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Wang Y, Zhang J, Huang K. A study on the effect of school and family environments and self-efficacy on health literacy of college students. Front Public Health 2024; 12:1449819. [PMID: 39211899 PMCID: PMC11358104 DOI: 10.3389/fpubh.2024.1449819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Background Health literacy is an important means to improve health outcomes and reduce health disparities. It plays an important role in promoting multiple health-related behaviors of individuals. Numerous studies have demonstrated a number of sociodemographic and school characteristics, and family related factors were related to health literacy among college students. However, these characteristics and factors were relatively unchangeable. Research on the relationship between factors, that can be intervened, and health literacy remains scarce. This study aims to explore the association between personal and changeable environmental factors, and the level of health literacy in college students. Methods A cross-sectional study, which used a stratified random sampling method, was conducted at a university in Wuhan (N = 447). The survey questionnaire included sociodemographic characteristics, the School Environment Questionnaire, the Family Environment Questionnaire, the General Self-Efficacy Scale Questionnaire, and the Health Literacy Questionnaire. We used Spearman correlation tests, and Student's tests or analyses of variance to describe the relationship among continuous variables. In addition, we employed linear regression analysis to test the mediating effect based on the bias-corrected nonparametric percentile Bootstrap method. Results Factors related to socioeconomic status, such as living costs (p = 0.011), residential area (p = 0.003), annual household income (p = 0.001), and parents' education level (fathers: p = 0.001; mothers: p = 0.01) and occupation type (fathers: p < 0.001; mothers: p = 0.044), had close correlations with health literacy. School and family environments and self-efficacy had a positive impact on college students' health literacy (β = 0.235, p < 0.001; β = 0.323, p < 0.001; β = 0.489, p < 0.001). Self-efficacy had a mediating effect on the relationship between school and family environments, as well as health literacy. The total, direct, and indirect effects of the school environment on health literacy were 0.235, 0.157, and 0.078, respectively. The total, direct, and indirect effects of the family environment on health literacy were 0.323, 0.189, and 0.134, respectively. Conclusion This study confirms that improving school and family environments could directly or indirectly increase college students' health literacy through promoting their self-efficacy. Socioeconomic status has a significant impact on their health literacy. Moreover, other factors that affect students' health literacy and relationships among self-efficacy, surrounding environments, and health literacy may need to be explored in the future.
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Affiliation(s)
- Yan Wang
- Hospital, China University of Geosciences (Wuhan), Wuhan, Hubei, China
| | - Jiayu Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kai Huang
- Luohu District Center for Disease Control and Prevention, Shenzhen, Guangdong, China
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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Wang D, Sun X, He F, Liu C, Wu Y. The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China. Int J Soc Psychiatry 2023; 69:1490-1500. [PMID: 37095729 DOI: 10.1177/00207640231166628] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND Mental health problems significantly affect people's well-being and result in a huge health burden. Health literacy and family health are critical to reducing people's mental health problems. However, limited studies have addressed their complex interaction. Thus, this study aims to elucidate the mediating effect of family health on the relationship between health literacy and mental health. METHODS A national cross-sectional study based on multistage random sampling was conducted from July 10 to Sep 15, 2021, in China. Information about the public's health literacy, family health, and the level of three common mental health problems (depression, anxiety, and stress) was collected. A structural equation model (SEM) was applied to explore the mediating effect of family health on the relationship between health literacy and mental health. RESULTS A total of 11,031 participants were investigated. Approximately 19.93 and 13.57% of participants experienced moderate or severe depressive and anxiety symptoms, respectively. The SEM showed that health literacy was directly associated with mental health, with higher health literacy resulting in lower levels of depression (coefficient: -0.018, p = .049), anxiety (coefficient: -0.040, p < .001), and stress (coefficient: -0.105, p < .001). In addition, family health played a significant mediating effect (p < .001) between health literacy and mental health, contributing to 47.5, 70.9, and 85.1% of the total effect of health literacy on personal stress, anxiety, and depression, respectively. CONCLUSIONS This study revealed that the improvement of health literacy is directly and indirectly associated with less likelihood of people's mental health problems via family health. Thus, future mental health interventions should be integrated and targeted both at individual level and the family level.
