Parental willingness and influencing factors for school-based mental health screening in Eastern China

Abstract

Abstract Background Adolescent mental health issues are increasingly prominent, making early screening essential for intervention. Schools, as the primary environment for adolescents, serve as ideal settings for screening programs. Parents, as key decision-makers, directly influence participation through their willingness. This study aimed to assess parents’ acceptance of school-based mental health screening among Chinese middle school students, identified relevant factors and concerns, with the goal of providing valuable insights for future programs. Methods A cross-sectional survey was conducted in Deqing County, Zhejiang Province, involving parents from three junior high schools. A total of 2,872 valid questionnaires were collected. A self-administered questionnaire assessed sociodemographic characteristics, mental health awareness, screening-related concerns, and willingness. Logistic regression analysis identified associated factors. Results 89.4% of parents expressed willingness for children to participate in screening. Parents of girls (OR = 0.68, 95% CI: 0.53–0.87) and older parents (age group 45 + vs. < 40 years: OR = 0.71, 95% CI: 0.51–0.99) were less willing, whereas those with high school education (high school/vocational school vs. junior high school or below: OR = 1.54, 95% CI: 1.11–2.13) and higher household income (5000–9999 vs. < 5000 RMB/month: OR = 1.77, 95% CI: 1.29–2.43; 10000 + vs. < 5000 RMB/month: OR = 1.71, 95% CI: 1.20–2.44) showed greater willingness. Parents whose children had a history of mental illness (OR = 0.46, 95% CI: 0.22–0.97) or no prior screening (OR = 0.25, 95% CI: 0.18–0.34) were less willing. Cognitive factors were significant: perceiving mental health issues as unimportant (OR = 0.13, 95% CI: 0.07–0.23), not severe (OR = 0.49, 95% CI: 0.35–0.71) or lacking knowledge (OR = 0.37, 95% CI: 0.24–0.57) was associated with lower willingness, whereas awareness of school-based services was associated with higher willingness (1–2 types: OR = 2.75, 95% CI: 1.86–4.05; ≥3 types: OR = 6.88, 95% CI: 3.29–14.41). Key concerns included children’s comprehension of questions, tool validity, and result reliability. Worries that screening content could negatively influence children were associated with lower willingness (OR = 0.66, 95% CI: 0.45–0.96). Conclusions Parents of Chinese junior high school students generally support screening. Willingness is associated with child’s gender, parental age, economic status, mental health awareness and concerns. Enhancing parents’ mental health knowledge and improving tool credibility may be associated with greater parental willingness of children’s mental health screening.