational resources to support government employees, such as adequate supervision, flexible schedules, and wellness programs, can increase employee engagement and protect against burnout. However, such resources often do not develop in the public sector, leaving employees with the psychological capital to deal with emotionally demanding situations . Awareness of the clinical importance of symptoms of mental disorders is notoriously insufficient. A lack of knowledge about the characteristics and treatment of mental disorders, prejudice, and discrimination against people who have mental disorders increases the likelihood of avoiding treatment . This stigma can have significant adverse effects, including social discrimination against patients and families, which discourages individuals from seeking appropriate support . A delay in seeking treatment can worsen the disease, increasing the difficulty of treatment or even causing irreparable damage . MHL is a fundamental factor in reducing stigma. People with higher MHL are more likely to seek professional assistance, while people who maintain stigmatizing biases tend to have lower intentions to seek professional help . Furthermore, individual and organizational MHL tend to be positively associated with employees’ psychological well-being . MHL in organizations makes it easier to navigate, understand, and apply information related to mental health to facilitate shared decision-making and improve health outcomes . Greater MHL influences employee productivity and reduces absenteeism . Increases in MHL can be achieved through public information campaigns, which play a vital role in addressing the professional consequences of psychiatric disorders . Such campaigns may be associated with programs to adopt standards of action in the workplace in addition to education and training . However, ignoring MHL aspects can result in significant costs for organizations, as early recognition and appropriate intervention benefit the individual and contribute to a healthier and more productive work environment . It is crucial to understand that MHL varies significantly among groups with different socioeconomic characteristics to consider strategies for expanding MHL. For instance, it is influenced by factors such as sex, with women having higher levels than men ; age, with young adults (between 25 and 40 years old) tending to have higher levels of literacy ; educational level ; income ; country or ethnicity , health professionals , people previously diagnosed with mental disorders, and their family members ; and people who have seen mental health professionals . Interestingly, several of these factors are related to determinants associated with mental disorders. On the one hand, there is evidence in the literature of a direct relationship based on sex; that is, women tend to have greater MHL, as mentioned above, and a greater likelihood of developing mental disorders . Regarding age, young adults also form a group with more significant tendencies to develop mental disorders , but this is not observed in general . The level of education is also a common determinant; however, people with higher education levels have higher MHL and are less likely to develop mental disorders . Income and work situation are also determining factors. People with higher income levels tend to have higher MHL, and people with lower income levels or unemployed individuals are more likely to develop mental disorders . In Brazil, mental disorders are pervasive in women, people with low levels of education and income, and unemployed people . Some diseases, such as cancer, may be associated with the development of mental disorders . However, studies indicate that individuals who have survived cancer or other serious illnesses can experience post-traumatic growth, leading to the development of positive health behaviors , which can be reflected in enhanced MHL. Recognizing the need to diagnose potential areas for improvement in employees’ MHL is essential for developing effective workplace mental health policies. This research aimed to evaluate the degree of MHL among the Secretariats of Finance and Planning, Budget, and Administration employees in the Federal District. Data from the Sub-Secretariat of Health of the Federal District, Brazil, indicate that, between 2019 and 2022, an average of 14.17% of health-related absences in these secretariats were due to mental health issues, highlighting the critical nature of this study. 

