Mental Health Literacy About Depression in Public Security Police Officers: A Descriptive Cross-Sectional Study

Abstract

Introduction: Mental health literacy is an emerging topic that has implications for individuals’ health and well-being. Objective: To assess Mental Health Literacy (MHL) regarding depression among Portuguese public security police officers. Methods: Quantitative, descriptive, cross-sectional study using the QualisMental Questionnaire, which includes a vignette describing a case of depression, and the Personal Stigma Scale. Results: The sample comprises 253 professionals. Only 36.36% of respondents correctly identified the case as depression (95% CI: 30.40; 42.33). The distress was predominantly classified as “stress” (34.78%) or “anxiety” (32.81%), suggesting a defense mechanism that opts for socially less stigmatizing labels. Although the majority reject the belief that depression is a “personal weakness,” revealing low explicit stigma, the perceived usefulness of hierarchical figures in help-seeking is low (38.7% useful). High confidence is observed in informal networks (friends: 95.7% useful) and in mental health professionals, but there is marked distrust of psychopharmacology (antidepressants: 40.7% harmful). Conclusions: A paradox is observed between low personal stigma and low recognition of depression. MHL interventions should focus on neutralizing organizational stigma and increasing competencies for managing mental health crises arising from first aid, namely direct approaches to topics such as suicide.

1. Introduction

The concept of MHL can be defined as the beliefs, attitudes, and knowledge about mental health (MH) and mental illness (MI), as well as the skills that enable individuals, regardless of their health status, to act in everyday life, managing and mobilizing their personal and community resources to maintain their MH and that of those around them [1,2]. MHL also includes knowledge about health services and health information and is part of the belief and value systems of the cultures to which individuals belong.

The concept, as operationalized [3], includes five components, respectively: (a) knowledge about when a person is developing a disorder; (b) knowledge about help-seeking options and available treatments; (c) knowledge about the effectiveness of self-help strategies for moderate problems; (d) knowledge and skills to provide first aid to others who are developing a mental disorder or experiencing a mental health-related crisis; and (e) knowledge on how to prevent mental health problems [4].

In the case of MHL regarding depression, and despite extensive empirical production, the vast majority of studies focus on samples of adolescents and young people [5], although there are studies conducted in adult populations, such as nurses or other healthcare professionals [6]. In the case of public security professionals, evidence regarding their MHL is scarce.

Added to these issues is the importance attributed to depression in MHL studies. The impact and burden that this disorder presents in daily life are enormous, to the point that it is considered one of the most disabling diseases, being also among the most prevalent and incapacitating. Evidence indicates that over 1 billion people suffer from some type of mental disorder, with anxiety and depression representing more than two-thirds of these conditions. Recent data [7] even suggest that over 300 million people worldwide, of all ages, suffer from depressive disorders.

Added to this scenario are the devastating effects of the COVID-19 pandemic, which triggered an estimated 25% increase in the prevalence of anxiety and depression. These findings become even more evident when we consider that depression is one of the leading causes of death among young people, particularly when it can lead to suicide [6].

In the case of public security professionals, depression is one of the most prevalent disorders, frequently coexisting with anxiety, occupational stress, and post-traumatic symptoms [7]. Organizational stigma and self-stigma constitute key barriers to recognition and help-seeking [8,9]. Shame and fear of judgment are direct predictors of the non-use of mental health services among police officers [10]. In Portugal, evidence shows that these professionals have low willingness to seek immediate support when experiencing depressive symptoms and maintain the persistent belief that emotional problems should be resolved individually, confirming the influence of cultural and institutional factors on these behaviors [11].

A relevant finding is that evidence regarding actions promoting mental health among public security police officers, through the introduction of MHL-promoting programs, shows a positive impact on stigma reduction and the increase in self-efficacy [12,13].

In this regard, the integration of MHL into curricula and the principles of training, supervision, and leadership policies is fundamental to normalize psychological care as a dimension of occupational safety. In this context, investment in MHL promotes individual well-being, improves decision-making, operational performance, and public safety [8,14].

Although recommendations advocate for the promotion of MH through MHL-promoting programs, it is necessary to first assess the existing MHL of the security forces.

Public security police officers constitute a distinct and particularly relevant occupational group within the field of occupational health, due to the high demands inherent to the role and the recurrent exposure to stressful events in the course of professional duties [15,16]. These conditions confer an increased vulnerability to mental health problems among these professionals, arising not only from the operational specificities of police work but also from the organizational context in which it is carried out, which directly influences how mental health is perceived, interpreted, and managed.

Police activity systematically involves exposure to potentially traumatic situations, requiring the continuous use of coping strategies for the management of occupational stress. However, the literature indicates that stigma associated with mental health within the policing context plays a decisive role in the selection and use of these strategies, in some cases favoring maladaptive responses that increase the risk of developing psychological disorders, namely depression, anxiety, and post-traumatic stress disorder [17,18].

Additionally, the markedly rigid hierarchical structure of police organizations, combined with a professional culture that prioritizes emotional invulnerability and the normativity of “mental toughness,” constitutes a significant barrier to seeking formal psychological support [13]. These barriers are frequently reinforced by concerns related to confidentiality, professional secrecy, and potential career repercussions, as well as by persistent institutional stigma that limits access to and utilization of mental health services [10]. In this context, empirical evidence underscores the central role of organizational and social support as protective factors for psychological well-being, demonstrating that occupational demands and available resources critically shape the mental health of police officers [16,19].

