Psychiatric disorders are common, chronic health conditions associated with high disease burden and significant disability rates [1, 2]. The implementation of the three-tier prevention system for mental illnesses relies on early detection, accurate diagnosis, and timely treatment to halt and reduce disease progression [3]. Because mental health awareness directly impacts early detection and effective intervention, healthcare professionals must integrate strong clinical skills with evidence-based understanding, appropriate attitudes toward mental conditions, and adequate mental health knowledge.

Recent medical evidence demonstrates that psychiatric disorders often coexist with other complex conditions and contribute to the pathogenesis of organic diseases, such as endocrine and metabolic disorders, cardiovascular pathologies, and a range of infectious and gastrointestinal diseases [4, 5, 6, 7]. Mental health-related hospitalization increases across clinical services, and medical professionals increasingly encounter patients with mental disorders, necessitating enhanced mental health knowledge among non-psychiatric practitioners.

Current research on mental health knowledge awareness is limited and predominantly focuses on student populations. Among adolescents, Chinese youth reveal an overall awareness rate of 66%, with a higher rate reported among university students (73%) and a lower rate among secondary students (61%) [8]. Indonesian adolescents demonstrate significant cognitive deficits that hinder disease recognition and delay treatment [9]. Similarly, secondary students in northern Jordan exhibit low understanding of mental health issues [10]. Notably, among medical undergraduates in Uganda, knowledge retention regarding mental disorders reaches 77.72%, yet positive attitudes (49.29%) and sufficient mental health cognition (46.92%) remain inadequate [11].

Beyond the student cohort, population-level gaps are more prominent. Community-based surveys in Ethiopia reveal relatively poor public awareness of mental illnesses [12]. In clinical settings, only 21 out of 245 registered mental health nurses in the United Kingdom scored $>$80% on the knowledge of anti-psychotic drug side effects [13], and only 2.7% of Australian midwives correctly answered $>$11 questions in a 13-item perinatal mental health test [14]. These findings collectively underscore significant global deficits in mental health literacy across both student and non-student cohorts.

Grassroots medical personnel primarily working in community health centers and township settings, including registered physicians, nursing staff, and allied health professionals, form the cornerstone of primary care and play a crucial role in delivering mental health services. Their proficiency in mental health knowledge directly influences patients’ adherence to treatment and recovery outcomes. However, systematic assessments of their current mental health knowledge remain limited. Consequently, this study investigates grassroots medical workers to assess their mental health knowledge and identify specific needs, providing empirical evidence to inform workforce development and capacity-building in primary care.

Among 503 grassroots medical workers, the mean mental health knowledge score was 53.22 out of 70 (76%). Although this indicates a foundational knowledge base, labeling it ‘moderate-to-high’ needs caution. The substantial standard deviation of 17.44 points reflects significant inter-individual variation and high scores may reflect item difficulty or specificity rather than practical competence. Over 80% of grassroots medical workers selected mental health training items as “urgently needed” or “needed”, with some items exceeding 90%. This indicates a consistently high demand for mental health training among primary healthcare providers. Key contributing factors include:

First, since 2018, China’s National Health Commission has required primary healthcare institutions to screen for severe mental disorders, register patients, and provide follow-up management [15]. In some regions, mental health training has been included in professional title assessments, directly driving the need for systematic training. Second, rising social stressors, changing living environments, and post-Coronavirus Disease 2019 (COVID-19) conditions have increased the incidence of mental disorders and psychologically mediated diseases [16, 17], surpassing primary care capacity and necessitating enhanced skills among frontline physicians. Moreover, recovery from mental disorders is chronic and clinically characterized by high relapse rates, requiring continuous rehabilitation management [18]. Consequently, grassroots medical workers need competencies spanning the full cycle of care, driving substantial demand for comprehensive mental health training.

For training delivery, grassroots physicians favor short-term, intensive training programs, with “half-day weekday sessions” as the preferred choice. This preference reflects the requirements to manage heavy clinical workloads while timely updating mental health knowledge. Evidence on teaching formats reveals a parallel demand for centralized onsite instruction and distance education. Centralized onsite training—typically brief sessions—minimizes repeated absences that disrupt clinical services and suits the “multi-role staffing” nature of primary care. Conversely, distance education enables learning during fragmented time slots (e.g., between shifts or post-night duties), eliminates geographical barriers to reduce travel time and costs, and allows revisiting complex content via recordings to accommodate diverse learning paces.

Regarding teaching methodologies, there is a high demand for multiple instructional approaches, consistent with modern medical education’s “theory-practice-innovation” progression. The leading motivations for participation were “job requirements” and “professional development”, underscoring that updated knowledge or skills are essential for maintaining clinical quality and career advancement. In contrast, principal barriers to attendance were overwhelming clinical duties that complicated scheduling, concerns about service coverage during leave, and perceptions of irrelevant or lengthy course content.