Research design This cross-sectional research was conducted through the administration of the MHL Scale  to the employees of the Secretariats of Finance, and Planning, Budget, and Administration in the Federal District, Brazil. The aim was to evaluate the degree of MHL among employees of these Secretariats. The survey was distributed via email to all agency employees and received 156 valid responses. The analyses were conducted using descriptive and inferential statistics in RStudio. Additionally, nonparametric tests assessed variables including knowledge, behavior towards mental disorders, health conditions, and socio-economic factors such as disability, medication usage, service usage, living conditions, income, age, gender, and ethnicity. The following subsections detail aspects related to the research instrument, data collection, research participants, as well as the tests used for data analysis. Research instrument The questionnaire used in the present research (MHLS) was constructed by O’Connor and Casey (2015) , translated into Portuguese by Campos (2016) , and validated for Brazilian Portuguese by Buta et al. (2024) . This questionnaire has been widely used to measure the level of mental health literacy . It is worth noting that not all items in this questionnaire were used, as this research transposes the instrument constructed in the field of knowledge of psychiatry to the field of public management. Attributes specifically aimed at the medical field were removed to take advantage of only those of interest to the public manager. In addition, items related to organizational support for people with mental disorders and the socioeconomic profile of the sample were added. The original instrument consists of 35 items, covering several aspects. It includes eight items on the ability to recognize disorders and 16 on attitudes that promote recognition or appropriate help-seeking behavior. There are 11 items detailing knowledge aspects: 4 on where to seek information, 2 on causes and risk factors, 2 on self-treatment, and 3 on available professional help. The original instrument presented an univariate structure with a Cronbach’s Alpha of 0.873 . The version adapted to Brazilian Portuguese has been condensed to 18 items. This version presents a Cronbach’s alpha of 0.81 and McDonald’s Omega of 0.85, demonstrating adequate reliability . It is essential to highlight that McDonald’s Omega is considered a measure with greater statistical robustness than Cronbach’s Alpha . The validation also involved empirical aspects, covering statistical factor analysis methods . For this research, we adopted the wording adaptations for the items made by Buta et al. (2024) , but not the scale’ structure. Instead, we fully maintained the items related to attitudes that promote recognition or appropriate help-seeking behavior, which we refer to as ’Behavior’ in this study. Additionally, we preserved two items concerning knowledge about available professional help and four items about where to seek information, which we refer to as ’Knowledge’. Certain items were excluded because they are too specific to the medical field and do not align with a manager’s desired knowledge and skills. For instance, while managers do not need to be versed in specific treatments or types of mental disorders, they should be able to recognize when their coworkers are not in their usual state, seek help, and work to prevent social stigma. We also added items developed by the authors to gauge employees’ perceptions of organizational support. These items address the possibility of discussing mental health within the organization and how employees perceive the support provided to individuals with mental disorders. The items were constructed using a five-point Likert-type perception scale, except for items x11 and x12, which use a four-point scale. The Cronbach’s alpha for this data set is 0.80, and the overall McDonald’s Omega is 0.84, indicating that this set of items is reliable and comparable to the original instrument. Items regarding organizational support are presented in Table 5, in the appendix, which also contains a summary of the research data. Data collection The data were collected using a questionnaire via the Internet in July and August 2023. Before starting the data collection, the research protocol was submitted for analysis by the Committee on Ethical Compliance in Research Involving Human Beings at the Getulio Vargas Foundation. The Committee understood that the protocol was suitable for execution and approved the research through Opinion P.216.2023. Then, a pilot application was conducted on a sample of six audience target audience members, employees of the Federal District’s Planning, Budget, and Administration secretariat. At this stage, information about the questionnaire was collected, covering its operation, delivery channels, response time, and how intelligible the questions were to the target audience. The information from this stage allowed minor wording adjustments to be made. Subsequently, the questionnaire was sent to all agency employees via email. The Subsecretariat for People Management made the emails available, which allowed individual messages to be sent to each employee. The emails inviting employees to take the survey were sent between the 27th and 31st of July, 2023, and a reminder was sent between the 3rd and 6th of August, 2023. In the end, a sample of 176 completed questionnaires was obtained. Of these, 20 responses that contained missing data or an excess of similar responses were excluded; these responses indicated withdrawal or negligence in responding to the questionnaire, leaving a sample of 156 valid responses. Participants The population of interest totals 2,264 active employees, 51.86% of whom are male and 48.14% of whom are female. Regarding the color/race aspect, 58% considered themselves white, 4% black, and 38% mixed race, yellow or indigenous. This profile is similar to that of the sample, as shown in the table below, which indicates that the sample tends to be representative. Table presents the gender and color/race aspects of the sample and population, and Table provides other information about the socioeconomic profile of the sample. Analyzes The analyses used descriptive and inferential statistics in the free software RStudio. The literacy score was calculated by summing the response values to the items divided by the number of items. Notably, O’Connor and Casey (2015)  did not establish a scale for classifying individuals according to their level of mental health literacy. These authors only score the collected responses by assigning points to the items answered as expected. Thus, an item that contains four possible answers (such as very likely, likely, unlikely, and very unlikely) would be worth four points. The original questionnaire had 35 items, a possible total score of 160 points. Given that the present research did not use the questionnaire in its entirety, the respondents’ scores are not comparable with those of other samples. The health literacy score is a value that varies from 0 to 5 for the dimensions of MHL and perception of support from the organization. To define the MHL level of the groups of respondents and to standardize the classification of individuals in the present study, we chose to establish the following classification for the MHL dimensions: inadequate health literacy is considered deficient when lower than 3; problematic when between 3 and 4; and sufficient when greater than 4. This means that individuals with mental literacy levels above 4 have the ability to seek information about mental disorders, as well as knowledge about activities that an individual can conduct for personal treatment, in addition to demonstrating behavior and attitudes that prove recognition of mental disorders. It is essential to state that the original scale  does not specify cut-off points for classifying MHL levels. Defining these points based on the data distribution is not a viable option, as it would merely reflect internal variations within the current sample. Therefore, we decided to establish these points according to the values of the questionnaire responses, which are logically ordered. Nonparametric tests were also carried out to compare different groups concerning the following variables of interest and socioeconomic variables: The mental health literacy score, calculated as the total literacy value of each individual on the MHLS; Knowledge - knowledge of personal treatment and knowledge of where to seek information about mental health (MHLS); Behavior - behavior and attitudes toward people with mental disorders that prove recognition of disorders (MHLS); Health conditions - the presence of diseases such as hypertension, cancer (except skin), depression, anxiety, diabetes, and others; People with disabilities - dummy variable indicating whether or not they have a physical disability; Frequent use of medication - dummy variable indicating whether or not you use medication continuously; SUS users - dummy variable indicating whether they are a user of the public health service or private services; Place of residence - a neighborhood in which the respondent resides; Housing situation—a dummy variable indicating whether the respondent lived alone or with someone; Income - respondent’s income range; Age - age range of the respondent; Gender; and. Color/race. We used the Wilcoxon two-sample statistic to compare MHL scores between two groups, such as males and females. For comparing MHL scores among three or more groups, such as different age groups or varying education levels, we employed the Kruskal-Wallis Rank Sum Test. Following this, Dunn’s test was used for multiple pairwise comparisons. 