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Affiliation(s)
- Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Feiying He
- School of Public Health, Southern Medical University, GuangZhou, China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
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Boutemen L, Miller AN. Readability of publicly available mental health information: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 111:107682. [PMID: 36944285 DOI: 10.1016/j.pec.2023.107682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Relatively little research has examined the health literacy demand of public communication (e.g. websites, pamphlets, and posters) about mental disorders. This study describes characteristics of existing research and summarizes what is known about the readability of such information. METHODS A search of eight data bases yielded 33 studies that met inclusion criteria. Studies were screened for relevance at each stage and then coded for key characteristics and appraised for quality by both authors working independently. RESULTS Grade-level readability scores as measured by the Flesch-Kincaid, SMOG, and other indices ranged from 6th to 17th grade. Most Flesch Reading Ease scores fell within the 30-50 range. Results of accessibility measures were inconsistent. CONCLUSION With the recommended readability level for health communication set at sixth grade, most publicly available information about mental disorders uses vocabulary and sentence structure that is too complex for the general public. Mixed evidence indicated that accessibility issues are also problematic. PRACTICE IMPLICATIONS Developers of health information need to decrease health literacy demand in written mental health information to ensure patients and their families may benefit from this information.
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Affiliation(s)
- Laura Boutemen
- Nicholson School of Communication and Media, University of Central Florida, Orlando, FL, USA
| | - Ann Neville Miller
- Nicholson School of Communication and Media, University of Central Florida, Orlando, FL, USA.
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Guo C, Cui Y, Xia Z, Hu J, Xue Y, Huang X, Wan Y, Fang J, Zhang S. Association between health literacy, depressive symptoms, and suicide-related outcomes in adolescents: A longitudinal study. J Affect Disord 2023; 327:15-22. [PMID: 36707037 DOI: 10.1016/j.jad.2023.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Health literacy is associated with mental disorders in adolescents. This study aimed to examine the associations between health literacy, depressive symptoms, and suicide-related outcomes. METHODS In terms of participants, 937 middle school students in Shenyang City, China were enrolled between December 2018 and December 2019 to assess health literacy, depressive symptoms and suicide-related outcomes. Multiple logistic regression models were used to examine possible associations. RESULTS Adequate health literacy was negatively associated with 12-month follow-up depressive symptoms (RR = 0.115, 95 % CI: 0.032-0.411) and suicide-related outcomes (RR = 0.230, 95 % CI: 0.085-0.618) in females. Meanwhile, in females, interpersonal relationship, stress management, and self-actualization were negatively related to depressive symptoms, while physical activities, self-actualization, and health awareness are protective factors for suicide-related outcomes (P < 0.05 for each). LIMITATIONS Recall and reporting bias might be inevitable for self-reported data, and due to the small sample size, the predictive effect may not be very significant. CONCLUSIONS These findings suggest that adequate health literacy may serve as a critical and independent protective factor for poor long-term mental health outcomes and that the predictive effect is more pronounced in female students. Public health efforts to enhance health literacy levels are required to maintain and improve adolescents' mental health outcomes.
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Affiliation(s)
- Chunyu Guo
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto 860-8556, Japan; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yingying Cui
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Zhengmei Xia
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Jie Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yanni Xue
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Xuexue Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China
| | - Jun Fang
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, Anhui, China; Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan.
| | - Shichen Zhang
- School of Public Health and Health Management, Anhui Medical College, No 632 Furong Road, Hefei 230601, Anhui, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei 230032, Anhui, China.
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Magallón-Botaya R, Méndez-López F, Oliván-Blázquez B, Carlos Silva-Aycaguer L, Lerma-Irureta D, Bartolomé-Moreno C. Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis. Front Public Health 2023; 11:1007238. [PMID: 36844856 PMCID: PMC9948257 DOI: 10.3389/fpubh.2023.1007238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders. Methods For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey. Results Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing. Conclusion Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.