Our analysis indicates that psychiatrists/psychiatric nurses, staff with senior professional titles, and those with longer years of service report a higher demand for psychiatric services. This likely reflects frequent, direct patient contact among psychiatrists/psychiatric professionals, supervisory and complex case responsibilities among senior medical staff, and greater overall exposure to cases among long-serving professionals, all of which indicate the need for continuous learning and ongoing competency development. The primary care health workers dealing with a huge number of patients need to understand the critical role of early psychiatric services in patient prognosis and also need extensive knowledge.

Furthermore, medical staff in public health, management, imaging, and laboratory professions also report greater demand for psychiatric services than clinical and nursing staff. The demand may likely be due to population-level responsibilities (public health), policy and resource planning (management) and the need to interpret laboratory findings in the context of psychiatric presentations (imaging and laboratory). In contrast, clinicians and nursing staff are more focused on acute care, which may reduce training needs. Consistent with expectations, higher psychiatric knowledge scores were observed among psychiatrists/psychiatric nurses, those with $>$10 years of service, and medical staff with prior participation in psychiatric work.

We acknowledge that this study has several limitations. First, it is a single-center, cross-sectional survey conducted in Tongxiang city, China, which limits the generalizability of the findings to regions with different healthcare systems, cultures, and economic contexts, warranting multi-center studies across diverse regions of China. Second, our statistical analysis relied on non-parametric tests and did not adjust for potential confounding factors using multivariate regression models. Thus, future studies with larger sample sizes could employ multiple linear or logistic regression to better estimate the independent effects of variables such as job position, years of service, and training participation on knowledge scores and training needs. Third, the very high Cronbach’s $\alpha$ coefficient (0.987) for the Mental Health Awareness Questionnaire suggests a potential redundancy among some items, which may inflate the reliability estimate and indicate that the instrument could be streamlined. Additionally, certain items in our Mental Health Awareness Questionnaire (e.g., knowledge of World Mental Health Day) assessed factual recall rather than practical, applied clinical reasoning. While this reflects awareness of policy and advocacy, future instruments should emphasize scenario-based questions that more directly assess competencies relevant to daily practice. Finally, administering the questionnaire 1–2 days after training completion may have increased response rates but could introduce bias, such as social desirability (participants providing answers as per the researchers’ needs) or the bandwagon or conformity effects (arising from recent group instruction). These limitations should be considered when interpreting our findings.

Primary care providers demonstrated foundational mental health knowledge, with significant inter-individual differences. Demand for mental health service training was uniformly high. Preferences for short-term, blended training formats and barriers of time constraints provide critical empirical evidence for informing the development of targeted training programs. Future research should implement and rigorously evaluate the effectiveness of such programs in improving clinical practices and patient outcomes.

To address these gaps, short-term intensive training courses that combine online and offline (in-person) approaches/components are recommended, with streamlined theoretical content and training programs or curricula tailored by position/role, professional title, and years of service. Policy guidance and incentive mechanisms should be used to enhance mastery of core mental health content. Furthermore, based on the significant disparities in mental health knowledge across job positions, a stratified training approach tailored to specific occupational roles should be implemented. For instance, psychiatric medical staff/clinicians, who had the highest scores, would benefit from advanced, case-based decision-making modules to further refine their diagnostic and intervention skills. Clinical physicians and nurses, who play a supplementary role in mental healthcare, should receive training on identification, referral, and basic psychosocial interventions. Similarly, public health workers and technicians should prioritize foundational mental health literacy and public health-oriented content.

• Grassroots medical workers demonstrated moderate-to-high baseline awareness of mental health challenges.

• Over 80% reported high training demand in both knowledge and skills, with some items exceeding 90%.

• Short-term workshops were the most preferred approach, with centralized lectures and distance education as favored formats.

• Key factors influencing participation in training included job requirements, career development needs, and workload constraints.

• Significant differences in training needs were observed across job positions/roles, specialties, titles, and service duration.

• Mental health knowledge scores were significantly affected by job role, years of service, and prior engagement in mental health work.

All data included in this study are available from the corresponding authors upon reasonable request.

YYM, CDT and JZ designed the research study and wrote the first draft. YYM and CDT performed the research. YYM analyzed the data. All authors contributed to the important editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

The study was approved by the Medical Ethics Committee of Kangci Hospital of Jiaxing (Approval No. 2025-LUNLI-013). All procedures performed in compliance with the Declaration of Helsinki. All patients provided informed consent.

Not applicable.

This study is supported by Zhejiang Province Medical and Health Science and Technology Plan Project (No. 2024XY180).

The authors declare no conflict of interest.