Background: Mental health is a vital aspect of overall well-being but remains under-recognized and stigmatized, particularly in rural communities. Conditions such as depression, anxiety, and stress significantly contribute to the global burden of disease. This study aimed to assess the level of mental health awareness, social attitudes, stigma, and help-seeking behaviors related to depression, anxiety, and stress among the rural population of Solan district, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional survey was conducted among 400 adult residents of rural Solan between January and March 2025. Participants were recruited through purposive and snowball sampling via digital platforms. Data were collected using a structured, bilingual (Hindi and English) online questionnaire assessing socio-demographic details, awareness of mental health conditions, stigma levels, and help-seeking behaviors. Responses were scored, and cumulative knowledge was categorized into four levels: very good, good, fair, and poor. Statistical analysis was performed using SPSS version 26.0. Results: Among the participants, 39.5% were aged 26–35 years, and 54.5% were female. A majority (37.0%) had secondary education, and all respondents resided in rural areas. Overall, 78.8% correctly identified disruptions in emotional or cognitive functioning as characteristics of mental disorders, and 80.8% recognized the neurobiological impact of prolonged stress. Although 82.3% acknowledged stigma as a barrier to treatment, misconceptions persisted, with only 64.3% rejecting the belief that mental disorders signify personal failure. Based on cumulative scores, 30.3% demonstrated very good knowledge, 43.8% good knowledge, 19.3% fair knowledge, and 6.8% poor knowledge. Conclusion: The rural population of Solan demonstrated encouraging levels of awareness regarding mental health conditions; however, critical gaps in knowledge and persistent stigma remain significant challenges. Tailored mental health education programs, community-based interventions, and stigma-reduction initiatives are urgently needed to foster a more informed, supportive, and resilient rural society, capable of addressing mental health issues with compassion and confidence.
Mental health is an integral component of overall well-being, yet it remains one of the most neglected areas of public health, particularly in rural communities across the globe. Conditions such as depression, anxiety, and stress-related disorders are among the most common mental health issues, contributing significantly to the global burden of disease and disability. According to the World Health Organization (WHO), one in eight people worldwide lives with a mental health condition, yet a majority remain untreated due to limited awareness, societal stigma, and inadequate access to mental health services. Early recognition and timely intervention for common mental disorders are critical in preventing severe psychological, social, and economic consequences, but success heavily depends on the public’s mental health literacy and willingness to seek help [1-4].
In India, mental health challenges are exacerbated by socio-economic disparities, cultural beliefs, and systemic barriers to care, with rural populations being particularly vulnerable. Despite national initiatives such as the National Mental Health Programme (NMHP) and increasing advocacy for mental well-being, awareness of mental health conditions in rural India remains fragmented. Deep-rooted stigma, myths, and misconceptions often discourage open discussion about mental health, leading to underreporting, social isolation, and reluctance to seek professional support. Depression and anxiety, in particular, are frequently misunderstood as personal weaknesses rather than legitimate health conditions requiring medical and psychological attention [5-7].
Solan district of Himachal Pradesh, characterized by its predominantly rural landscape, traditional lifestyles, and evolving social dynamics, provides an important setting to explore mental health awareness and stigma at the community level. While the district has seen gradual improvements in education and healthcare access, mental health continues to be shrouded in silence and misinformation, particularly among rural populations. Localized data examining the extent of mental health literacy, prevalent attitudes toward individuals experiencing psychological distress, and barriers to seeking help are critically lacking.
This study aims to assess the level of awareness regarding common mental health conditions specifically depression, anxiety, and stress among rural residents of Solan district, and to evaluate prevailing social attitudes, stigma, and help-seeking behaviors related to mental health. By identifying gaps in knowledge and societal perceptions, the study seeks to provide evidence-based insights for designing culturally sensitive mental health education programs and strengthening community-based mental health interventions, ultimately promoting a more informed, supportive, and inclusive approach to mental well-being in rural Solan.