This cross-sectional research was conducted through the administration of the MHL Scale  to the employees of the Secretariats of Finance, and Planning, Budget, and Administration in the Federal District, Brazil. The aim was to evaluate the degree of MHL among employees of these Secretariats. The survey was distributed via email to all agency employees and received 156 valid responses. The analyses were conducted using descriptive and inferential statistics in RStudio. Additionally, nonparametric tests assessed variables including knowledge, behavior towards mental disorders, health conditions, and socio-economic factors such as disability, medication usage, service usage, living conditions, income, age, gender, and ethnicity. The following subsections detail aspects related to the research instrument, data collection, research participants, as well as the tests used for data analysis. 

The questionnaire used in the present research (MHLS) was constructed by O’Connor and Casey (2015) , translated into Portuguese by Campos (2016) , and validated for Brazilian Portuguese by Buta et al. (2024) . This questionnaire has been widely used to measure the level of mental health literacy . It is worth noting that not all items in this questionnaire were used, as this research transposes the instrument constructed in the field of knowledge of psychiatry to the field of public management. Attributes specifically aimed at the medical field were removed to take advantage of only those of interest to the public manager. In addition, items related to organizational support for people with mental disorders and the socioeconomic profile of the sample were added. The original instrument consists of 35 items, covering several aspects. It includes eight items on the ability to recognize disorders and 16 on attitudes that promote recognition or appropriate help-seeking behavior. There are 11 items detailing knowledge aspects: 4 on where to seek information, 2 on causes and risk factors, 2 on self-treatment, and 3 on available professional help. The original instrument presented an univariate structure with a Cronbach’s Alpha of 0.873 . The version adapted to Brazilian Portuguese has been condensed to 18 items. This version presents a Cronbach’s alpha of 0.81 and McDonald’s Omega of 0.85, demonstrating adequate reliability . It is essential to highlight that McDonald’s Omega is considered a measure with greater statistical robustness than Cronbach’s Alpha . The validation also involved empirical aspects, covering statistical factor analysis methods . For this research, we adopted the wording adaptations for the items made by Buta et al. (2024) , but not the scale’ structure. Instead, we fully maintained the items related to attitudes that promote recognition or appropriate help-seeking behavior, which we refer to as ’Behavior’ in this study. Additionally, we preserved two items concerning knowledge about available professional help and four items about where to seek information, which we refer to as ’Knowledge’. Certain items were excluded because they are too specific to the medical field and do not align with a manager’s desired knowledge and skills. For instance, while managers do not need to be versed in specific treatments or types of mental disorders, they should be able to recognize when their coworkers are not in their usual state, seek help, and work to prevent social stigma. We also added items developed by the authors to gauge employees’ perceptions of organizational support. These items address the possibility of discussing mental health within the organization and how employees perceive the support provided to individuals with mental disorders. The items were constructed using a five-point Likert-type perception scale, except for items x11 and x12, which use a four-point scale. The Cronbach’s alpha for this data set is 0.80, and the overall McDonald’s Omega is 0.84, indicating that this set of items is reliable and comparable to the original instrument. Items regarding organizational support are presented in Table 5, in the appendix, which also contains a summary of the research data. 

