Depression literacy, mental health literacy, and their relationship with psychological status and quality of life in patients with type 2 diabetes mellitus

Background

This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies.

Results

In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = -0.236), anxiety (r = -0.243), and stress (r = -0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = -0.192), anxiety (r = -0.238), and stress (r = -0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = -0.251), anxiety (r = -0.257), and stress (r = -0.203) had a significant negative correlation with DQOL (P < 0.001).

Conclusion

MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life.

Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth

OBJECTIVE

There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth.

METHOD

Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years.

RESULTS

In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes.

CONCLUSION

Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.

PLAIN LANGUAGE SUMMARY

The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.

[Mental health in the workplace - What role do socioeconomic-, gender-, and migration-related inequalities play?]

BACKGROUND

Risk factors for mental health can be found in socio-economic-, gender- and migration-specific inequalities. These factors and the extent of depression, anxiety, and somatization among employees were examined in the present study.

METHODS

As part of the Early Intervention in the Workplace Study (friaa), mentally burdened employees at five locations in Germany were surveyed on socio-demographic-, work-, migration-, and health-related content. Regression analyses were used to examine the relationship between these factors and depression (Patient-Health-Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-2, GAD-2), and somatization (Somatic Symptom Scale-8, SSS-8) in the entire sample and in people with migration background (MB). For the latter, acculturation (Frankfurt Acculturation Scale, FRACC) and the perception of burden in terms of demands of immigration (Demands of Immigration Scale, DIS) were also taken into account.

RESULTS

On average, the 550 employees (12% with MB) showed clinically relevant depression (M = 13.0, SD = 5.1) (PHQ-9 ≥ 10), anxiety (M = 3.5, SD = 1.7) (GAD ≥ 3) and somatization (M = 13.0, SD = 5.8) (SSS-8 ≥ 12). Female gender was associated with higher anxiety and somatization. Older age and night shift work were associated with higher somatization.

DISCUSSION

The results confirm the high level of mental burden among this sample of employees in Germany. In order to maintain their mental health, support measures should be offered, especially for vulnerable groups such as women, older employees, and night shift workers.

The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants

BACKGROUND AND OBJECTIVES

The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States.

RESEARCH DESIGN AND METHODS

Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.

RESULTS

Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants-Black, Hispanic, and Asian/Pacific Islander-even when holding socioeconomic status constant.

DISCUSSION AND IMPLICATIONS

Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.

Readability of publicly available mental health information: A systematic review

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.

Refugee Family Health Brokers' (FHBs') Experiences with Health Care Providers: A Thematic Analysis

BACKGROUND

The resettlement and post-resettlement quality of life of refugees is often marred by chronic health/mental health conditions. To adequately care for refugees suffering these conditions, a promising strategy is the use of refugee Family Health Brokers (FHBs). FHBs are safe and trusted family members functioning as intermediaries between one's family and health care providers. Although FHBs are known to positively influence health care utilization in their families, little is known about them and this aspect of their family caregiving role and experiences, particularly with health care providers, necessitating further research.

METHODS

Fourteen Bhutanese and three Bosnian refugee FHBs participated in a 2-hr focus group discussing their experiences with health care providers after being surveyed about their FHB role.

RESULTS

Thematic analysis yielded five themes centered around perceptions, knowledge, communication, behavior, and responsibilities reflective of FHBs' experiences, which can be understood as symptoms of existing structural inequalities.

CONCLUSIONS

FHBs primarily conveyed problems, struggles, and dilemmas they experienced more so than rewarding aspects of being an FHB. Suggestions are provided on how to avert these negative experiences from occurring and becoming barriers to developing allyship with FHBs in the context of existing structural inequalities.

Factors influencing the well-being of Asian American LGBT individuals across the lifespan: perspectives from leaders of community-based organizations

BACKGROUND

Lesbian, gay, bisexual, and transgender (LGBT) individuals have documented disparities in mental health that are experienced across the life course. However, limited research has been conducted to identify the factors which contribute to evaluated risk for poor mental health among older Asian Americans who identify as LGBT. The purpose of this study was to determine the perspectives of leaders of community-based organizations about the mental health needs and concerns of their LGBT constituents from diverse Asian backgrounds.