This study employed a descriptive, cross-sectional survey design to evaluate the level of awareness regarding mental health conditions specifically depression, anxiety, and stress as well as to assess stigma, social attitudes, and help-seeking behaviors among the rural population of Solan district, Himachal Pradesh. A cross-sectional approach was selected to capture a real-time snapshot of community perceptions and mental health literacy at the grassroots level.
The study was conducted in various rural villages of Solan district, ensuring representation across different socio-economic and cultural backgrounds. The target population included adults aged 18 years and above, residing in rural areas, irrespective of their previous mental health status. Practicing healthcare professionals, such as doctors, nurses, and mental health counselors, were excluded to ensure the focus remained on the general rural community’s awareness and attitudes.
Data collection was carried out over a three-month period, from January to March 2025, to allow for comprehensive outreach and participant inclusion across different rural locations.
A minimum sample size of 400 participants was determined based on a 95% confidence level, a 5% margin of error, and an assumed 50% prevalence of mental health awareness in the absence of prior localized data. Participants were selected using purposive and snowball sampling techniques. The initial participants were recruited through rural WhatsApp groups, local Facebook communities, village WhatsApp committees, and email outreach. They were encouraged to circulate the survey among their networks to maximize participation and diversity within the rural population.
Inclusion Criteria:
Adults aged 18 years and above residing in Solan district.
Ability to comprehend and respond to the survey in Hindi or English.
Access to an internet-enabled device (smartphone, tablet, or computer).
Provision of informed online informed online consent before participation.
Exclusion Criteria:
Practicing healthcare professionals (including mental health workers).
Incomplete or partially filled survey responses.
Data Collection Tool
Data Collection Tool
A structured, pre-validated, bilingual (Hindi and English) online questionnaire was developed through consultations with experts in public health nutrition, dietetics, and epidemiology. Hosted via Google Forms, the survey was designed to be mobile-friendly and easily accessible. The questionnaire consisted of four sections:
Demographic Information: Capturing age, gender, education, occupation, and residential setting.
Knowledge Assessment: Evaluating awareness of recommended sugar intake limits, risks of excessive sugar consumption, and knowledge about obesity and metabolic syndrome.
Dietary Habits and Behaviors: Investigating frequency of sugar consumption, beverage choices, snacking habits, and reading of nutritional labels.
Perceptions and Misconceptions: Identifying prevalent myths regarding sugar, weight, and non-communicable disease risks.
Participants were provided with a survey link accompanied by a detailed introduction outlining the study objectives, confidentiality assurances, and informed consent declaration. Only fully completed surveys were considered valid for analysis, ensuring data integrity and consistency.
Each correct response in the knowledge section was awarded one point, while incorrect or "don't know" responses received zero points. Based on total scores, participants' knowledge levels were categorized as:
Very Good Knowledge (≥80% correct responses)
Good Knowledge (60%–79% correct responses)
Fair Knowledge (41%–59% correct responses)
Poor Knowledge (<40% correct responses)
Stigma levels and attitudes were analyzed using a combination of Likert scale-based responses and thematic categorization.
Data were exported into Microsoft Excel for initial cleaning and coding, and then analyzed using SPSS version 26.0. Descriptive statistics such as frequencies, percentages, and means were used to summarize demographic profiles, knowledge scores, dietary patterns, and perceptions.
Prior to participation, online informed consent was obtained from all participants. Anonymity and confidentiality of all responses were strictly maintained throughout the study. No personally identifiable information was collected. Participants were assured of their right to withdraw from the study at any point without providing any reason. The study adhered to ethical standards laid down for research involving human participants.