In this context, the present study was developed with the objective of assessing MHL regarding depression among Portuguese public security police officers, across the following components: (a) recognition of the problem; (b) knowledge about help-seeking options and available treatments; (c) knowledge about the effectiveness of self-help strategies; (d) knowledge to provide first aid to those who are developing a mental disorder or experiencing a mental health-related crisis; and (e) knowledge on how to prevent mental health problems. This objective also includes the assessment of personal stigma regarding depression.

2. Materials and Methods

2.1. Study Design and Research Question

We conducted a quantitative, descriptive, cross-sectional study during September and October 2025. The STROBE checklist for cross-sectional studies was used to report the findings of this study [20]. To address the study objective, the following research question was formulated: What are the levels of mental health literacy across five domains among Portuguese public security police officers?

2.2. Instruments

In this study, three instruments were used, namely:

2.2.1. Sociodemographic and Professional Characterization Questionnaire

It included questions such as age, gender, unit of assignment, weekly working hours, shift work, among others.

2.2.2. Mental Health Literacy Assessment Questionnaire—QualisMental [21]

It is a questionnaire that assesses the five components of MHL, including personal stigma. In this study, we used the Portuguese version for adults.

The first part of the QuALiSMental includes completion instructions and sociodemographic characterization questions (gender, age, etc.). The second part consists of different sections corresponding to each component of MHL. A vignette describing a mental health problem (depression), in accordance with the DSM-5 diagnostic criteria [22], is presented beforehand.

Vignette content:

“Joana is a 21-year-old young woman who has been feeling unusually sad over the past few weeks. She feels constantly tired and has trouble falling asleep and staying asleep. She has lost her appetite and has recently been losing weight. She has difficulty concentrating on her studies, and her grades have dropped. Even everyday tasks seem very difficult to her, causing her to postpone some decisions. Her parents and friends are very worried about her.”

The assessment of the component regarding the recognition of mental health problems and disorders, in order to promote and facilitate help-seeking, consists of several items. After the presentation of the vignettes, the following question is asked: “In your opinion, what is happening with Joana? (You may select multiple answers).” The possible responses consist of different mental health problem labels, namely: “depression”; “schizophrenia”; “psychosis”; “mental illness”; “bulimia”; “stress”; “nervous exhaustion”; “substance abuse (e.g., alcohol)”; “age crisis”; “psychological/mental/emotional problems”; “anorexia”; “anxiety”; and “alcoholism.”

The component assessing knowledge about available professionals and treatments is preceded by the following instructions: (a) “There are different people and health professionals who could help Joana. Indicate your opinion for each one,” and (b) “Of the following medications/products, which, in your opinion, would be useful or could help Joana? Indicate your opinion for each one. The items related to question (a) are: a “general practitioner”; “hierarchical superior”; “psychologist”; “nurse”; “social worker”; “psychiatrist”; “telephonic helpline”; “close family member”; “close friend”; and “co-worker” For each item, the participant may select one of four response options: “useful,” “harmful,” “neither,” or “don’t know”.

Question (b) includes the following items: “vitamins”; “tea”; “tranquilizers”; “antidepressants”; “antipsychotics”; and “sleeping pills.” In this case as well, the participant may select one of four response options: “useful,” “harmful,” “neither,” or “don’t know.”

For the component assessing knowledge about effective self-help strategies, both vignettes are preceded by the following instructions: “There are different activities that could help Joana. Indicate your opinion for each one.”

The 12 items that make up this component use the same response format as the previously mentioned component (“useful,” “harmful,” “neither,” and “don’t know”). The items presented in the questionnaire are: “engage in physical exercise”; “practice relaxation training”; “practice meditation”; “undergo acupuncture”; “wake up early every morning and get sunlight”; “attend therapy with a specialized professional”; “consult a website containing information about the problem”; “read a self-help book about the problem”; “join a support group for people with similar problems”; “seek specialized mental health help”; “use alcoholic beverages to relax”; and “smoke to relax.”

The component assessing knowledge and skills to provide support and first aid consists of 10 items, preceded by the following instruction: “The following are different options you could use to help Joana. Indicate your opinion for each one.”

The questionnaire items related to this component are: “listen to her problems empathetically”; “firmly tell her to move on”; “suggest that she seek help from a specialized health professional”; “schedule an appointment with her family doctor without her knowledge”; “ask if she has suicidal thoughts”; “suggest that she drink alcohol to forget her problems”; “gather her group of friends to cheer her up”; “devalue her problem, ignoring her until she feels better”; “keep her busy so she does not think so much about her problems”; and “encourage her to engage in physical exercise.” The response format for these items is the same as for the two previously mentioned components (“useful,” “harmful,” “neither,” and “don’t know”).

The last MHL component assessed by QuALiSMental refers to knowledge about how to prevent mental health disorders. The items are preceded by the following text: “Do you think the risk of developing a situation like Joana’s would be reduced if young people…”. Participants can select “yes,” “no,” or “don’t know.”