The data were collected using a questionnaire via the Internet in July and August 2023. Before starting the data collection, the research protocol was submitted for analysis by the Committee on Ethical Compliance in Research Involving Human Beings at the Getulio Vargas Foundation. The Committee understood that the protocol was suitable for execution and approved the research through Opinion P.216.2023. Then, a pilot application was conducted on a sample of six audience target audience members, employees of the Federal District’s Planning, Budget, and Administration secretariat. At this stage, information about the questionnaire was collected, covering its operation, delivery channels, response time, and how intelligible the questions were to the target audience. The information from this stage allowed minor wording adjustments to be made. Subsequently, the questionnaire was sent to all agency employees via email. The Subsecretariat for People Management made the emails available, which allowed individual messages to be sent to each employee. The emails inviting employees to take the survey were sent between the 27th and 31st of July, 2023, and a reminder was sent between the 3rd and 6th of August, 2023. In the end, a sample of 176 completed questionnaires was obtained. Of these, 20 responses that contained missing data or an excess of similar responses were excluded; these responses indicated withdrawal or negligence in responding to the questionnaire, leaving a sample of 156 valid responses. 

The population of interest totals 2,264 active employees, 51.86% of whom are male and 48.14% of whom are female. Regarding the color/race aspect, 58% considered themselves white, 4% black, and 38% mixed race, yellow or indigenous. This profile is similar to that of the sample, as shown in the table below, which indicates that the sample tends to be representative. Table presents the gender and color/race aspects of the sample and population, and Table provides other information about the socioeconomic profile of the sample. 

The analyses used descriptive and inferential statistics in the free software RStudio. The literacy score was calculated by summing the response values to the items divided by the number of items. Notably, O’Connor and Casey (2015)  did not establish a scale for classifying individuals according to their level of mental health literacy. These authors only score the collected responses by assigning points to the items answered as expected. Thus, an item that contains four possible answers (such as very likely, likely, unlikely, and very unlikely) would be worth four points. The original questionnaire had 35 items, a possible total score of 160 points. Given that the present research did not use the questionnaire in its entirety, the respondents’ scores are not comparable with those of other samples. The health literacy score is a value that varies from 0 to 5 for the dimensions of MHL and perception of support from the organization. To define the MHL level of the groups of respondents and to standardize the classification of individuals in the present study, we chose to establish the following classification for the MHL dimensions: inadequate health literacy is considered deficient when lower than 3; problematic when between 3 and 4; and sufficient when greater than 4. This means that individuals with mental literacy levels above 4 have the ability to seek information about mental disorders, as well as knowledge about activities that an individual can conduct for personal treatment, in addition to demonstrating behavior and attitudes that prove recognition of mental disorders. It is essential to state that the original scale  does not specify cut-off points for classifying MHL levels. Defining these points based on the data distribution is not a viable option, as it would merely reflect internal variations within the current sample. Therefore, we decided to establish these points according to the values of the questionnaire responses, which are logically ordered. Nonparametric tests were also carried out to compare different groups concerning the following variables of interest and socioeconomic variables: The mental health literacy score, calculated as the total literacy value of each individual on the MHLS; Knowledge - knowledge of personal treatment and knowledge of where to seek information about mental health (MHLS); Behavior - behavior and attitudes toward people with mental disorders that prove recognition of disorders (MHLS); Health conditions - the presence of diseases such as hypertension, cancer (except skin), depression, anxiety, diabetes, and others; People with disabilities - dummy variable indicating whether or not they have a physical disability; Frequent use of medication - dummy variable indicating whether or not you use medication continuously; SUS users - dummy variable indicating whether they are a user of the public health service or private services; Place of residence - a neighborhood in which the respondent resides; Housing situation—a dummy variable indicating whether the respondent lived alone or with someone; Income - respondent’s income range; Age - age range of the respondent; Gender; and. Color/race. We used the Wilcoxon two-sample statistic to compare MHL scores between two groups, such as males and females. For comparing MHL scores among three or more groups, such as different age groups or varying education levels, we employed the Kruskal-Wallis Rank Sum Test. Following this, Dunn’s test was used for multiple pairwise comparisons. 

