The Relationship of Mental Health Literacy (MHL) with Psychological Status in Patients with Diabetes Mellitus - Pulmonary Tuberculosis at the Gorontalo City Health Center

  • Sri Melinda Hippy Program Studi Ilmu Keperawatan, Fakultas Olahraga Dan Kesehatan, Universitas Negeri Gorontalo
  • Zainuddin Program Studi Ilmu Keperawatan, Fakultas Olahraga Dan Kesehatan, Universitas Negeri Gorontalo
  • Rachmawaty D. Hunawa Program Studi Ilmu Keperawatan, Fakultas Olahraga Dan Kesehatan, Universitas Negeri Gorontalo
Keywords: Mental Health Literacy, Psychological Status, Diabetes Mellitus, Pulmonary Tuberculosis, Pulmonary DM-TB, Psychological Disorders

Abstract

Background: Diabetes Mellitus (DM) and Pulmonary Tuberculosis (Pulmonary TB) are two interrelated chronic diseases that can cause various psychological problems in sufferers. Pulmonary DM-TB patients are at risk of experiencing stress, anxiety, and depression that have an impact on psychological status. One of the factors that is suspected to play a role in this condition is Mental Health Literacy (MHL), which is an individual's ability to understand, recognize, and manage mental health problems.

Objective: This study aims to determine the relationship between Mental Health Literacy and psychological status in patients with Diabetes Mellitus–Pulmonary Tuberculosis at the Gorontalo City Health Center.

Methods: This study used a quantitative design with a cross-sectional approach. The research population amounted to 75 patients with Pulmonary DM-TB registered in six health centers in the Gorontalo City area. A sample of 63 respondents was selected using the purposive sampling technique. Data were collected using the Mental Health Literacy and psychological status questionnaire, then analyzed using the Chi-Square test with a significance level of 0.05.

Results: The results showed that most of the respondents had  high Mental Health Literacy as many as 41 respondents (65.1%), while 22 respondents (34.9%) had  low Mental Health Literacy. The psychological status of respondents was dominated by the severe distress  category of 37 respondents (58.7%) and mild distress as many as 26 respondents (41.3%). The results of the Chi-Square test showed  a p-value of 0.006 (p < 0.05), which means that there is a significant relationship between Mental Health Literacy and psychological status in patients with Pulmonary DM-TB.

Conclusion: There is a significant relationship between Mental Health Literacy and psychological status in Diabetes Mellitus–Pulmonary Tuberculosis patients at the Gorontalo City Health Center. The better the level  of Mental Health Literacy that a patient has, the better their ability to manage psychological conditions during the treatment of chronic diseases.

References

Amatullah, A. R., & Hazim, H. (2025). Psychological Well-Being - Definition, Aspects and Influencing Factors. 8(1), 287–304.

Anggreni, D. (2022). Health Research Methodology.

Apriliani, P., Katili, A., & Basir, I. S. (2025). THE RELATIONSHIP BETWEEN STRESS AND BLOOD SUGAR LEVELS OF PATIENTS WITH TYPE II DIABETES MELLITUS AT THE KABILA HEALTH CENTER. Sec. 1(1), 28–44.

Asrulla, Risnita, Jailani, M. S., & Jeka, F. (2023). Population and Sampling (Quantitative), as well as the Selection of Key Informants (Qualitative) in a Practical Approach. Journal of Tambusai Education, 7(3), 26320–26332.

Bagubair, A. A., & Dapari, R. (2025). Factors associated with mental health literacy among healthcare workers in a university hospital in Selangor. Clinical Epidemiology and Global Health, 35(January 2024), 102142. https://doi.org/10.1016/j.cegh.2025.102142

Coal, F. A., & Lukito, A. (2024). Relationship Of Type II Diabetes Mellitus With The Risk Of Enhancement The Incidence Of Pulmonary Tuberculosis At Haji General Hospital Medan In 2022. Ibn SIna: Journal of Medicine and Health, Faculty of Medicine, Islamic University of North Sumatra, 23(2), 178–185.