METHODS

Semi-structured qualitative interviews were conducted with leaders of community-based organizations serving the needs of LGBT individuals. A qualitative framework analysis approach was used to identify, analyze and report themes within the data.

RESULTS

11 members of community organizations located in California (54.5%), Chicago (27.2%), and New York (18.1%) were interviewed. Chronic stress was identified as negatively impacting constituents' lives and was attributed to social determinants of health, including inadequate housing, financial insecurity, discrimination, barriers to adequate health care, and immigration status. Ageism, social isolation, language barriers, and limited connections to cultural, religious, or LGBT communities were identified as factors impacting middle-aged and older adults. Participants identified homelessness, violence, and lack of parental acceptance as contributing to distress among youth and younger adults. The most vulnerable community members were identified as gender minorities, undocumented individuals, and individuals with limited English proficiencies. Organizational leaders described strategies to address social determinants.

CONCLUSIONS

Asian Americans who are LGBT are confronted with substantial risks for poor mental health that are linked to modifiable social determinants of health. Organizations serving these populations play a vital role in meeting the needs of a highly underserved population.

Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.

Immigration-related stressors and health outcomes among low-wage immigrant hotel workers: A pilot study

BACKGROUND

Immigrants comprise over 40% of the low-wage workforce. They are more likely to be employed in service industries, paid less, and experience more illness and injuries than their native counterparts.

DESIGN/OBJECTIVE

The aim of this cross-sectional pilot study was to explore the relationship between immigrant workers' stressors and health.

SAMPLE

Twenty-five female Mexican immigrant hotel workers.

MEASUREMENTS

Surveys and blood samples were analyzed and compared to national data. Descriptive statistics and linear regression were used for analysis.

RESULTS

Longer length of stay, older age at migration, and higher Demands of Immigration (DI) were significantly associated with more chronic conditions. Higher DI were significantly associated with more depressive symptoms. This is comparable to national data (n = 468) which shows a significant relationship between length of stay, Allostatic Load (AL), and chronic conditions (β = 0.14, p = .043; β = 0.13, p = .025).

CONCLUSIONS

Immigrant-specific factors affect individuals' health. More studies are needed to further explore the relationship between DI and health among foreign-born workers.

The Mediation Effect of Health Literacy on Social Support with Exchange and Depression in Community-Dwelling Middle-Aged and Older People in Taiwan

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.

How different health literacy dimensions influences health and well-being among men and women: The mediating role of health behaviours

Background

Health literacy, the ability to access, understand, evaluate and apply health information, was found to contribute to positive health outcomes, possibly via promoting healthy behaviours. However, the specific pathways linking different health literacy skills to health and well‐being have remained unclear.

Methods

A cross‐sectional survey with structural questionnaires was administered among 2236 adults in Hong Kong (mean age = 46.10 ± 19.05). Health literacy was measured by HLS‐Asian‐47. Participants' physical conditions and subjective well‐being were predicted by health literacy and health behaviours with structural modelling path analysis.

Results

Health literacy in finding and understanding information showed a direct effect on enhancing physical health, while applying information capacity had an indirect positive effect via promoting health behaviours, which was moderated by sex. Only among women, this indirect effect predicting fewer physical symptoms and better well‐being was significant.

Conclusions

Different health literacy dimensions showed distinct direct and indirect pathways in influencing health for men and women. Based on the findings, skill trainings should be developed to enhance both gender's abilities of finding and understanding health information, while the ability of applying health information should also be improved for modifying lifestyle and promoting health, particularly for women.

Patient or Public Contribution

Two thousand and two hundred thirty‐six adults from different districts of Hong Kong participated in the study, and responded to questions on health literacy, behaviours and health status.