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Affiliation(s)
- Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Fátima Méndez-López
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | - David Lerma-Irureta
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Cruz Bartolomé-Moreno
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
- Department of Family and Community Care Teaching - Sector I, Aragonese Healthcare Service, Zaragoza, Spain
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Shan D, Li S, Xu R, Huang J, Wang Y, Zheng Y, Huang S, Song Y, Han J, Suto S, Dai Z. Low depression literacy exacerbates the development and progression of depressive mood in Chinese adult social media users during COVID-19: A 3-month observational online questionnaire-based study with multiple cross-sectional analyses. Front Public Health 2023; 11:1096903. [PMID: 36875375 PMCID: PMC9978449 DOI: 10.3389/fpubh.2023.1096903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/18/2023] Open
Abstract
Background The main purpose of this study was to explore the relationship between depression literacy (D-Lit) and the development and progression of depressive mood. Methods This longitudinal study with multiple cross-sectional analyses used data from a nationwide online questionnaire administered via the Wen Juan Xing survey platform. Eligible participants were 18 years or older and had subjectively experienced mild depressive moods at the time of their initial enrollment in the study. The follow-up time was 3 months. Spearman's rank correlation test was used to analyze the predictive role of D-Lit on the later development of depressive mood. Results We included 488 individuals with mild depressive moods. No statistically significant correlation between D-Lit and Zung Self-rating Depression Scale (SDS) at baseline was observed (adjusted rho = 0.001, p = 0.974). However, after 1 month (adjusted rho = -0.449, p < 0.001) and after 3 months (adjusted rho = -0.759, p < 0.001), D-Lit was significantly and negatively correlated with SDS. Limitations The targeted subjects were limited to the Chinese adult social media users; meanwhile, China's current management policies for COVID-19 differ from most of the other countries, limiting the generalizability of this study. Conclusion Despite the limitations, our study provided novel evidence supporting that low depression literacy may be associated with exacerbated development and progression of depressive mood, which, if not appropriately and promptly controlled, may ultimately lead to depression. In the future, we encourage further research to explore the practical and efficient ways to enhance public depression literacy.
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Affiliation(s)
- Dan Shan
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Shaoyang Li
- Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ruichen Xu
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jingtao Huang
- School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Yi Wang
- China-Japan Friendship Clinical School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuandian Zheng
- Department of Biobehavioral Sciences, Columbia University, New York, NY, United States
| | - Shanshan Huang
- Department of Medical Imaging, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Yuming Song
- School of Medical Imaging, Hebei Medical University, Shijiazhuang, China
| | - Junchu Han
- Department of Human Development, Columbia University, New York, NY, United States
| | - Sayaka Suto
- Department of Human Development, Columbia University, New York, NY, United States
| | - Zhihao Dai
- School of Medicine, Royal College of Surgeons, Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Gavurova B, Popesko B, Ivankova V, Rigelsky M. The Role of Self-Care Activities (SASS-14) in Depression (PHQ-9): Evidence From Slovakia During the COVID-19 Pandemic. Front Public Health 2022; 9:803815. [PMID: 35111721 PMCID: PMC8801882 DOI: 10.3389/fpubh.2021.803815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
In the ongoing situation, when the world is dominated by coronavirus disease 2019 (COVID-19), the development of self-care programs appears to be insufficient, while their role in mental health may be crucial. The aim of the study was to evaluate the associations between self-care activities and depression in the general Slovak population, but also in its individual gender and age categories. This was achieved by validating the self-care screening instrument, assessing differences, and evaluating the associations using quantile regression analysis. The final research sample consisted of 806 participants [males: 314 (39%), females: 492 (61%)] and data were collected through an online questionnaire from February 12, 2021 to February 23, 2021. Patient Health Questionnaire (PHQ-9) for depression (α = 0.89) and Self-Care Activities Screening Scale (SASS-14) [health consciousness (HC) (α = 0.82), nutrition and physical activity (NPA) (α = 0.75), sleep quality (SLP) (α = 0.82), and interpersonal and intrapersonal coping strategies (IICS) (α = 0.58)] were used as screening measures. Mild depressive symptoms were found in 229 participants (28.41%), moderate depressive symptoms in 154 participants (19.11%), moderately severe depressive symptoms in 60 participants (7.44%) and severe depressive symptoms in 43 participants (5.33%). The main findings revealed the fact that individual self-care activities were associated with depression. This supported the idea that well-practiced self-care activities should be an immediate part of an individual's life in order to reduce depressive symptoms. Sleep quality played an important role, while HC indicated the need for increased attention. Other dimensions of self-care also showed significant results that should not be overlooked. In terms of depression, females and younger individuals need targeted interventions. The supportive educational intervention developed based on the self-care theory can help manage and maintain mental health during a stressful period, such as the COVID-19 pandemic. Health policy leaders should focus on health-promoting preventive self-care interventions, as the demand for them increases even more during the pandemic.