Table 1 presents the socio-demographic characteristics of the 400 participants from rural Solan district. The age distribution shows that the majority belonged to the 26–35 years age group (39.5%), followed by those aged 36–45 years (26.0%) and 18–25 years (23.0%), while participants aged 46 and above constituted 11.5%. There was a slight predominance of females (54.5%) compared to males (45.5%), offering valuable insights into gendered perspectives on mental health. In terms of education, 37.0% of participants had completed secondary schooling, 28.0% held undergraduate degrees, and 19.0% had primary education, although 8.5% reported having no formal education highlighting the mixed literacy levels prevalent in rural areas. Occupation-wise, homemakers formed the largest group (36.5%), followed by self-employed individuals (20.5%) and students/unemployed participants (21.3%), with smaller proportions working in the government (11.8%) and private sectors (10.0%). Notably, all respondents (100%) were from rural settings, ensuring that the findings authentically reflect the rural community's mental health knowledge and attitudes in Solan district.
Table 2 provides a comprehensive assessment of participants’ awareness and understanding of mental health conditions, symptoms, and treatment modalities. Overall, the majority demonstrated substantial knowledge, with 78.8% correctly identifying disruptions in emotional or cognitive functioning as hallmarks of mental disorders and 80.8% acknowledging that prolonged stress alters brain chemistry and function. Similarly, 79.3% recognized persistent excessive worry as a defining feature of generalized anxiety disorder. Awareness of the role of stigma was notable, with 82.3% acknowledging its impact on discouraging help-seeking behaviors. However, gaps were evident: only 64.3% correctly rejected the misconception that mental health disorders are indicative of personal failure, and just 63.0% understood the broader societal benefits of destigmatizing mental health. Other key findings included strong awareness about the effectiveness of psychotherapy (71.5%), lifestyle interventions (76.5%), and the critical role of timely interventions in improving prognosis (81.0%). Overall, correct response rates across questions ranged from 61.5% to 84.5%, highlighting both encouraging strengths and specific areas requiring targeted mental health literacy initiatives within the rural population.
Table 3 classifies the participants based on their cumulative mental health knowledge scores, offering a clear snapshot of overall awareness levels. Impressively, 30.3% of respondents achieved a "Very Good" knowledge score (≥80% correct responses), reflecting strong mental health literacy among nearly one-third of the sample. The largest proportion, 43.8%, fell into the "Good" knowledge category (60%–79%), suggesting a reasonably high level of understanding but with room for further improvement. However, 19.3% of participants were categorized under
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency | Percentage |
Age Group (Years) | 18–25 | 92 | 23.0 |
26–35 | 158 | 39.5 | |
36–45 | 104 | 26.0 | |
46 and above | 46 | 11.5 | |
Gender | Female | 218 | 54.5 |
Male | 182 | 45.5 | |
Education Level | No formal education | 34 | 8.5 |
Primary school | 76 | 19.0 | |
Secondary school | 148 | 37.0 | |
Undergraduate degree | 112 | 28.0 | |
Postgraduate degree | 30 | 7.5 | |
Occupation | Homemaker | 146 | 36.5 |
Self-employed | 82 | 20.5 | |
Government employee | 47 | 11.8 | |
Private sector | 40 | 10.0 | |
Student/Unemployed | 85 | 21.3 | |
Residential Setting | Rural | 400 | 100.0 |
18–25 | 92 | 23.0 |
Table 2: Awareness and Knowledge of Mental Health Conditions Among Participants
Question | Options | Correct Responses (n) | Percentage (%) |
How are mental health disorders primarily characterized? | a) Chronic infections, b) Disruptions in emotional or cognitive functioning, c) Physical deformities, d) Nutritional deficiencies | 315 | 78.8 |
Can chronic depression lead to somatic manifestations like fatigue or pain? | a) Yes, b) No, c) Only in severe cases, d) Only with coexisting illnesses | 301 | 75.3 |
What distinguishes generalized anxiety disorder as a clinical condition? | a) Persistent excessive worry impacting daily life, b) Occasional nervousness, c) Only work-related stress, d) Only genetic predisposition | 317 | 79.3 |
