Non-inferiority of Virtual vs. Traditional Methods in Adolescent Mental Health Literacy

Mental health literacy is assessed using the Universal Mental Health Literacy Scale for Adolescents (UMHL-A), a validated 17-item Chinese-language instrument. Part A contains eight items assessing attitudes toward help-seeking and mental health-related stigma, scored on a 5-point Likert scale (range: 8-40). Part B contains nine items assessing general mental health knowledge and knowledge of specific mental illnesses, with each item scored 0 or 1 (range: 0-9). The total score ranges from 8 to 49. Higher scores indicate greater mental health literacy, including more positive attitudes and better knowledge, whereas lower scores indicate poorer mental health literacy. The Chinese version has demonstrated good reliability and validity among adolescents.

Depressive symptoms were assessed using the Visual Analogue Scale-Depression (VAS-Depression).Depressive symptoms during the preceding week are assessed using a 10-cm visual analogue scale ranging from 0 ("not depressed at all") to 10 ("extremely depressed"). Higher scores indicate greater symptom severity. Scores are categorized as mild (0-3), moderate (4-6), or severe (7-10). The scale demonstrates good concurrent validity with established depression measures, including the Beck Depression Inventory (r = 0.70-0.78), and test-retest reliability exceeding 0.80.

Anxiety symptoms were assessed using the Visual Analogue Scale-Anxiety. Anxiety symptoms during the preceding week are assessed using a 10-cm visual analogue scale ranging from 0 ("not anxious at all") to 10 ("extremely anxious"). Higher scores indicate greater symptom severity. Scores are categorized as mild (0-3), moderate (4-6), or severe (7-10). Correlations with established measures, including the State-Trait Anxiety Inventory, range from 0.65 to 0.76.

Sleep quality over the past month is assessed using the PSQI (Pittsburgh Sleep Quality Index), a 19-item self-report instrument that evaluates seven dimensions: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Total scores range from 0 to 21, with higher scores indicating poorer sleep quality.

Risk of gaming disorder is measured using the GDSS (Gaming Disorder Screening Scale), an 18-item Likert-type scale based on DSM-5 and ICD-11 criteria. It assesses symptoms such as loss of control over gaming, prioritizing gaming over other activities, and continued use despite negative consequences. Total scores range from 18 to 72, with higher scores indicating greater risk.

Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Chinese version of the Rosenberg Self-Esteem Scale is a 10-item unidimensional measure rated on a 4-point Likert scale, with five reverse-scored items. Total scores range from 10 to 40, with higher scores indicating greater self-esteem. Scores are classified as low (10-20), moderate (21-30), or high (31-40). The Chinese version has shown good internal consistency (Cronbach's α = 0.84-0.88) and test-retest reliability of approximately 0.82.

Perceived social support was assessed using the Adolescent Social Support Scale (ASSS). The Chinese Adolescent Social Support Scale comprises 17 items assessing support from parents, teachers, classmates, close friends, and the school. Items are rated on a 5-point Likert scale (1 = never to 5 = always), yielding a total score of 17-85; higher scores indicate greater perceived social support. Scores are classified as low (17-39), moderate (40-62), or high (63-85). The scale has excellent internal consistency overall (Cronbach's α = 0.96), with subscale α coefficients of 0.85-0.93 and test-retest reliability of 0.84.

Psychological resilience was assessed using the Resilience Scale for Chinese Adolescents (RSCA). The Resilience Scale for Chinese Adolescents contains 27 items covering two broad domains-personal strength and supportive resources-and five underlying factors. Items are rated on a 5-point Likert scale, with 12 reverse-scored items. Total scores range from 27 to 135, with higher scores indicating greater resilience. Scores are classified as low (27-81), moderate (82-105), or high (106-135). The scale has demonstrated good internal consistency (Cronbach's α = 0.83) and split-half reliability (0.80).