The items that make up this component are: “engage in physical exercise”; “avoid stress-inducing situations”; “maintain regular contact with friends”; “maintain regular contact with family”; “not use drugs”; “not consume alcoholic beverages”; “regularly practice relaxing activities”; and “have a religious or spiritual belief.”

QuALiSMental also includes additional questions regarding the intention to seek help in a situation similar to that described in the vignettes, confidence in providing help, familiarity with the problems described, and the person they would talk to if experiencing a situation similar to those described.

2.2.3. Personal Stigma Scale

The Personal Stigma Scale [23] (Portuguese adult version) consists of 6 items with a Likert-type response format ranging from 1 (strongly disagree) to 5 (strongly agree). The response to the items is preceded by the previously mentioned vignette, and the following items are then presented: “If Joana wanted, she could get out of this situation on her own”; “Joana’s situation is a sign of personal weakness”; “This situation is not a real illness”; “Joana is dangerous to others”; “The best way to prevent a situation like Joana’s is to stay away from her”; “Joana’s situation makes her an unpredictable person.” In this study, regarding reliability, the estimated Cronbach’s alpha was α = 0.94, a value considered very good.

2.3. Ethical Considerations and Data Collection Process

This study is part of the Health Sciences Research Unit: Nursing and was conducted in accordance with the Declaration of Helsinki. Approval for the study was obtained from the Director of ISCPSI. The research received authorization from the Ethics Committee of the Health Sciences Research Unit: Nursing (Declaration. P1178_08_2025).

Recruitment was conducted through the institutional email system, inviting all professionals (with successful completion) to complete an online questionnaire hosted on Google Forms. The response rate to the questionnaire was 27.9% (253 respondents) out of 907 eligible participants.

The study population comprised all newly graduated public security police officers from two training cohorts (907 police officers from the 19th and 20th courses at the ISCPSI) whose length of active service in operational units was ≤12 months. A census-based study including all 907 eligible police officers was intended; however, only 253 participants completed the questionnaire. The inclusion criteria were: (a) ≤12 months of active service in an operational unit; and (b) willingness to participate in the study, expressed through the provision of written informed consent. The principles of anonymity and confidentiality were strictly observed.

2.4. Statistical Analysis

The present analysis was conducted using appropriate descriptive statistics (mean, SD) and absolute and percentage distributions. These statistics were used as point estimates, and confidence intervals for the proportions were also calculated. IBM SPSS version 30 was used for the analysis.

3. Results

A total of 253 public security police officers participated in the study, with a mean age of 25.23 years (SD = 3.96 years). Regarding gender, 20.9% were female and 79.1% male. Of the total sample, 78.7% were male. Regarding training cohort, 49.4% of participants belonged to the 19th CFA and 50.6% to the 20th CFA. With respect to participants’ geographical origin prior to entry into the institution, the most represented districts were Lisbon (28.5%), Setúbal (12.6%), Porto (11.1%), and the Autonomous Region of Madeira (10.3%). The remaining districts accounted for 37.5% of participants, each with proportions equal to or below 6.3%.

Table 1. Labels used by participants to characterize the person described in the vignette (N = 253).

Labels:	n.°	%	IC 95%
Stress	88	34.78	28.86; 40.70
Depression	85	33.60	27.76; 39.44
Anxiety	83	32.81	27.05; 38.57
Nervous breakdown	56	22.13	16.89; 27.37
Psychological/Mental/Emotional problems	53	20.95	15.83; 26.07
Age crisis	16	6.32	3.36; 9.28
Mental illness	12	4.74	2.13; 7.35
Anorexy	7	2.77	0.75; 4.79
Bulimia	5	1.98	0.25; 3.71
Recognition of depression (correct)	92	36.36	30.40; 42.33

presents the distribution of labels selected by participants regarding the labels used to describe the case presented in the vignette.

As can be seen, the most frequently selected labels were “stress” (34.78%), “depression” (33.60%), and “anxiety” (32.81%). It is also noteworthy that the label “nervous exhaustion” (22.13%) was selected by a considerable margin, and, although less frequent, “age-related crisis” (6.32%). Regarding the correct recognition of the situation described, it was identified by 36.36% of the participants (95% CI: 30.40–42.33). Correct recognition was considered correct if the respondent chose depression, either alone or in combination with one of the following options: mental illness, anxiety, stress or psychological/mental/emotional problems.

In

Table 2. Distribution of participants endorsing various potential types of help and knowledge about self-help interventions (N = 253).