How does prolonged stress influence neurobiological pathways in mental health? | a) Alters brain chemistry and function, b) Only affects sleep, c) Causes physical injuries, d) No significant impact | 323 | 80.8 |
Are evidence-based interventions effective for managing mental health disorders? | a) Yes, b) No, c) Only surgical treatments, d) Only traditional remedies | 308 | 77.0 |
Does clinical depression differ from transient emotional distress? | a) Yes, b) No, c) Only in duration, d) Only in elderly | 262 | 65.5 |
What is a hallmark cognitive symptom of anxiety disorders? | a) Catastrophic thinking patterns, b) Improved focus, c) Memory enhancement, d) Only physical symptoms | 293 | 73.3 |
How do untreated mental health conditions contribute to suicide risk? | a) Increase vulnerability through emotional dysregulation, b) No impact, c) Only in urban settings, d) Only with substance abuse | 314 | 78.5 |
Can psychotherapy yield measurable improvements in mental health outcomes? | a) Yes, b) No, c) Only for mild cases, d) Only in hospitals | 286 | 71.5 |
Are mental health disorders indicative of personal failure? | a) Yes, b) No, c) Only in specific cultures, d) Only in youth | 257 | 64.3 |
Can structured lifestyle interventions mitigate mental health symptoms? | a) Yes, b) No, c) Only with medication, d) Only for stress | 306 | 76.5 |
How does social stigma act as a barrier to mental health treatment access? | a) Discourages help-seeking through fear of judgment, b) No effect, c) Only in rural areas, d) Only for severe disorders | 329 | 82.3 |
Are genetic factors implicated in the etiology of mental health disorders? | a) Yes, b) No, c) Only for schizophrenia, d) Only in women | 279 | 69.8 |
Is cognitive-behavioral therapy a validated mental health treatment? | a) Yes, b) No, c) Only for children, d) Only in urban clinics | 291 | 72.8 |
How do mental health disorders impact physiological health outcomes? | a) Exacerbate chronic physical conditions, b) No impact, c) Only in elderly, d) Only with stress | 304 | 76.0 |
What are the societal benefits of destigmatizing mental health discussions? | a) Encourages early intervention and support, b) No benefits, c) Only in schools, d) Only for families | 252 | 63.0 |
Why is community-level mental health education critical? | a) Enhances awareness and reduces stigma, b) No importance, c) Only for urban communities, d) Only in healthcare settings | 319 | 79.8 |
Which symptom is least associated with mental health disorders? | a) Emotional instability, b) Cognitive distortions, c) Chronic fatigue, d) Bone fractures | 246 | 61.5 |
How does timely mental health intervention affect long-term prognosis? | a) Significantly improves recovery outcomes, b) No effect, c) Only with medication, d) Only in youth | 324 | 81.0 |
Who is best equipped to diagnose and treat mental health disorders? | a) Community leaders, b) Licensed mental health specialists, c) General physicians, d) Self | 338 | 84.5 |
Table 3: Knowledge Score Classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 121 | 30.3 |
Good | 60%–79% | 175 | 43.8 |
Fair | 41%–59% | 77 | 19.3 |
Poor | <40% | 27 | 6.8 |
"Fair" knowledge (41%–59%), and 6.8% demonstrated "Poor" knowledge (<40%), indicating that around one-quarter of the rural population surveyed lacked adequate awareness about mental health conditions. These findings underscore the need for sustained and targeted mental health education campaigns in rural areas, with a special focus on elevating knowledge among those currently falling within the Fair and Poor categories to promote early recognition, reduce stigma, and enhance help-seeking behaviors.
This community-based cross-sectional study provides valuable insights into the level of mental health awareness, prevailing stigma, and social attitudes among the rural population of Solan district, Himachal Pradesh. The findings reveal a cautiously optimistic scenario, characterized by encouraging levels of foundational knowledge about mental health conditions such as depression, anxiety, and stress. However, critical gaps in technical understanding, persistent misconceptions, and deeply rooted stigma highlight the pressing need for culturally sensitive and targeted mental health literacy interventions.