Bevery, E. A., Ritholz, M. D., & Dhanyamraju. (2020). The effect of social support in reducing psychological distress and depressive symptoms due to diabetes in adults with Type 1 and Type 2 diabetes. BMC Public Health. https://pubmed.ncbi.nlm.nih.gov/33258148/

Caskie, G. I. L., & Root, E. Z. (2023). The Associations between eMental Health Literacy , Barriers to Mental Health Services , and Psychological Distress in Older Adults. 42(5), 951–961. https://doi.org/10.1177/07334648221146775

Chauhan, A., Parmar, M., Dash, G. C., Chauhan, S., Sahoo, K. C., Samantaray, K., Sharma, J., Mahapatra, P., & Pati, S. (2024). Health literacy and tuberculosis control: systematic review and meta-analysis. Bulletin of the World Health Organization, 102(6), 421–431. https://doi.org/10.2471/BLT.23.290396

Chen, H., Wang, B., Liu, Y., Liu, Q., Bai, J., Yao, L., & Shen, B. (2025). The relationship between diabetes distress and eHealth literacy among patients under 60 years of age with diabetes : a multicenter cross-sectional survey.

Chen, X., Wu, R., Xu, J., Wang, J., Gao, M., Chen, Y., Pan, Y., Ji, H., Duan, Y., Sun, M., Du, L., & Zhou, L. (2021). Prevalence and associated factors of psychological distress in tuberculosis patients in Northeast China: a cross-sectional study. BMC Infectious Diseases, 21(1), 1–12. https://doi.org/10.1186/s12879-021-06284-4

Dekanawati, V., Astriawati, N., Setiyantara, Y., Subekti, J., & Kirana, A. F. (2023). Analysis of the Influence of Customs Training Service Quality on Trainee Satisfaction. Journal of Maritime Science and Technology, 23(2), 159. https://doi.org/10.33556/jstm.v23i2.344

Elsiandi, C. A., Turana, Y., Handajani, Y. S., Francisco, J., & Barus, A. (2024). QUALITY OF LIFE IN THE ELDERLY, DEPRESSION AND LOW EDUCATION AS A MAJOR DETERMINANT OF QUALITY OF LIFE IN ELDERLY. 23(3).

Fatmawaty, D., Febrianti, C. A., & Sari, N. (2024). Determinants of Situational Factors Related to Mental Health Literacy in Students. Surya Medika: Scientific Journal of Nursing and Public Health Sciences, 19(1), 1–8. https://doi.org/10.32504/sm.v19i01.907

Handayani, T., Ayubi, D., & Anshari, D. (2020). Adult Mental Health Literacy and the Use of Mental Health Services. Behavior and Health Promotion: Indonesian Journal of Health Promotion and Behavior, 2(1), 9. https://doi.org/10.47034/ppk.v2i1.3905

Haryani, W., & Setyobroto, I. (2022). RESEARCH ETHICS MODULE. Department of Health GIgi Polytechnic Jakarta. https://www.studocu.id/id/document/universitas-sebelas-april/ilmu-pengetahuan-sosial/modul-etika-penelitian-kesehatan-metodologi-penelitian-mkes/131650352

Huang, Y., Li, S., Lu, X., Chen, W., & Zhang, Y. (2024). The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis. Healthcare (Switzerland), 12(21). https://doi.org/10.3390/healthcare12212151

Idaini, S., & Suhardi. (2019). GHQ 2006_Sri I_validitas-and-reliability. In Validity and Reliability of the General Health Questionnaire for Screening for Psychological Distress and Social Dysfunction in the Community (Vol. 34, Issue 4, pp. 161–173).

Jafari, A., Moshki, M., Naddafi, F., Ghelichi-Ghojogh, M., Armanmehr, V., Kazemi, K., & Nejatian, M. (2024). Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1421053

Jolly, A., Farrell, S., Chua, K., Sungmin, J., Khangura, R., & Henderson, C. (2022). SSM - Mental Health Mental health literacy : A focus on daily life context for population health measurement. SSM - Mental Health, 2(May), 100118. https://doi.org/10.1016/j.ssmmh.2022.100118

Kang, J. Y., Han, K., Lee, S. H., & Kim, M. K. (2023). Diabetes severity is strongly associated with the risk of active tuberculosis in people with type 2 diabetes: a nationwide cohort study with a 6-year follow-up. Respiratory Research, 24(1), 1–9. https://doi.org/10.1186/s12931-023-02414-5

Klainin-Yobas, P., Vongsirimas, N., Ramirez, D. Q., Sarmiento, J., & Fernandez, Z. (2021). Evaluating the relationships among stress, resilience and psychological well-being among young adults: a structural equation modelling approach. BMC Nursing, 20(1), 1–10. https://doi.org/10.1186/s12912-021-00645-9

Koutra, K., Pantelaiou, V., & Mavroeides, G. (2024). Breaking Barriers: Unraveling the Connection between Mental Health Literacy, Attitudes towards Mental Illness, and Self-Stigma of Psychological Help-Seeking in University Students. Psychology International, 6(2), 590–602. https://doi.org/10.3390/psycholint6020035