Different People Who Could Possibly Help:	Don’t Know	Neither	Harmful	Helpful
A general practitioner	21 (8.3)	51 (20.2)	2 (0.8)	179 (70.8)
Hierarchical superior	44 (17.4)	88 (34.8)	23 (9.1)	98 (38.7)
A psychologist	5 (2.0)	8 (3.2)	2 (0.8)	238 (94.1)
A nurse	39 (5.4)	100 (39.5)	5 (2.0)	109 (43.1)
A social worker	53 (20.9)	122 (48.2)	16 (6.3)	62 (24.5)
A psychiatrist	41 (16.2)	29 (11.5)	9 (3.6)	174 (68.8)
A telephonic helpline	49 (19.4)	73 (28.9)	10 (4.0)	121 (47.8)
A close family member	8 (3.2)	7 (2.8)	2 (0.8)	236 (93.3)
A close friend	5 (2.0)	6 (2.4)	0 (0.0)	242 (95.7)
Co-worker	43 (17.0)	49 (19.4)	11 (4.3)	150 (59.3)
Medicines
Vitamins	51 (20.2)	29 (11.5)	3 (1.2)	170 (67.2)
Tea	54 (21.3)	53 (20.9)	3 (1.2)	143 (56.5)
Tranquilizers	91 (36.0)	36 (14.2)	97 (38.3)	29 (11.5)
Antidepressants	89 (35.2)	22 (8.7)	103 (40.7)	39 (15.4)
Antipsychotics	103 (40.7)	22 (8.7)	118 (46.6)	10 (4.0)
Sleeping pills	88 (34.8)	32 (12.6)	88 (34.8)	45 (17.8)
Knowledge of Interventions:
Becoming more physically active	2 (0.8)	2 (0.8)	1 (0.4)	248 (98.0)
Getting relaxation training	8 (3.2)	11 (4.3)	1 (0.4)	233 (92.1)
Practicing meditation	25 (9.9)	20 (7.9)	1 (0.4)	207 (81.8)
Getting acupuncture	103 (40.7)	63 (24.9)	0 (0.0)	87 (34.4)
Getting up early	30 (11.9)	54 (21.3)	0 (0.0)	169 (66.8)
Receiving therapy….	20 (7.9)	18 (7.1)	0 (0.0)	215 (85.0)
Looking up a web site ….	47 (18.6)	68 (26.9)	53 (20.9)	85 (33.6)
Reading a self-help ….	38 (15.0)	47 (18.6)	4 (1.6)	164 (64.8)
Joining a support group ….	53 (20.9)	45 (17.8)	14 (5.5)	141 (55.7)
Going to a specialized ….	23 (9.1)	12 (4.7)	2 (0.8)	216 (85.4)
Using alcohol to relax	5 (2.0)	8 (3.2)	235 (92.9)	5 (2.0)
Smoking ….	7 (2.8)	12 (4.7)	229 (90.5)	5 (2.0)

, the remaining components of the MHL are presented. Regarding the knowledge of professional help and treatments available, we can observe that participants show strong confidence in the effectiveness of professional help and primary support networks, in contrast with a mixed or negative perception of psychiatric pharmacotherapy. Mental health professionals such as the “psychologist” (94.1%) and the “psychiatrist” (68.8%) are widely recognized as helpful, as is the “general practitioner” (70.8%). However, informal support networks register the highest consensus of usefulness: significant friends are perceived as helpful by 95.7% and close family members by 93.3%. In contrast, the perceived usefulness of hierarchical figures, such as the “supervisor” (38.7%) or the “social worker” (24.5%), is significantly lower, with a high proportion of individuals indicating “Don’t know” or considering them neither helpful nor harmful.

Regarding treatments involving medications and other products, there is pronounced distrust, with a substantial portion of the sample considering them harmful compared to their perceived benefit. More than one-third of respondents view “antidepressants” (40.7%), “antipsychotics” (46.6%), and “tranquilizers/sedatives” (38.3%) as harmful. These are the three items most consistently classified as “harmful.”

On the other hand, other non-prescription products such as “vitamins” (67.2%) and “teas (e.g., chamomile or St. John’s wort)” (56.5%) are mostly perceived as useful, reinforcing a preference for non-pharmacological approaches.

In terms of knowledge of interventions, it can be observed that the understanding shows a consensus regarding the usefulness of active strategies that may be subject to professional support. Notably, “physical exercise” is considered useful by 98.0%, closely followed by “relaxation training” (92.1%). “Meditation” and “getting up early every morning to get sunlight” also show strong recognition of usefulness, with 81.8% and 66.8%, respectively. In parallel, “seeking specialized mental health help” (85.4%) and “therapy with a specialized professional” (85.0%) are consistently rated as useful, demonstrating an appreciation for structured professional intervention.

Strategies that can be considered self-destructive, such as “using alcoholic beverages to relax” (92.9%) and “smoking to relax” (90.5%), are rated as harmful by the vast majority of the sample. Regarding “acupuncture,” nearly half of the participants report a lack of knowledge, with 40.7% indicating “Don’t know,” and only 34.4% considering it “useful.” Self-care interventions based on information and group support, such as “consulting a website containing information about the problem” (33.6% useful) and “joining a support group” (55.7% useful), have lower recognition of usefulness or show a high percentage of uncertainty.

Suggesting that the person firmly “pull themselves together” also shows a low consensus regarding usefulness (35.2%) and a high percentage of neutrality or perception of harm. However, more complex or sensitive interventions show mixed results: “asking whether they have suicidal tendencies” is considered useful by 58.1% of respondents, but a significant percentage (14.6%) views this approach as harmful. Similarly, “keeping the person busy so they don’t think so much about their problems” has a usefulness rating of only 51.8%, indicating a lack of consensus about the effectiveness of these more evasive or distraction-based strategies.

In terms of knowledge and skills for providing first aid and initial support to others (

Table 3. Distribution of participants endorsing knowledge about mental health first aid (N = 253).