The socio-demographic profile of participants (Table 1) reflects the diverse composition of rural Solan, with a strong representation of young and middle-aged adults (39.5% aged 26–35 years and 26.0% aged 36–45 years) and a slight female predominance (54.5%). The literacy spread, with 37.0% having completed secondary education and 28.0% holding undergraduate degrees, indicates a relatively educated rural sample, yet the presence of participants without formal education (8.5%) underscores the persistent educational disparities that may influence mental health understanding and help-seeking behavior. The dominance of homemakers (36.5%) and self-employed individuals (20.5%) suggests that economic and domestic responsibilities may intersect significantly with mental health perceptions and behaviors in these communities.
The awareness assessment (Table 2) revealed a relatively robust understanding of mental health fundamentals, with the majority correctly identifying mental health disorders as disruptions in emotional or cognitive functioning (78.8%) and recognizing the neurobiological impact of prolonged stress (80.8%). Encouragingly, participants demonstrated strong awareness of key symptoms of depression, anxiety, and the importance of evidence-based interventions, including psychotherapy and structured lifestyle modifications. The role of stigma as a barrier to help-seeking was acknowledged by 82.3% of respondents, aligning with global evidence that social stigma remains one of the most significant impediments to accessing mental health care, particularly in rural areas.
Nevertheless, the study identified several important knowledge gaps and misconceptions. Only 64.3% rejected the notion that mental health disorders are indicative of personal failure, reflecting deep-rooted cultural stigma that frames mental illness as a character flaw rather than a legitimate health condition. Similarly, understanding of the broader societal benefits of destigmatizing mental health discussions was limited (63.0%), suggesting that public health messaging must not only target individual awareness but also promote community-wide shifts in attitudes. Alarmingly, misconceptions about the biological basis and chronic nature of mental disorders persisted among a notable proportion of participants, with only 69.8% recognizing the role of genetic factors, and 61.5% correctly identifying symptoms least associated with mental health conditions. These findings mirror trends observed in other rural regions of India, where stigma, lack of knowledge, and traditional beliefs often contribute to delayed diagnosis, underreporting, and poor mental health outcomes.
The cumulative knowledge scores (Table 3) provide further context to these findings. While 74.1% of participants achieved "Good" or "Very Good" knowledge levels, approximately one-quarter (26.1%) exhibited only "Fair" or "Poor" awareness. This substantial minority represents a critical target group for intervention, particularly given the well-documented association between low mental health literacy and increased morbidity, poorer quality of life, and higher suicide risk. Notably, the higher awareness levels observed may be partially attributed to the study's online methodology, which likely captured participants who are relatively more digitally literate and health-conscious. It is reasonable to infer that awareness levels in digitally disconnected and more marginalized segments of rural Solan may be even lower, emphasizing the need for proactive, ground-level mental health promotion efforts.
Furthermore, the results underscore the urgent need to address rural-specific barriers to mental health care. Traditional beliefs, stigma attached to seeking professional help, and a strong preference for informal community or religious support over medical interventions continue to influence help-seeking behavior. As studies have shown, rural communities often perceive mental health services as inaccessible, stigmatizing, or irrelevant to their context, leading to reliance on home remedies, traditional healers, or complete avoidance of care. This cultural dynamic necessitates that any public health interventions be community-driven, culturally appropriate, and delivered through trusted local channels, such as Accredited Social Health Activists (ASHAs), school teachers, village leaders, and religious figures.
In terms of public health strategy, these findings highlight several critical priorities. First, there is an urgent need to integrate mental health literacy into primary healthcare outreach programs, using simple, relatable language and culturally resonant examples. Second, destigmatization campaigns must be normalized within rural discourse, emphasizing that mental health conditions are common, treatable, and not a sign of personal weakness. Third, initiatives must actively involve rural youth and homemakers the dominant demographic groups identified in the study who can serve as important change agents in transforming community attitudes. Schools, workplaces, and self-help groups offer promising platforms for delivering mental health education and support [7-9].