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Affiliation(s)
- Beata Gavurova
- Center for Applied Economic Research, Faculty of Management and Economics, Tomas Bata University in Zlín, Zlín, Czechia
| | - Boris Popesko
- Department of Business Administration, Faculty of Management and Economics, Tomas Bata University in Zlín, Zlín, Czechia
| | - Viera Ivankova
- Institute of Earth Resources, Faculty of Mining, Ecology, Process Control and Geotechnologies, Technical University of Košice, Košice, Slovakia
| | - Martin Rigelsky
- Department of Marketing and International Trade, Faculty of Management and Business, University of Prešov, Prešov, Slovakia
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Shih YL, Hsieh CJ, Lin YT, Wang YZ, Liu CY. The Mediation Effect of Health Literacy on Social Support with Exchange and Depression in Community-Dwelling Middle-Aged and Older People in Taiwan. Healthcare (Basel) 2021; 9:healthcare9121757. [PMID: 34946483 PMCID: PMC8701837 DOI: 10.3390/healthcare9121757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
The proportion of the world’s population that are over 60 years old is increasing rapidly. The physical and mental health of older people is affected by depression. Health literacy is a major determinant of health and healthcare for the aging; middle-aged and older people with high health literacy are more likely to maintain a healthy lifestyle, and control or manage their chronic diseases. Therefore, this study explored the relationship between health literacy, social support with exchange, and depression, in middle-aged and older adults in the community, using data from the 2015 Taiwan Longitudinal Study on Aging (TLSA) database. Of the 7636 participants, 1481 (19.4%) were middle-aged or older persons with depression symptoms. We found age, gender, and education level to be significantly related to health literacy status, social support with exchange, and depression. Health literacy was positively correlated with depression and social exchange in social support with exchange, whereas the emotional support component of social support with exchange was negatively correlated with depression. Regression-based process analysis was used to verify the mediation effect of health literacy. Our results indicated that when health literacy was entered into the regression model (a × b path), the effect of social exchange on depression was insignificant (c′ = −0.01, p = 0.84), indicating a complete mediation effect. These findings suggest that improving health literacy may offset the impact of social support with exchange on depression, and lead to the mitigation of depression in middle-aged and older people in Taiwanese communities.
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Affiliation(s)
- Ya-Ling Shih
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (Y.-L.S.); (Y.-T.L.); (Y.-Z.W.)
| | - Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (Y.-L.S.); (Y.-T.L.); (Y.-Z.W.)
- Correspondence: ; Tel.: +886-(2)-2822-7101-3135; Fax: +886-2-2820-6729
| | - Ya-Ting Lin
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (Y.-L.S.); (Y.-T.L.); (Y.-Z.W.)
- ST. Mary’s Junior College of Medicine, Nursing and Management, Yilan 266006, Taiwan
| | - Yi-Zhu Wang
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (Y.-L.S.); (Y.-T.L.); (Y.-Z.W.)
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
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Li A. Individual and organizational health literacies: moderating psychological distress for individuals with chronic conditions. J Public Health (Oxf) 2021; 44:651-662. [PMID: 33955477 DOI: 10.1093/pubmed/fdab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/13/2021] [Accepted: 04/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with chronic conditions experience high psychological distress. METHODS Using the National Health Survey in Australia during 2017-18, the study assessed whether and which health literacies moderated the relationship between chronic conditions and psychological distress for diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), arthritis, other musculoskeletal conditions, asthma, other chronic lower respiratory diseases and cancer. Psychological distress was regressed on chronic diseases, health literacy domains and their interactions, controlling for demographic, socioeconomic and health factors. RESULTS Of 5790 adults, 4212 (72.75%) aged 18-64; 846 (14.6%) had high or very high psychological distress, 1819 (31.4%) had diabetes, CKD or CVD, 2645 (45.7%) musculoskeletal conditions, and 910 (15.7%) lower respiratory conditions. Having sufficient information from healthcare providers was associated with the lowest level of psychological distress for CKD and cancer. Social support was associated with significantly lower levels of psychological distress for cardiovascular, musculoskeletal and lower respiratory conditions. Understanding health information was associated with the largest improvement in psychological distress for diabetes. CONCLUSIONS Higher health literacies were associated with reduced risks of psychological distress among individuals managing chronic conditions. Interventions for improving self-management and health inequalities should incorporate disease-specific health literacy enhancement strategies at individual and organizational levels.