MHL levels Table presents a description of the respondents’ mental health literacy levels in the MHLS column, as well as the values for each of the other aspects measured in the survey, covering: (a) knowledge about how to seek information about mental health, and knowledge about personal treatment; (b) behaviors that prove recognition of mental disorders; and (c) perceptions of the organization’s support for people with mental disorders. In addition to the descriptive statistics, Table presents the sample strata with sufficient, problematic or inadequate literacy levels. Indicators related to mental health vary between 0 and 5 points, and the average MHL value of respondents is 3.48. With regard to MHL, 27.6% of the respondents had sufficient levels of literacy, 67.9% had problematic levels, and 4.5% had inadequate levels. In the present research, MHL comprises two other dimensions: knowledge and behavior. The average for knowledge was 3.48, while the average for behavior was 3.90, suggesting greater proficiency in behaviors that prove recognition of mental disorders than in knowledge about how to seek information about mental health and knowledge about personal treatment. Knowledge Regarding knowledge, a stratum of 5.1% of the sample presented a level of literacy considered sufficient, which points to a significant gap in the ability to seek information about mental disorders and activities for personal treatment. 76.9% of the sample had problematic levels of literacy, and 17.9% of the respondents were categorized as having inadequate levels of literacy, indicating a pressing need for educational interventions to improve understanding of mental health. The items with the lowest scores are related to people’s knowledge about personal treatment, difficulty managing their own emotions, and seeking professional help. Behavior For aspects related to behavior and attitudes, the average literacy level of the sample is 3.9, which reveals a more positive outlook than the knowledge dimension. A stratum of 40.4% of the sample has a sufficient literacy level. These data indicate that a considerable proportion of employees demonstrate behaviors and attitudes that impact their recognition of mental disorders and their willingness to seek help. However, 55.1% of the respondents were categorized as having problematic levels of literacy in the behavior dimension, and 4.5% had an inadequate level of literacy, suggesting the need for strategies to improve behavioral practices related to mental health in the workplace. The items with the lowest scores are related to the social stigma about mental disorders, represented by aversion to personal, professional, or political relationships with people who experience mental disorders. Perception of support The sample’s average score regarding the perception of organizational support for people with mental disorders was 2.05. No individuals’ average perceived support exceeds 4. For 12.2% of respondents, there are average levels of perceived support from the organization, and 87.8% of respondents perceive insufficient support. Items with lower scores indicate that many people stay away for health and mental health reasons. Furthermore, the topic of mental health has rarely been discussed in the organizations, and there is little perception of support for colleagues who face mental health problems. This indicates that employees feel the need for secretariats to promote programs specifically aimed at mental health. Group comparison tests Tests for median comparisons of independent group samples presented in Table below indicate some differences in the literacy of groups divided based on socioeconomic variables such as physical disability, sex, housing situation, use of health systems, frequent use of medication, place of residence, color/race, income, education and the presence of diseases or mental disorders. Comparisons for MHL levels The findings suggest that MHL and its related dimensions vary according to socioeconomic characteristics. This highlights the importance of strategies focused on several traits in educational and support programs. Notably, women have higher literacy levels than men (W = 3954, p-value = 0.001). In addition, there was evidence of significant differences in the levels of MHL (KW = 12.994, p-value = 0.043), between groups of people with certain health conditions. Generally, people with cancer, depression, or other illnesses have higher levels of literacy than people who do not have diseases. People with cancer had higher literacy levels than people with diabetes (d = 2,845, p-value = 0.002), hypertension (d = 2.684, p-value = 0.003), or no disease (d = 2.31, p-value = 0.010). People with depression had significantly greater MHL than people with diabetes (d = 2.066, p-value = 0.019). No significant differences were found for any of the dimensions of MHL, namely, place of residence, housing situation, color/race, income, age, education, or frequent use of medication. Knowledge and behavior dimensions Significant differences were found between genders in the levels of knowledge and behavior concerning mental health. Women exhibited higher levels of knowledge (W = 3738.5, p-value = 0.011) and behavior (W = 3790, p-value = 0.007). Additionally, significant differences were observed in the knowledge dimension of MHL among groups with different health conditions (KW = 19.025, p-value = 0.004). Specifically, in the knowledge dimension, people with cancer demonstrated higher literacy levels than those with diabetes (d = 2,450, p-value = 0.007) or hypertension (d = 1.924, pvalue = 0.027). Similarly, individuals with depression exhibited greater literacy levels compared to those with diabetes (d = 3,128, p-value ¡ 0.001), hypertension (d = 2.531, p-value = 0.005), or no disease (d = 1,645, p-value = 0.049). No significant differences were noted in the behavior dimension. Organizational support Regarding the perception of the organization’s support, the results indicate that people who frequently use medications have a significantly greater perception of support (W = 2225, p-value = 0.004). In addition, people with disabilities had a significantly lower perception of the organization’s support than people with no disabilities did (W = 685.5, p-value = 0.029). Notably, there were no significant differences in mental health literacy levels between these groups. 