Knowledge and Skills to Give First Aid and Support	Don’t Know	Neither	Harmful	Helpful
Listen to her problems	4 (1.6)	5 (2.0)	1 (0.4)	243 (96.0)
Talk to her firmly about	36 (14.2)	78 (30.8)	50 (19.8)	89 (35.2)
Suggest she seek	17 (6.7)	19 (7.5)	0 (0.0)	217 (85.8)
Make an appointment for	26 (10.3)	28 (11.1)	4 (1.6)	195 (77.1)
Ask her whether she is	37 (14.6)	32 (12.6)	37 (14.6)	147 (58.1)
Suggest she have a few drinks	8 (3.2)	15 (5.9)	216 (85.4)	14 (5.5)
Rally friends to cheer	21 (8.3)	26 (10.3)	6 (2.4)	200 (79.1)
Not acknowledging	10 (4.0)	14 (5.5)	226 (89.3)	3 (1.2)
Keep her busy to	18 (7.1)	79 (31.2)	25 (9.9)	131 (51.8)
Encourage her to	4 (1.6)	6 (2.4)	4 (1.6)	239 (94.5)

), the results show a very high recognition of the usefulness of emotional support approaches and seeking specialized help. Almost all respondents (96.0%) consider “listening to their problems empathetically” a useful attitude, and “encouraging them to engage in physical exercise” is also seen as beneficial by a large majority (94.5%). Similarly, the suggestion to “seek help from a specialized health professional” (85.8%) and “schedule an appointment with a general practitioner with their knowledge” (77.1%) are perceived as highly useful and appropriate interventions. These responses indicate that the sample values strategies that combine active empathy with referral to the formal support system as the most effective ways to assist someone in distress.

In contrast, approaches corresponding to confrontation strategies are largely rejected. Attitudes perceived as harmful include “suggesting they drink to forget their problems” (85.4%) and “not valuing their problem, ignoring them until they feel better” (89.3%).

Regarding prevention strategies (

Table 4. Distribution of participants endorsing each item on beliefs about prevention (N = 253).

Knowledge of How to Prevent Mental Disorders	No	Don’t Know	Yes
Keeping physically active	9 (3.6)	13 (5.1)	231 (91.3)
Avoiding situations that	34 (13.4)	34 (13.4)	185 (73.1)
Keeping regular contact	11 (4.3)	15 (5.9)	227 (89.7)
Keeping regular contact	9 (3.6)	14 (5.5)	230 (90.9)
Not using drugs	12 (4.7)	8 (3.2)	233 (92.1)
Never drinking alcohol	16 (6.3)	22 (8.7)	215 (85.0)
Making regular time for	4 (1.6)	22 (8.7)	227 (89.7)
Having a religious or spiritual	34 (13.4)	139 (54.9)	80 (31.6)

), there is a consensus on the effectiveness of mental health prevention strategies focused on lifestyle and social support networks. More than 90% of respondents consider “engaging in physical exercise” (91.3%), “maintaining regular contact with family” (90.9%), and “avoiding drug use” (92.1%) as useful preventive measures. Equally valued are actions such as “maintaining regular contact with friends” (89.7%) and self-care, namely “engaging in relaxing activities regularly” (89.7%). Additionally, 73.1% believe that one should “avoid stressful situations,” without perceiving that this might increase anxiety.

The role of religious or spiritual belief shows considerable uncertainty, with 54.9% of respondents indicating “Don’t know,” and only 31.6% considering it an effective preventive strategy.

In terms of personal stigma (

Table 5. Distribution of participants endorsing each item of personal stigma scale (N = 253).

Items	Completely Disagree	Disagree	Neither Agree Nor Disagree	Agree	Completely Agree
1. If (….) gets out this situation by herself.	13 (5.1)	43 (17.0)	105 (41.5)	69 (27.3)	23 (9.1)
2. The condition (….) personal weakness.	108 (42.7)	80 (31.6)	46 (18.2)	15 (5.9)	4 (1.6)
3. (….) it not a real disease.	96 (37.9)	81 (32.0)	56 (22.1)	13 (5.1)	7 (2.8)
4. Joana is dangerous to others.	92 (36.4)	101 (39.9)	50 (19.8)	6 (2.4)	4 (1.6)
5. The best way to avoid developing…	157 (62.1)	76 (30.0)	17 (6.7)	0 (0.0)	3 (1.2)
6. The condition (….) an unpredictable person.	38 (15.0)	71 (28.1)	85 (33.6)	48 (19.0)	11 (4.3)
7. I would never tell anyone if I had….	107 (42.3)	94 (37.2)	39 (15.4)	7 (2.8)	6 (2.4)

), the data appear to reveal a rejection of perspectives that associate mental health problems with personal weakness and dangerousness, suggesting a low level of social stigma. A vast majority disagree that a situation of distress is a sign of personal weakness and strongly reject the idea that a disorder “is not a real illness.”

Even more markedly, 76.3% disagree that a person in distress is “dangerous to others.” However, perceptions regarding the ability to self-resolve mental health problems are ambiguous, as 41.5% remain neutral about whether the person will overcome the situation on their own, while 79.5% disagree with the statement “I would never tell anyone if I were experiencing a similar situation,” suggesting a tendency to seek help. Finally, 92.1% of participants disagree that “the best way to avoid developing a disorder is to stay away from this person,” indicating that this approach does not function as a preventive action.