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Affiliation(s)
- Ang Li
- Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
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Zhong Y, Schroeder E, Gao Y, Guo X, Gu Y. Social Support, Health Literacy and Depressive Symptoms among Medical Students: An Analysis of Mediating Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020633. [PMID: 33451118 PMCID: PMC7828636 DOI: 10.3390/ijerph18020633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
Depressive symptoms are prevalent in university students and may impair their social, educational, and economic transition into adulthood. Identifying the factors that determine depressive symptoms is crucial for the design of effective policy interventions. This study aims to examine the associations between health literacy and depressive symptoms among medical students, and to evaluate the effect of different types of social support as a potential mediator. A cross-sectional survey of medical students was conducted through convenience sampling in East China. Associations between variables were explored using OLS and the mediation effect was estimated using the Karlson, Holm and Breen method. A total of 746 valid questionnaires were collected. The prevalence of depressive symptoms among the sample was 32.4%. Higher health literacy levels and social supports were significantly associated with lower levels of depressive symptoms. Social support partially mediated the association between health literacy and depressive symptoms, accounting for a 54.03% of the total effect size. These findings suggest that interventions for medical student mental wellbeing could improve health literacy. Whilst family support reflects greatest impact, Universities can also lead and innovate novel interventions for this critical stage of life. Future research can extend this study by exploring the dynamic interactions between health literacy, depressive symptoms, and other sources of social support. Comparisons of these findings across the different regions of China and in other university subject disciplines are also warranted.
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Affiliation(s)
- Yaqin Zhong
- School of Public Health, Nantong University, Nantong 210029, China; (Y.Z.); (Y.G.)
| | - Elizabeth Schroeder
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, NSW 2109, Australia;
- Department of Health Systems and Populations, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Yuexia Gao
- School of Public Health, Nantong University, Nantong 210029, China; (Y.Z.); (Y.G.)
| | - Xiaojun Guo
- School of Sciences, Nantong University, Nantong 210029, China;
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, NSW 2109, Australia;
- Correspondence: ; Tel.: +61-298-504-619
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Zhang B, Zhang W, Sun X, Ge J, Liu D. Physical Comorbidity and Health Literacy Mediate the Relationship Between Social Support and Depression Among Patients With Hypertension. Front Public Health 2020; 8:304. [PMID: 32850572 PMCID: PMC7419472 DOI: 10.3389/fpubh.2020.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/04/2020] [Indexed: 02/05/2023] Open
Abstract
Depression is a common comorbidity among patients with hypertension. Patients with hypertension and depression have worse health outcomes compared to those without depression. The combined effects of social support, physical comorbidity, and health literacy on depression among individuals with hypertension remain unclear. A survey was conducted between December 2017 and May 2018 to investigate the relationships among social support, physical comorbidity, health literacy, and depression in a population of patients with hypertension in rural areas of Sichuan province, China. Multiple linear regression was used to examine factors that influenced depression, and structural equation modeling (SEM) was used to examine the relationships among the four study variables. The mean scores of 549 patients with hypertension were 37.17 ± 6.84 for social support, 14.62 ± 6.26 for health literacy, and 3.56 ± 3.05 for depression; furthermore, 34.2% of participants had physical comorbidity. Gender and per capita annual family income were significantly associated with depression. Physical comorbidity was directly positively related to depression while health literacy was directly negatively related to depression. Social support had an indirect negative association with depression by the mediating effects of health literacy and physical comorbidity. Adequate social support and health literacy, and less physical comorbidity could potentially contribute to reducing depression. The study highlights the importance of social support in maintaining mental health among patients with hypertension. Strategies that target the enhancement of social support and health literacy should be prioritized to relieve depression among patients with hypertension. More attention should be paid to women, low-income individuals, and patients with physical comorbidities.
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Affiliation(s)
- Baiyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenjie Zhang
- The Department of Academic Affairs, West China School of Medicine/ West China Hospital, Sichuan University, Chengdu, China
| | - Xiaxia Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jingjing Ge
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Danping Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Liu Y, Meng H, Tu N, Liu D. The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China. Front Public Health 2020; 8:280. [PMID: 32714893 PMCID: PMC7344226 DOI: 10.3389/fpubh.2020.00280] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/28/2020] [Indexed: 01/23/2023] Open
Abstract
Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.
