JMIR Publications

ABSTRACT

Background:

Mental health disorders represent a major public health challenge worldwide and substantially affect work ability, productivity, and social functioning. Public-sector employees are particularly exposed to psychosocial demands, yet data on their mental health literacy and supportive behaviors remain scarce. Mental Health First Aid (MHFA) aims to improve knowledge, attitudes, and behaviors (KAB) toward psychological distress among non-specialists, but evidence among civil servants and on skill retention over time is limited.

Objective:

This study aimed to (1) determine knowledge, attitudes, and behaviors related to psychological distress among French civil servants; (2) examine associations between KAB scores and MHFA training exposure and (3) explore gradients according to time since training as a proxy for skill retention.

Methods:

A nationwide cross-sectional survey was conducted in November 2025 among French civil servants. Participants completed an online questionnaire adapted from a validated KAB instrument. The scores for the three dimensions were normalized on a 0–40 scale, yielding a total KAB score ranging from 0 to 120. They were categorized as inadequate (0–70), marginal (71–88), or adequate (89–120). Multivariable linear regression models were used to identify factors associated with KAB outcomes, adjusting for sociodemographic and professional variables.

Results:

Among 338,560 eligible civil servants, 6,526 participants (1.93%) were included and 4,679 (1.38%) fully completed the questionnaire. Participants were predominantly female (64.6%), aged 40–69 years (92.3%), and belonged to professional category A (47.2%). The mean total KAB score in the overall population was 82.88 (SD 19.14), corresponding to a marginal level. Mean subscores were 31.31 (SD 5.26) for knowledge, 29.72 (SD 11.52) for attitudes, and 21.86 (SD 7.96) for behaviors. Participants who had completed MHFA training (11.6%) showed significantly higher total KAB scores than untrained participants (95.56 [SD 14.17] vs 81.21 [SD 19.09]; p<.001), with higher scores for knowledge (33.31 vs 31.04), attitudes (34.35 vs 29.10), and behaviors (27.87 vs 21.06; all p<.001). Among trained participants, a decreasing gradient was observed with increasing time since training (<6 months, 6–12 months, >12 months; p<.001), although scores remained higher than in untrained individuals beyond 12 months. In adjusted models, MHFA training was strongly associated with higher KAB scores (β = 14.63 for <6 months; β = 13.61 for 6–12 months; β = 10.33 for >12 months; all p<.001). Lower scores were observed in professional categories B and C compared with category A and among males.

Conclusions:

Mental health literacy and supportive behaviors among French civil servants remain heterogeneous and, on average, marginal. MHFA training is associated with substantially higher KAB scores, even beyond 12 months, supporting its role as a public health literacy intervention in occupational settings. The attenuation of scores over time highlights the relevance of reinforcement strategies to sustain mental health competencies within the civil service.