4. Discussion

4.1. Recognition of Depression

It is well known that the recognition of mental health problems is a prerequisite for seeking mental health help [1,2]. In this context, the results reveal that only 36.36% (95% CI: 30.40; 42.33) of the surveyed law enforcement professionals correctly identified the case as depression. Despite the impact and global burden of depression [7], the results seem to indicate a significant gap in recognition.

This difficulty in recognizing depressive symptoms confirms previous findings in the general population and in high-demand professional contexts, in light of the literature on mental health literacy [24,25], as well as in public security police officers and security professional populations, where recent studies highlight similar patterns of under-recognition and ambivalent attitudes toward seeking help [26].

In the Portuguese context, the value obtained (36.36%) is lower, for example, than that found in adult populations of healthcare professionals (82.19%), such as nurses [5,6]; however, it is higher than the results obtained in samples of university students (21.92%) [26], which used similar methodological approaches, namely the same measurement instrument.

Another factor that may help to explain these findings relates to the representativeness of the sample. It is possible that police officers experiencing mental health problems and/or personal stigma may be under-represented in the sample, which could, in fact, lead to an underestimation of difficulties in recognizing depression. Although this limitation can be considered significant, it was unfortunately not possible to conduct a formal non-responder analysis.

A critical reading shows that the weight of the labels used—namely “stress” (34.78%), “anxiety” (32.81%), followed by “nervous exhaustion” (22.13%)—is also notable compared to the point estimate for the label depression (33.60%).

This tendency to incorrectly classify distress associated with depression, favoring categories that are more socially acceptable in public and simultaneously less stigmatizing, tends to be seen as “normal” consequences of occupational risk [7] in high-pressure professions, and may suggest a collective defense mechanism, as professionals avoid the deeper and more stigmatizing implications associated with the label “depression.”

This phenomenon of apparent “devaluation” of depression can be clarified when knowledge is considered alongside beliefs (personal stigma). The results seem to indicate that security professionals actively reject stigmatizing perspectives. The vast majority strongly disagree that depression is a sign of “personal weakness” (74.3% total or partial disagreement) or that “it is not a real illness” (69.9% total or partial disagreement). Even more markedly, the perception of “dangerousness” is mostly rejected (76.3% total or partial disagreement).

We may be facing an apparent paradox: low social stigma, yet low problem recognition, where the difficulty in correctly labeling depression is not so much due to the internalization of stigmatizing beliefs, but rather to an apparent concern about the consequences and public perceptions within the professional class.

Personal stigma thus constitutes a strong barrier or obstacle to seeking mental health help, in line with what is evidenced in the literature [11]. In this sense, emotional problems are expected to be resolved individually, reflecting a cultural influence that frames depression as more intolerable and subject to judgment than “stress” or “anxiety.”

Furthermore, this apparent paradox between low levels of personal stigma and a limited ability to recognize depression may be understood in light of organizational and cultural factors inherent to the policing context. Despite the explicit rejection of stigmatizing beliefs (e.g., personal weakness or dangerousness), a preference for labels such as “stress” or “anxiety” suggests a process of normalization of psychological distress, consistent with institutional norms that value emotional control, individual resilience, and self-sufficiency. In this sense, the issue may not necessarily involve internalized stigma, but rather professional role expectations and a help-seeking culture that discourages formal clinical labeling, as this may entail symbolic and organizational consequences.

4.2. Knowledge About Help-Seeking Options and Available Treatments

Regarding the component of knowledge about help-seeking options and available treatments, the data reflect the priorities and the cultural and organizational barriers faced by public security professionals, in line with findings from other studies. There is high confidence in informal networks (friends and family) and mental health professionals, particularly psychologists and psychiatrists, but reservations regarding psychopharmacology persist. This pattern, which favors interpersonal support and non-pharmacological interventions, is consistent with the literature on literacy and help-seeking both in the general population and in professional groups [16,19]. Among public security police officers, this preference is often amplified by contextual barriers (stigma, concerns about confidentiality, and career impact), which helps explain the hesitation toward formal help and the lower acceptance of psychotropic medication [9,10].

The high value attributed to the informal network is a crucial finding, suggesting that interventions that engage peers and the family context are more likely to be effective. In contrast, institutional and hierarchical figures are perceived as having low utility. Only 38.7% of respondents consider a superior officer as “useful,” with a large percentage rating them as “neither useful nor useless” or indicating “don’t know.” This finding directly confirms the literature, which points to stigma and organizational distrust as significant barriers [8,11]. Security professionals, despite knowing that professional help exists and is useful (e.g., psychologists), hesitate to seek support within their own structure, fearing judgment, which perpetuates low willingness to seek immediate help in the presence of depressive symptoms [11].

The data regarding treatments reveal marked distrust, particularly concerning psychiatric pharmacotherapy. More than one-third of respondents consider antidepressants (40.7%), antipsychotics (46.6%), and anxiolytics (38.3%) as harmful. This high level of perceived risk is concerning, as it suggests that even when depression is correctly identified and the professional is referred to a psychiatrist, adherence to treatment may be compromised [4].

In contrast, the majority of respondents perceive over-the-counter products as useful, such as vitamins (67.2%) and herbal teas (56.5%), reinforcing a preference for “natural” or self-care approaches. This contrast highlights a tendency toward self-medication or the preference for non-pharmacological approaches over evidence-based interventions. These findings are consistent with what has been reported in the literature.