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Affiliation(s)
- Yan Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Naidan Tu
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Chengdu, China
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Family members' perceptions and experiences of older people displaying major depression. Arch Psychiatr Nurs 2020; 34:2-7. [PMID: 32248929 DOI: 10.1016/j.apnu.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
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Lee HY, Hwang J, Ball JG, Lee J, Albright DL. Is health literacy associated with mental health literacy? Findings from Mental Health Literacy Scale. Perspect Psychiatr Care 2020; 56:393-400. [PMID: 31736081 DOI: 10.1111/ppc.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/08/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to measure associated factors of Mental Health Literacy (MHL) among Minnesotans by using the Mental Health Literacy Scale and Andersen's Health Behavior Model. DESIGN AND METHODS This study utilized cross-sectional survey data with 732 participants. FINDINGS Participants in higher education groups showed higher MHL levels than those who have less education. Non-Latino Whites had higher MHL levels than any other racial group. Participants who engaged in social groups had higher MHL levels. Interestingly, the relationship between health literacy and MHL was the most substantial factor. PRACTICE IMPLICATIONS Interventions aiming to improve health literacy seems beneficial to increase MHL. In addition, a variety of programs should be implemented, such as social programs that target those with less social group interaction.
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Affiliation(s)
- Hee Yun Lee
- Endowed Academic Chair on Social Work (Health), School of Social Work, University of Alabama, Tuscaloosa, Alabama
| | - Junseon Hwang
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York
| | - Jennifer G Ball
- Department of Advertising and Public Relations, Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania
| | - Jongwook Lee
- Department of Applied Economics, University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - David L Albright
- Hill Crest Foundation Endowed Chair in Mental Health Research, School of Social Work, The University of Alabama Tuscaloosa, Tuscaloosa, Alabama
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Hsu YL, Su DH, Kuo SC. Health literacy and depression in women with type 2 diabetes mellitus. Clinics (Sao Paulo) 2020; 75:e1436. [PMID: 32490935 PMCID: PMC7233688 DOI: 10.6061/clinics/2020/e1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women. METHODS In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses. RESULTS One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=-2.05, p=0.042). CONCLUSIONS A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.
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Affiliation(s)
- Yu-Ling Hsu
- Department of Health, Taipei City Government, Taipei, Taiwan
| | - Deng-Huang Su
- Department of Internal Medicine, Far-Eastern Polyclinic, Taipei, Taiwan
| | - Su-Chen Kuo
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- *Corresponding author. E-mail:
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Chung SS, Joung KH. Demographics and Health Profiles of Depressive Symptoms in Korean Older Adults. Arch Psychiatr Nurs 2017; 31:164-170. [PMID: 28359428 DOI: 10.1016/j.apnu.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 12/28/2022]
Abstract
This study examined the demographics and health characteristics of depressive symptoms of Korean older adults. Data were from the 2014 survey of the Korean Longitudinal Study of Aging (KLoSA). Hierarchical logistic regression was conducted to identify risk factors of depressive symptoms. Model 2 including socio-demographics and health characteristics explained 19.2% of depressive symptoms. Significant risk factors of depressive symptoms were men, age of 53-60 years, mid-sized city and rural area residents, less than high-school education, adults without spouse, 1st (lowest) quintile of annual household income, body shape as underweight, ex-smokers, non-drinkers, no regular exercise, perceived health status as poor, limited activities of daily living, and the number of comorbidities. Interventions to reduce depressive symptoms in these populations should include strategies to change some of these modifiable risk factors.
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Affiliation(s)
- Sung Suk Chung
- Department of Statistics and Institute of Applied Statistics, Chonbuk National University, Jeonju, Republic of Korea.
| | - Kyoung Hwa Joung
- Department of Nursing, Jeonju University, Jeonju, Republic of Korea.
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Abstract
BACKGROUND Existing literature suggests that mental health literacy is positively associated with mental health services utilization. Despite an aging population that faces significant mental health concerns in Korea, the role of mental health literacy on mental health services utilization is not known among older adults in Korea. This study aimed to (1) identify whether mental health literacy mediates the association between population characteristics and mental health services utilization and (2) identify an optimal path model for mental health services utilization among Korean older adults. METHODS Using a cross-sectional survey with a quota sampling strategy, we collected and analyzed responses from 596 community-dwelling individuals ages 65 years and older. We used structural equation modeling (SEM) to estimate the effect of mental health literacy as a mediator. RESULTS When controlling for other relevant covariates in the optimal path model, mental health literacy mediated the relationships between three socio-demographic factors (education, general literacy, and health status) and mental health services utilization. The model fit index shows that the SEM fits very well (CFI = 0.92, NFI = 0.90, RMSEA = 0.07). CONCLUSIONS Efforts to improve mental health literacy through community-based education programs may need to particularly target Korean older adults with the relevant socio-demographic characteristics to enhance their utilization of appropriate mental health services.
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