Table presents a description of the respondents’ mental health literacy levels in the MHLS column, as well as the values for each of the other aspects measured in the survey, covering: (a) knowledge about how to seek information about mental health, and knowledge about personal treatment; (b) behaviors that prove recognition of mental disorders; and (c) perceptions of the organization’s support for people with mental disorders. In addition to the descriptive statistics, Table presents the sample strata with sufficient, problematic or inadequate literacy levels. Indicators related to mental health vary between 0 and 5 points, and the average MHL value of respondents is 3.48. With regard to MHL, 27.6% of the respondents had sufficient levels of literacy, 67.9% had problematic levels, and 4.5% had inadequate levels. In the present research, MHL comprises two other dimensions: knowledge and behavior. The average for knowledge was 3.48, while the average for behavior was 3.90, suggesting greater proficiency in behaviors that prove recognition of mental disorders than in knowledge about how to seek information about mental health and knowledge about personal treatment. Knowledge Regarding knowledge, a stratum of 5.1% of the sample presented a level of literacy considered sufficient, which points to a significant gap in the ability to seek information about mental disorders and activities for personal treatment. 76.9% of the sample had problematic levels of literacy, and 17.9% of the respondents were categorized as having inadequate levels of literacy, indicating a pressing need for educational interventions to improve understanding of mental health. The items with the lowest scores are related to people’s knowledge about personal treatment, difficulty managing their own emotions, and seeking professional help. Behavior For aspects related to behavior and attitudes, the average literacy level of the sample is 3.9, which reveals a more positive outlook than the knowledge dimension. A stratum of 40.4% of the sample has a sufficient literacy level. These data indicate that a considerable proportion of employees demonstrate behaviors and attitudes that impact their recognition of mental disorders and their willingness to seek help. However, 55.1% of the respondents were categorized as having problematic levels of literacy in the behavior dimension, and 4.5% had an inadequate level of literacy, suggesting the need for strategies to improve behavioral practices related to mental health in the workplace. The items with the lowest scores are related to the social stigma about mental disorders, represented by aversion to personal, professional, or political relationships with people who experience mental disorders. Perception of support The sample’s average score regarding the perception of organizational support for people with mental disorders was 2.05. No individuals’ average perceived support exceeds 4. For 12.2% of respondents, there are average levels of perceived support from the organization, and 87.8% of respondents perceive insufficient support. Items with lower scores indicate that many people stay away for health and mental health reasons. Furthermore, the topic of mental health has rarely been discussed in the organizations, and there is little perception of support for colleagues who face mental health problems. This indicates that employees feel the need for secretariats to promote programs specifically aimed at mental health. 

Regarding knowledge, a stratum of 5.1% of the sample presented a level of literacy considered sufficient, which points to a significant gap in the ability to seek information about mental disorders and activities for personal treatment. 76.9% of the sample had problematic levels of literacy, and 17.9% of the respondents were categorized as having inadequate levels of literacy, indicating a pressing need for educational interventions to improve understanding of mental health. The items with the lowest scores are related to people’s knowledge about personal treatment, difficulty managing their own emotions, and seeking professional help. 

For aspects related to behavior and attitudes, the average literacy level of the sample is 3.9, which reveals a more positive outlook than the knowledge dimension. A stratum of 40.4% of the sample has a sufficient literacy level. These data indicate that a considerable proportion of employees demonstrate behaviors and attitudes that impact their recognition of mental disorders and their willingness to seek help. However, 55.1% of the respondents were categorized as having problematic levels of literacy in the behavior dimension, and 4.5% had an inadequate level of literacy, suggesting the need for strategies to improve behavioral practices related to mental health in the workplace. The items with the lowest scores are related to the social stigma about mental disorders, represented by aversion to personal, professional, or political relationships with people who experience mental disorders. 

The sample’s average score regarding the perception of organizational support for people with mental disorders was 2.05. No individuals’ average perceived support exceeds 4. For 12.2% of respondents, there are average levels of perceived support from the organization, and 87.8% of respondents perceive insufficient support. Items with lower scores indicate that many people stay away for health and mental health reasons. Furthermore, the topic of mental health has rarely been discussed in the organizations, and there is little perception of support for colleagues who face mental health problems. This indicates that employees feel the need for secretariats to promote programs specifically aimed at mental health. 