With regard to the perception of antidepressants as harmful (40.7%), it is important to emphasize that the instrument items require a general assessment (useful, harmful, or neither useful nor harmful), without allowing for the differentiation of specific concerns. Thus, the classification of antidepressants as harmful may reflect fears related to side effects, dependence, sedation, or impact on operational performance, rather than a globally negative attitude towards psychopharmacology. This finding is consistent with the coexistence of a high valuation of psychiatrists and psychologists as helpful professionals and a marked preference for non-pharmacological approaches, suggesting a cautious stance towards psychotropic medication.

In our view, the pattern of trust (perceived utility) in professionals (psychologists/psychiatrists) versus distrust in psychopharmacology suggests that a culture of professional stigma may also help to explain this perspective. Seeking professional help may be perceived as preferable to medication, which is often stigmatized as a potential cause of dependence and as posing a risk to the ability to perform policing duties. This dichotomy may point to the need to enhance mental health literacy regarding the efficacy and safety of evidence-based pharmacological treatments.

4.3. Self-Help Strategies and Knowledge of Interventions

Participants attributed high usefulness to active interventions, such as physical exercise, relaxation training, and meditation, as well as seeking professional help. These results align with recent evidence showing that healthy lifestyle interventions can reduce depressive and anxious symptoms [27]. However, the lower valuation of strategies based solely on information (such as reading materials or consulting websites) reflects the documented limitations of such isolated approaches, which show lower effectiveness if not integrated into a structured context or supported environment [28,29].

Therefore, there is an almost total consensus on the usefulness of lifestyle strategies and professional support, demonstrating the presence of an apparent functional MHL in these areas [12,13].

In parallel, therapy with a specialized professional (85.0%) and seeking specialized help (85.4%) are considered “useful,” reaffirming that, despite organizational barriers, the value of structured intervention is recognized. The rejection of maladaptive strategies, such as alcohol use (92.9% harmful) and tobacco consumption (90.5% harmful), also represents a strong point of MHL in this component.

4.4. Knowledge of Mental Health First Aid

MHL related to providing mental health first aid is high in terms of supportive attitudes, that is, there is strong appreciation for empathetic listening and referral to formal care. “Listening to their problems empathetically” (96.0% useful) is the most consensual attitude, followed by “encouraging them to engage in physical exercise” (94.5%) and “suggesting they seek help from a professional” (85.8%).

The rejection of less effective practices, such as minimizing the problem or suggesting alcohol consumption, is a good indicator. These results are consistent with best practices advocated by Mental Health First Aid programs, which emphasize the importance of listening without judgment, providing support, and making referrals [25].

However, crisis management presents ambiguities. The usefulness of “asking whether they have suicidal tendencies” is recognized by 58.1%, but the percentage of individuals who consider it harmful (14.6%) indicates a critical gap. Similarly, confrontational or evasive strategies (e.g., “telling them firmly to pull themselves together” or “keeping them busy”) have low or mixed consensus on usefulness, highlighting that more sensitive and complex communication skills need to be developed.

It should be noted, however, that the hesitation to directly address the topic of suicide—considered useful by only 58.1% of participants—reveals the need for additional training, given that asking directly is a recognized protective strategy [30].

This finding is highly relevant. While 58.1% of respondents consider asking directly about suicide to be useful, 14.6% perceive it as harmful, which may reflect the persistence of a myth that the literature has sought to dispel—namely, that asking about suicide increases the risk of suicidal behavior. This perception is particularly concerning in a population that frequently serves as a first line of response in crisis situations. Distrust or reluctance to ask direct questions may be explained by a lack of specific training in suicide-related mental health literacy, resulting in high levels of discomfort, fear of “putting the idea into the person’s head,” or even anxiety about how to manage an affirmative response from an individual in distress. It is therefore essential to transform this critical gap in mental health literacy into an intervention capacity that can save lives.

4.5. Knowledge About Prevention

Regarding prevention, there is consensus on the effectiveness of strategies focused on healthy lifestyles and the maintenance of social support networks, which reinforces the protective role of social support while simultaneously emphasizing the value of individual protective factors.

These results are consistent with recent evidence identifying physical exercise, adequate sleep, and social support as central determinants of psychological well-being and burnout prevention among public security police officers [31]. However, the literature also cautions that an exclusive focus on individual factors may obscure the relevance of organizational and cultural conditions, which play a critical role in the mental health of these professionals [31,32].

The most uncertain aspect lies in the role of religious or spiritual belief, with 54.9% of respondents indicating “Don’t know.” The uncertainty observed in the present study is consistent with mixed results reported in international research. While some studies identify positive associations between secular spirituality and better mental health or lower suicidal ideation among police recruits [33], others have found no significant relationships between religiosity and psychological well-being [34]. These discrepancies suggest that spirituality may constitute a relevant protective factor, but one that is dependent on cultural context and on how it is conceptualized and integrated into organizational practices [34,35].

Thus, mental health promotion strategies in the policing context should balance the emphasis on individual behaviors with structural and cultural measures that foster psychologically safe work environments.

4.6. Personal Stigma

Finally, the analysis of personal stigma revealed overall low levels of explicit beliefs, such as depression being a sign of weakness or representing dangerousness, indicating a rejection of stigmatizing ideas. However, ambivalent attitudes remain regarding the ability to overcome problems individually, suggesting the presence of residual self-stigma.

