Mental health knowledge-stigma profiles among primary healthcare workers involved in severe mental disorder management in Hainan, China

Under China’s Project 686 and the National Basic Public Health Service Program, primary healthcare workers play a central role in the community management of severe mental disorders. However, little is known about heterogeneity in mental health knowledge and perceived public stigma toward mental illness within this workforce. A province-wide cross-sectional census survey was conducted in Hainan Province, China (January–June 2025), including 694 primary healthcare workers. Mental health knowledge and perceived public stigma toward mental illness were assessed using standardized questionnaires. Latent profile analysis was conducted, followed by multinomial logistic regression to examine factors associated with profile membership. Among primary healthcare workers, the mental health knowledge awareness rate was 81.2%, although gaps persisted in etiology and suicide prevention. Perceived public stigma toward mental illness was prevalent. Three profiles were identified: low knowledge–high perceived public stigma (11.4%), high knowledge–low perceived public stigma (3.0%), and moderate knowledge–moderate perceived public stigma (85.6%). Using the moderate knowledge–moderate perceived public stigma profile as the reference, rural primary healthcare workers were more likely to belong to the low knowledge–high perceived public stigma profile (OR = 2.44, 95% CI: 1.30–4.56), whereas those with formal employment status were more likely to belong to the high knowledge–low perceived public stigma profile (OR = 7.78, 95% CI: 2.53–23.95). Primary healthcare workers show substantial heterogeneity in mental health knowledge and perceived public stigma toward mental illness, highlighting the need for stratified training and targeted interventions, particularly in rural and non–formally employed settings.