Tests for median comparisons of independent group samples presented in Table below indicate some differences in the literacy of groups divided based on socioeconomic variables such as physical disability, sex, housing situation, use of health systems, frequent use of medication, place of residence, color/race, income, education and the presence of diseases or mental disorders. Comparisons for MHL levels The findings suggest that MHL and its related dimensions vary according to socioeconomic characteristics. This highlights the importance of strategies focused on several traits in educational and support programs. Notably, women have higher literacy levels than men (W = 3954, p-value = 0.001). In addition, there was evidence of significant differences in the levels of MHL (KW = 12.994, p-value = 0.043), between groups of people with certain health conditions. Generally, people with cancer, depression, or other illnesses have higher levels of literacy than people who do not have diseases. People with cancer had higher literacy levels than people with diabetes (d = 2,845, p-value = 0.002), hypertension (d = 2.684, p-value = 0.003), or no disease (d = 2.31, p-value = 0.010). People with depression had significantly greater MHL than people with diabetes (d = 2.066, p-value = 0.019). No significant differences were found for any of the dimensions of MHL, namely, place of residence, housing situation, color/race, income, age, education, or frequent use of medication. Knowledge and behavior dimensions Significant differences were found between genders in the levels of knowledge and behavior concerning mental health. Women exhibited higher levels of knowledge (W = 3738.5, p-value = 0.011) and behavior (W = 3790, p-value = 0.007). Additionally, significant differences were observed in the knowledge dimension of MHL among groups with different health conditions (KW = 19.025, p-value = 0.004). Specifically, in the knowledge dimension, people with cancer demonstrated higher literacy levels than those with diabetes (d = 2,450, p-value = 0.007) or hypertension (d = 1.924, pvalue = 0.027). Similarly, individuals with depression exhibited greater literacy levels compared to those with diabetes (d = 3,128, p-value ¡ 0.001), hypertension (d = 2.531, p-value = 0.005), or no disease (d = 1,645, p-value = 0.049). No significant differences were noted in the behavior dimension. Organizational support Regarding the perception of the organization’s support, the results indicate that people who frequently use medications have a significantly greater perception of support (W = 2225, p-value = 0.004). In addition, people with disabilities had a significantly lower perception of the organization’s support than people with no disabilities did (W = 685.5, p-value = 0.029). Notably, there were no significant differences in mental health literacy levels between these groups. 

The findings suggest that MHL and its related dimensions vary according to socioeconomic characteristics. This highlights the importance of strategies focused on several traits in educational and support programs. Notably, women have higher literacy levels than men (W = 3954, p-value = 0.001). In addition, there was evidence of significant differences in the levels of MHL (KW = 12.994, p-value = 0.043), between groups of people with certain health conditions. Generally, people with cancer, depression, or other illnesses have higher levels of literacy than people who do not have diseases. People with cancer had higher literacy levels than people with diabetes (d = 2,845, p-value = 0.002), hypertension (d = 2.684, p-value = 0.003), or no disease (d = 2.31, p-value = 0.010). People with depression had significantly greater MHL than people with diabetes (d = 2.066, p-value = 0.019). No significant differences were found for any of the dimensions of MHL, namely, place of residence, housing situation, color/race, income, age, education, or frequent use of medication. 

Significant differences were found between genders in the levels of knowledge and behavior concerning mental health. Women exhibited higher levels of knowledge (W = 3738.5, p-value = 0.011) and behavior (W = 3790, p-value = 0.007). Additionally, significant differences were observed in the knowledge dimension of MHL among groups with different health conditions (KW = 19.025, p-value = 0.004). Specifically, in the knowledge dimension, people with cancer demonstrated higher literacy levels than those with diabetes (d = 2,450, p-value = 0.007) or hypertension (d = 1.924, pvalue = 0.027). Similarly, individuals with depression exhibited greater literacy levels compared to those with diabetes (d = 3,128, p-value ¡ 0.001), hypertension (d = 2.531, p-value = 0.005), or no disease (d = 1,645, p-value = 0.049). No significant differences were noted in the behavior dimension. 

Regarding the perception of the organization’s support, the results indicate that people who frequently use medications have a significantly greater perception of support (W = 2225, p-value = 0.004). In addition, people with disabilities had a significantly lower perception of the organization’s support than people with no disabilities did (W = 685.5, p-value = 0.029). Notably, there were no significant differences in mental health literacy levels between these groups. 