Kurniawan, Y. F., & Wijaya, D. S. (2025). RISK FACTORS FOR THE OCCURRENCE OF DIABETES MELLITUS. Journal of Health Sciences, 9(2), 94. https://doi.org/10.32831/jik.v9i2.304

Latif, A. Insani, Tiala, N., & Masahuddin, L. (2023). TUBERCULOSIS A Review of Medical, Nursing Care, and E-Health (A. Hapsan (ed.)). CV.TENTOR'S ROOM. https://doi.org/https://www.google.co.id/books/edition/TUBERKULOSIS_Tinjauan_Medis_Asuhan_Keper/uPu6EAAAQBAJ?hl=id&gbpv=1&dq=pemeriksaan+penunjang+tuberkulosis&pg=PA18&printsec=frontcover

Lestari, Zulkarnain, & Sijid Aisyah. (2021). Diabetes Mellitus: Review of Etiology, Pathophysiology, Symptoms, Methods of Examination, Treatment and Prevention. Journal of UIN Alaudin, November, 237–241.

Li, A. (2021). Individual and organizational health literacies : moderating psychological distress for individuals with chronic conditions. 44(3), 651–662.

Li, X., Fang, X., Zhou, L., & Mao, Y. (2023). Prevalence and Factors Associated with Depression in Patients with Diabetes Mellitus and Pulmonary Tuberculosis (DM-PTB): A Hospital-Based Cross-Sectional Study. International Journal of General Medicine, Volume 16 (August), 3465–3472. https://doi.org/10.2147/ijgm.s412675

Lisa, R., Fox, G. J., Thu Anh, N., Bernarys, S., Paul, M., Anh Vu, V., Viet Nhung, N., & Ellen, M. M. H. (2024). Tuberculosis and diabetes mellitus: The complexity of the comorbid interactions. International Journal of Infectious Diseases, 146, 107140. https://doi.org/10.1016/j.ijid.2024.107140

Listrianti, M., Garna, H., & Pearl, G. (2023). Literature Review: Anxiety in People with Type 2 Diabetes Mellitus. Bandung Conference Series: Medical Science, 3(1), 453–459. https://doi.org/10.29313/bcsms.v3i1.6243

Luo, Z., Li, K., Chen, A., Qiu, Y., Yang, X., Lin, Z., Liu, J., & Wu, Y. (2024). The influence of family health on self - efficacy in patients with chronic diseases : the mediating role of perceived social support and the moderating role of health literacy. https://doi.org/10.1186/s12889-024-20906-x

Minhat, H. S., Guo, K., & Ouyang, J. (2023). The mediating role of health literacy between the presence of chronic disease and psychological distress among older persons in Xi'an city of China. BMC Public Health, 23(1), 1–13. https://doi.org/10.1186/s12889-023-17315-x

Minsarnawati, & Maziyya, A. A. (2023). Patterns of Tuberculosis (TB) in East Java Province (M. Nasrudin (ed.)). PT Nasya Expanding Management. https://doi.org/https://www.google.co.id/books/edition/Pola_Penyakit_Tuberkulosis_TBC_di_Provin/iP2xEAAAQBAJ?hl=id&gbpv=1&dq=Pemeriksaan+penunjang+tuberkulosis&pg=PA12&printsec=frontcover

Moshki, M., Jafari, A., Ghelichi-Ghojogh, M., & Nejatian, M. (2024). Role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting quality of life in type 2 diabetes. Scientific Reports, 14(1), 1–10. https://doi.org/10.1038/s41598-024-51245-x

Muslic, L., Buric, D. J., Markelic, M., & Milanovic, S. M. (2021). Mental health literacy. Socijalna Psihijatrija, 48(3), 324–343. https://doi.org/10.24869/SPSIH.2020.324

Negeri, S. D., & Tuntungan, M. (2022). 3) 1)2)3). 6(1), 77–86.

Nugraha, M. D., Ramdhani, Y. N., & Utami, M. (2023). The relationship between family support and the level of stress in the elderly with Type 2 Diabetes Mellitus in the Kuningan Health Center Working Area in 2023. 4(1), 172–179.