Finally, there is a strong case for investing in rural mental health infrastructure, including mobile mental health units, tele-counseling services, and training of rural health workers in basic mental health care and psychosocial support. Tailored interventions that respect local traditions while promoting evidence-based treatments will be crucial in bridging the urban-rural mental health divide. Only through a multi-pronged approach combining education, service accessibility, stigma reduction, and community empowerment can rurally districts like Solan move towards achieving true mental health equity.
This study highlights a promising yet incomplete landscape of mental health awareness among the rural population of Solan district, Himachal Pradesh, revealing substantial foundational knowledge about conditions such as depression, anxiety, and stress, but also exposing persistent stigma, misconceptions, and critical knowledge gaps that threaten to undermine early intervention and help-seeking behaviors. While a significant majority demonstrated good to very good awareness levels, approximately one-fourth of the participants still exhibited fair to poor knowledge, indicating an urgent need for targeted educational initiatives. Deep-rooted cultural stigmas framing mental health disorders as personal failures, limited understanding of the societal benefits of destigmatization, and misconceptions surrounding treatment options underscore the complexity of challenges facing rural mental health promotion. These findings call for a multi-pronged, culturally sensitive public health approach integrating mental health literacy into primary care, leveraging trusted community figures, expanding rural mental health infrastructure, and normalizing conversations around psychological well-being to foster a more informed, supportive, and resilient rural society capable of addressing its growing mental health needs with compassion and confidence.
Srivastava, K., K. Chatterjee, and P. S. Bhat. "Mental Health Awareness: The Indian Scenario." Indian Psychiatry Journal, vol. 25, no. 2, 2016, pp. 131–34.
Shivani, K. M., and J. Judge. "Exploration of Mental Health Awareness and Stigma Associated with Mental Illness Among College Students." International Journal of Health Sciences, vol. 6, suppl. 2, 2022, pp. 8068–76.
Meghrajani, V. R., M. Marathe, R. Sharma, A. Potdukhe, M. B. Wanjari, and A. B. Taksande. "A Comprehensive Analysis of Mental Health Problems in India and the Role of Mental Asylums." Cureus, vol. 15, no. 7, 2023, e42559.
Gaiha, S. M., T. Taylor Salisbury, M. Koschorke, et al. "Stigma Associated with Mental Health Problems Among Young People in India: A Systematic Review of Magnitude, Manifestations and Recommendations." BMC Psychiatry, vol. 20, 2020, p. 538.
"Breaking the Stigma: Addressing Mental Health in India." Times of India Blog, https:// timesofindia. indiatimes. com/ readersblog/myamusings/breaking-the-stigma-addressing-mental-health-in-india-49561/. Accessed 29 Mar. 2025.
"Strategies for Mental Health Awareness in India." The Live Love Laugh Foundation, https:// www. Thelivelovelaugh foundation. org/ blog/ others/ strategies-for-mental-health- awareness-in-india. Accessed 29 Mar. 2025.
Kulkarni, K. S., M. N. Joshi, H. S. Sathe, and C. Maliye. "Awareness and Attitude About Mental Illness in the Rural Population of India: A Mixed Method Study." Indian Journal of Psychiatry, vol. 65, no. 10, 2023, pp. 1069–77.
Kaur, A., S. Kallakuri, A. Mukherjee, et al. "Mental Health Related Stigma, Service Provision and Utilization in Northern India: Situational Analysis." International Journal of Mental Health Systems, vol. 17, 2023, p. 10.
Sindhu, M., S. Phadnis, Z. Chouhan, P. Saraswat, and S. Maheshwari. "Awareness and Attitudes Towards Common Mental Health Problems of Community Members in Udupi Taluk, Karnataka: A Mixed Method Study." Clinical Epidemiology and Global Health, vol. 10, 2021, p. 100679.
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