The results showed that the MHL of Finance and Planning, Budget and Administration Secretariat employees is classified as sufficient for 27.6% of the respondents. This primarily reflects aspects related to the behaviors of employees in these organizations that demonstrate recognition of disorders, a dimension in which 40.4% of respondents exhibited a sufficient level of literacy. Although much of the sample has reached a sufficient literacy level for the behavior dimension, 59.6% of the respondents still have problems or insufficient levels. Regarding knowledge about personal treatment and where to seek information, 94.9% of the respondents had problematic or insufficient literacy. It is important to highlight the points of greatest concern about MHL. In the knowledge dimension, the most relevant points are related to weaknesses in knowledge about the personal treatment of people who have difficulty managing their own emotions, as well as the search for professional help. Therefore, educational interventions, such as public information campaigns and first aid training programs, which tend to expand employees’ knowledge and confidence in mental health and reduce associated social stigma, are needed . The purpose of these policies should be not only to increase knowledge about mental health but also to encourage positive attitudes and behaviors in relation to people with mental disorders. A crucial aspect of MHL is awareness of its relevance, understanding what constitutes mental health and how to improve it. This involves understanding the factors that influence mental health and knowledge of the strategies and resources available to promote and maintain it. These findings underline the importance of educational health initiatives for employees, aiming at a timelier identification of the need for health treatments, when necessary. In the behavior dimension, the most relevant points cover social stigma related to mental disorders, represented by aversion to personal, professional or political relationships with people who experience mental disorders. Notably, MHL is an essential element in reducing the stigma associated with mental disorders. When people are well informed and have positive attitudes toward mental health, they are more likely to seek help when necessary, which can have a significant impact on their health . Research findings also showed that women have a significantly greater mental health literacy level than men. This result is in line with other reports found in the literature on the subject . It is important to highlight that women are more affected by mental disorders than men are , and have higher levels of suicide and suicide attempts . This can result in greater openness to the search for help and information . In addition, in many cultures, there is greater social support for women, in relation to men, for the expression of emotional suffering . The results also revealed significantly greater levels of MHL in patients with diseases or disorders, especially depression and anxiety (common mental disorders), cancer and other diverse diseases. In fact, there are reports in the literature that indicate greater MHL in people who have already been diagnosed with some mental health conditions . Notably, cancer tends to negatively impact the mental health of patients and their families , which may imply a greater propensity to seek information on the subject. Furthermore, survivors of cancer or other severe diseases tend to undergo post-traumatic growth, which fosters positive health behaviors . This behavior change could subsequently lead to improved MHL. No significant differences were found in any of the dimensions of literacy according to place of residence, color/race, income, education or housing condition. This contradicts the findings of other studies, which indicate a positive relationship between MHL and income  and education . Therefore, it is essential to emphasize that the sample in this research has relatively high incomes; 80.56% of the respondents have incomes greater than six times the minimum wage, which puts them in the highest income stratum among Brazilians. In addition, the education of individuals in the sample was relatively homogeneous, and 95.3% of the respondents had completed higher education. Regarding race, the literature indicates distinct literacy levels between people of different ethnic groups, notably migrants . However, this is not what the concept of race in the present sample indicates; it is not possible to presuppose significant cultural differences between white, black or mixed-race civil servants. Overall, 87.8% of the respondents had a negative perception of the support of organizations for people with mental disorders. Respondents realize that there is a stigma in discussing mental health at the secretariat they work, so that the subject is little discussed. It is important to highlight that MHL is essential for promoting awareness, reducing stigma and improving the mental well-being of individuals. Successful MHL interventions in the workplace bring greater focus to people who occupy leadership roles . Based on mental health training policies, these leaders tend to gain confidence in responding to other team members who may face mental health problems, as well as initiating conversations about mental health and applying interventions to promote an environment of mentally healthy work that promotes well-being . The results also indicate the need for policies aimed at promoting MHL to focus on male people who apparently do not have diagnosed health conditions. This profile provides evidence of stigma related to mental disorders. This implies a delay in treatment, representing greater social, personal and economic costs . 

This research sought to evaluate MHL among employees of the Secretariats of Finance and Planning, Budget, and Administration of the Federal District. Most respondents’ MHL is relatively low. The majority of respondents had a negative view of the support offered by these organizations to people with mental disorders. It is also noteworthy that aspects related to the skills and behaviors of employees in these bodies reflect some employees’ low level of mental health literacy. Educational initiatives, including public awareness campaigns and psychological first aid training programs, are essential to mitigate these problems. These actions have the potential to increase employees’ knowledge and confidence in mental health issues and reduce related social stigma. Furthermore, the need for such actions to focus more on men is also highlighted. Based on the work of O’Connor and Casey (2015), the questionnaire used in the present research provided a comprehensive assessment of employees’ knowledge and perceptions regarding mental health. This study was restricted to just two government secretariats, leaving room for expansion and deepening of the research. Therefore, to advance the search for effective solutions, it would be beneficial to expand the scope of this study to encompass all bodies of the Government of the Federal District. Additionally, conducting different research models, such as comprehensive studies and clinical trials, could provide a more complete understanding of interventions that can be implemented to improve employee mental health. It is also worth highlighting that the sample for this study was obtained by convenience. This may imply selection bias since people who already have some interest in the topic tend to be more encouraged to participate in the research. Sampling bias is a limitation of this study and could reflect responses from people with greater mental health literacy. Another limitation of this study is the establishment of cut-off points for classifying MHL levels based on the available response options. Future studies could compare multiple samples to determine the most effective classification method. A promising avenue for future research would be to identify areas in which employees have limited knowledge and develop targeted training and awareness programs. These efforts tend to create a healthier and more productive work environment while reducing the adverse impacts of mental disorders. 

Below is the link to the electronic supplementary material. Supplementary Material 1 