Nur, M., Soraya, Af., Hady, A. J., & Health Ministry of Health Makassar, P. (2022). The literature reviews risk factors for DM incidence in TB patients. Scientific Journal of Health Diagnosis, 17(4), 146–154. https://jurnal.stikesnh.ac.id/index.php/jikd/article/view/1181

Oliveira, T. A. A., Gouveia, V. V., Ribeiro, M. G. C., Oliveira, K. G., de Melo, R. L. P., & Montagna, E. (2023). General Health Questionnaire (GHQ12): new evidence of construct validity. Collective Health Science, 28(3), 803–810. https://doi.org/10.1590/1413-81232023283.09452022

Prasiska, D. I., Chapagain, D. D., Osei, K. M., Rajaguru, V., Kang, S. J., Kim, T. H., Lee, S. G., & Han, W. (2024). Non-communicable comorbidities in pulmonary tuberculosis and healthcare utilization: a cross-sectional study of 2021 Indonesian national health insurance data. Archives of Public Health, 82(1), 1–10. https://doi.org/10.1186/s13690-024-01352-y

Putri, P. R. (2024). Journal of Community Service. Sec. 3(01), 1–6.

Raya, K. B. U., & Barat, K. (2024). 1), 2) 1). 9(1), 2018–2022.

Sari, G. K., Sarifuddin, & Setyawati, T. (2022). Pulmonary Tuberculosis Post Wodec Pleural Effusion: Case Report Pulmonary Tuberculosis Post Wodec Pleural Effusion: Case Report. Journal of the Medical Profession, 4Ns. Aulia(2), 174–182.

Satriadi, S.AP, M. S., Prof. Dr. Ir. Anoesyirwan Moeins, M. Sc., M. ., Tubel Agusven, S.T., M. ., Sjukun, S.T., M. ., & Dr. Sumardin, S.E., M. . (2023). Quantitative Research Methodology (Moh Suardi). PUBLISHER. CV.AZKA PUSTAKA. https://www.google.co.id/books/edition/METODOLOGI_PENELITIAN_KUANTITATIF/xvHAEAAAQBAJ?hl=id&gbpv=1&dq=inauthor:%22Satriadi,+S.AP,+M.Sc+Prof.+Dr.+Ir.+Anoesyirwan+Moeins,+M.Sc.,+M.M+Tubel+Agusven,+S.T.,+M.M.+Sjukun,+S.T.,+M.M.+Dr.+Sumardin,+S.E.,+M.M.%22&pr

Schimmelmann, N. O. C. M. B. G., Schilbach, L., & Lutter, E. M. F. S. (2023). Influence of mental health literacy on help - seeking behaviour for mental health problems in the Swiss young adult community : a cohort and longitudinal case – control study. European Archives of Psychiatry and Clinical Neuroscience, 273(3), 649–662. https://doi.org/10.1007/s00406-022-01483-9

Sihotang, H. (2023). Quantitative Research Methods. In Center for Publishing and Printing Higher Education Books, Indonesian Christian University, Jakarta.

Solichin, I., & Alkarni, M. D. (2022). Upper thoracic spondylitis tubercolosis treated by posterior approach only: A case report. International Journal of Surgery Case Reports, 96(June), 107321. https://doi.org/10.1016/j.ijscr.2022.107321

Subhaktiyasa, P. G. (2024). Determining Population and Sample: Quantitative and Qualitative Research Methodology Approach. 9, 2721–2731.

Suhardi, M. (2023). Research Methodology. Center for the Development of Indonesian Education and Research. https://www.google.co.id/books/edition/Buku_ajar_Dasar_Metodologi_Penelitian/nhCmEAAAQBAJ?hl=id&gbpv=1&dq=data+primer+adalah+data+yang+diperoleh+atau+dikumpulkan+oleh+peneliti+secara+langsung+dari+sumber+datanya&pg=PA81&printsec=frontcover

Syafyu Sari, F., Afnuhazi, R., & Hendrawati, H. (2024). Nursing Care for Mr. S with Instability of Blood Glucose Levels. Journal of Nursing Literature (Center for Access to Nursing Studies), 3(1), 20–28. https://doi.org/10.55382/jurnalpustakakeperawatan.v3i1.723

Tamunu, M. Sarra, Pareta, D. N., Hariyadi, H., & Karauwan, F. A. (2022). Phytochemical screening and antioxidant activity test of benalu leaf extract on dendrophtoe pentandra (L.) kersen using the 2,2- diphenyl-1- picrylhydrazyl (DPPH) method. Tropical Biopharmaceuticals, 5(1), 79–82. https://doi.org/10.55724/jbiofartrop.v5i1.378

Tareke, M., Bayeh, A. B., Birhanu, M., & Belete, A. (2022). Psychological distress. (2025). Literacy. https://www.unesco.org/en/literacy/need-know people living with chronic medical illness and the general population, Northwest Ethiopia: A comparative cross-sectional study. PLoS ONE, 17(12 December), 1–13. https://doi.org/10.1371/journal.pone.0278235