Although explicit stigma appears to be low, the high prevalence of neutral responses (e.g., 41.5% neutrality on the self-resolution item) warrants cautious interpretation. This elevated neutrality may be indicative of social desirability bias. It is plausible that, given the sensitive nature of the topic and the hierarchical professional environment, police officers avoid overtly stigmatizing responses because they are aware of the socially acceptable position, even if they retain implicit biases or do not fully believe in the effectiveness of treatment.

These results align with studies in public security police officers contexts, which show that although many officers explicitly reject the notion of illness as weakness, a significant percentage still associate help-seeking with the risk of judgment or career impact [9]. For example, a study with security professionals (public security police officers) found that stigma regarding help-seeking was negatively associated with the intention to seek help. Additionally, reviews indicate that approximately 33% of first responders exhibit stigma, with notable concerns about confidentiality and professional consequences [9].

This evidence reinforces that strengthening mental health literacy (MHL) should be coupled with institutional policies to combat stigma, promoting confidentiality, peer support, and active leadership involvement. Only these actions can adequately address the attention that has been given to the mental health and well-being of public security police officers [15,19,36].

5. Conclusions

The present study demonstrates that MHL among law enforcement professionals is characterized by a set of robust functional competencies, but is weakened by certain contextual barriers. The findings allow for three main conclusions with direct implications for occupational health policy and intervention: recognition of depression in this population is significantly low, contrasting with the explicit rejection of personal stigma. The use of alternative labels suggests a reclassification that allows individuals and the organization to avoid the stigmatizing consequences of the label “depression” and the need for structural intervention, framing distress as a “normal” byproduct of occupational risk rather than recognizing it as a clinical pathology.

Despite the high recognition of the value of mental health professionals (psychologists and psychiatrists), organizational stigma and concerns about professional consequences constitute critical barriers to formal help-seeking. The low perceived usefulness of hierarchical figures and the marked distrust of psychopharmacology—viewed as harmful by more than one-third of respondents—indicate that treatment adherence and timely access to support may be compromised by the absence of psychologically safe work environments. The strong preference for informal networks and non-pharmacological strategies (herbal teas, vitamins) reinforces the need for interventions that neutralize internalized stigma and improve institutional confidentiality policies. Mental health literacy at the level of first aid is high (with strong emphasis on empathetic listening and referral), but there is a critical gap in crisis management skills. Hesitation to directly address the topic of suicide reveals a shortcoming in “Mental Health First Aid” literacy.

Our data indicate trust in mental health professionals, alongside simultaneous distrust of psychopharmacological treatment and of intervening in crisis situations (e.g., suicide). From our perspective, external mental health services should therefore be implemented in order to mitigate fears related to evaluation outcomes, prejudice, and related consequences. At the same time, priority should be given to targeted training initiatives addressing the identified areas of deficit.

In conclusion, strengthening mental health in law enforcement cannot be achieved solely by increasing formal knowledge. It requires an institutional and cultural effort that balances the promotion of individual lifestyle behaviors (where there is already high consensus) with the implementation of organizational policies to combat stigma, targeted training for crisis and suicide management, and the creation of peer support mechanisms that do not rely on formal hierarchical intervention.

It is also important to outline several methodological limitations within the context of this study. In addition to the constraints inherent to a cross-sectional design, which does not allow for the establishment of causal relationships, the data are based on self-report measures and may therefore be subject to social desirability bias. This is particularly relevant in a professional context such as policing, where cultural and organizational norms may influence how attitudes and beliefs about mental health are expressed. Furthermore, voluntary participation may have introduced selection bias, as professionals with greater sensitivity to or interest in mental health issues may be overrepresented in the sample, thereby limiting the generalizability of the findings. These factors should be taken into account when interpreting the results.

To address the study objectives, the statistical analysis focused on frequency distributions (absolute and relative), which were used as point estimates of proportions. Accordingly, the results should be interpreted as descriptive estimates derived from the surveyed participants rather than as inferential statistics intended to establish causal relationships or support broad generalizations to the target population. Although confidence intervals were calculated for selected proportions to provide an indication of estimate precision, these measures remain subject to uncertainty arising from the cross-sectional design, voluntary participation, and potential non-response bias. Therefore, the findings should be interpreted with caution and regarded as indicative rather than definitive.

Another limitation is the low response rate, which may have been influenced by organizational stigma or by the fact that only those more interested in or holding more positive attitudes toward mental health chose to respond. This could, for example, lead to an underestimation of the true extent of personal and perceived stigma.

Future research should build on these findings by adopting more robust and diverse methodological approaches. In particular, multivariate analytical designs are needed to examine the complex interrelationships among mental health literacy, stigma, help-seeking behaviors, and both individual- and organizational-level factors. Longitudinal studies would enable the examination of changes over time and the identification of potential causal pathways, especially with regard to the evolution of stigma and help-seeking attitudes across police careers. Additionally, mixed-methods research that integrates quantitative data with qualitative inquiry is strongly recommended to capture the contextual, cultural, and organizational dimensions shaping mental health perceptions and practices within police institutions. Such approaches would contribute to a more comprehensive and nuanced understanding of mental health literacy and its determinants in public security settings.