Thong, P. M., Wong, Y. H., Kornfeld, H., Goletti, D., & Ong, C. W. M. (2025). Immune dysregulation of diabetes in tuberculosis. Seminars in Immunology, 78(November 2024), 101959. https://doi.org/10.1016/j.smim.2025.101959

Tiera, I., Beeh, K., Ruliati, L. P., Pello, S. C., & Kiling, I. Y. (2025). Coping Stress Strategy in the Elderly in Oetete Village, Oebobo District, Kupang City JOURNAL OF MEDIA INFORMATICS [ JUMIN ]. 6(3), 1977–1983.

Tran, N. M. H., Le, T. T. A., Ho, D., Tran, H. V., Lam, T. B., Nguyen, T. H. N., Pham, M. T., Nguyen, V. T., & Ngo, T. K. C. (2025). Assessing mental health literacy among patients with chronic physical diseases and its associated sociodemographic factors. T?p Chí and D??c Hu?, 15(2), 28–35. https://doi.org/10.34071/jmp.2025.2.4

Umayya, L. I., & Wardani, I. S. (2023). The link between diabetes mellitus and glaucoma. Journal of Medika Hutama, 04(01), 3280–3291.

UNESCO. (2024). Literacy. https://www.unesco.org/en/literacy/need-know

Wahdi, A., & Puspitosari, D. R. (2021). Getting to Know Tuberculosis. Angewandte Chemie International Edition, 6(11), 951–952., 23–24.

Wang, D., Sun, X., & Wu, Y. (2023). The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China. BMC Public Health, 69(1), 1–17. https://journals.sagepub.com/doi/10.1177/00207640231166628

Wardhana, A. (2023). Quantitative and qualitative research instruments. In Health Research Methodology (November issue).

Waruwu, M., Pu'at, S. N., Utami, P. R., Yanti, E., & Rusydiana, M. (2025). Quantitative Research Methods: Concepts, Types, Stages and Advantages. Scientific Journal of the Education Profession, 10(1), 917–932. https://doi.org/10.29303/jipp.v10i1.3057

WHO. (2025). WHO operational handbook on TB and comorbidities, Diabetes. Diabetes Mellitus with Tuberculosis is now one of the leading causes of global deaths, which is very worrying. Based on a report from the World Health Organization (WHO), in 2021, there were 10.7 million cases of pulmonary TB worldwide, with s

Wuisang, M., & Lainsamputty, F. (2023). The relationship between healthy living behavior and psychological distress in nursing students. Holistic Health Journal, 17(2), 142–149. https://doi.org/10.33024/hjk.v17i2.9363

Xu, G., Hu, X., Lian, Y., & Li, X. (2023). Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMC Infectious Diseases, 23(1), 1–13. https://doi.org/10.1186/s12879-023-08765-0

Yang, J., Li, Y., Gao, R., Chen, H., & Yang, Z. (2023). Relationship between mental health literacy and professional psychological help-seeking attitudes in China: a chain mediation model. BMC Psychiatry, 23(1), 1–11. https://doi.org/10.1186/s12888-023-05458-5

Yulta Kadang, Ns S.Kep., M. K., Adi Sucipto, S.Kep., Ns., M. K., Hermanto, S.Kep, Ns., M. K., dr. Fika Tri Anggraini, M.Sc, P. ., Decy Erni Nasution, M. K., Ns. Fajar Susanti, M.Kep., S. K. K., Hamdani, SKM, M. K., Ns. Sri Marnianti Irnawan, S.Kep, M. K., Yuyun Tafwidhah, SKM, M. K., Deden Iwan Setiawan, S. Kep., Ns., M. K., Ns. Afni Yan Syah, S.Kep., M. K., Ns. Elin Hidayat, S.Kep., M. K., dr. Fika Tri Anggraini, M.Sc, P. ., & Ns. Fauzi Ashra, M.Kep., P. . (2025). Research Methodology. In Cv.Eureka Media Aksara.

Published
2026-06-13
How to Cite
Sri Melinda Hippy, Zainuddin, & Rachmawaty D. Hunawa. (2026). The Relationship of Mental Health Literacy (MHL) with Psychological Status in Patients with Diabetes Mellitus - Pulmonary Tuberculosis at the Gorontalo City Health Center. International Journal of Health, Economics, and Social Sciences (IJHESS), 8(3). https://doi.org/10.56338/ijhess.v8i3.9855
Section
Articles