Moderating Role of Health Literacy on the Association between Alexithymia and Depressive Symptoms in Middle School Students

Depression is a common psychological problem in adolescents. At present, few studies have described the moderating role of health literacy on the association between alexithymia and depressive symptoms among adolescents. The purpose of this study was to explore the relation among health literacy, alexithymia, and depressive symptoms and the moderating role of health literacy in middle school students. In December 2017, data were collected from a school in Shenyang by the convenient sampling method using a questionnaire including demographic information, health literacy, alexithymia, and depressive symptoms. A total of 1068 junior and senior high school students were selected as subjects, and 1062 valid questionnaires were retained for analysis. Logistic regression models were used to examine the association between health literacy and alexithymia with depressive symptoms. The prevalence of depressive symptoms was 48.2%, and the prevalence of alexithymia was 17.9%. Low health literacy was significantly associated with depressive symptoms (odds ratio (OR) (95% confidence interval (CI)) = 3.648 (2.493–5.338)). Alexithymia was significantly correlated with depressive symptoms (OR (95% CI) = 3.091 (2.156–4.429)). Low health literacy was related to a greater increase in the risk of depressive symptoms for students with alexithymia (OR (95% CI) = 10.566 (5.175–21.570)). The findings suggest that alexithymia and health literacy are important factors influencing depressive symptoms and health literacy has a moderating role on the association between alexithymia and depressive symptoms. Enhancing health literacy of middle school students with alexithymia may improve their mental health.

Is health literacy associated with mental health literacy? Findings from Mental Health Literacy Scale

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.

Urban Latinx parents' attitudes towards mental health: Mental health literacy and service use

Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.

Mentes Positivas en Acción: Feasibility Study of a Promotor-Delivered Cognitive Behavioral Stress Management Program for Low-Income Spanish-Speaking Latinas

Purpose: Low-income Latino immigrants lack access to mental health providers. We explored the feasibility of training promotores to deliver a stress management program in community settings. Methods: We trained promotores to deliver an 8-week intervention program comprising evidence-based cognitive-behavioral stress management techniques. Trained promotores then delivered the program to Spanish-speaking Latino immigrants. Results: Promotores (n=10) improved their knowledge significantly after the training (p<0.001) and delivered the program demonstrating excellent fidelity. Participants who received the program (n=50) had significantly improved scores on immigration stress, perceived stress, and depressive symptoms (p<0.001). Conclusion: It is feasible to train Latino promotores to deliver an effective stress management program to low-income Latino immigrants in their communities. Results contribute to a growing literature on the value of such interventions in community settings. If it is found to be effective in future studies, the program could help fill a large need in the Latino community.

Social, Occupational, and Spatial Exposures and Mental Health Disparities of Working-Class Latinas in the US

Grounded in ecosocial theory, this paper discusses the mental health disparities of working-class Latinas from multiple perspectives. An overview of working-class Latinas' prevalent mental health disorders, barriers to care and suggestions for interventions and future studies are provided.

The Role of Health Literacy in Predicting Multiple Healthcare Outcomes Among Hispanics in a Nationally Representative Sample: A Comparative Analysis by English Proficiency Levels

Health literacy (HL) research among Hispanics currently focuses on individuals with limited English proficiency but impacts of HL on healthcare outcomes among other English language proficiency groups is relatively unknown. Regression models assessed associations between HL and healthcare outcomes for Hispanics overall (n = 4013) and for proficiency level sub-populations using the 2007 Pew Hispanic Health Survey. Overall, Hispanics with adequate HL percieved US medical care as "excellent," were more satisfied with their doctor's help, and reported "excellent" overall health. In the sub-population analysis, "excellent" perception of US healthcare was associated with HL among the Spanish and English dominant groups. Among bilinguals, adequate HL was associated with decreased use of traditional medicine. The effect of adequate HL varied within English proficiency groups. HL research that focuses only on Spanish dominant speakers can exclude a substantial percentage of English proficient or bilingual populations who have low HL.

Is Health Literacy Associated With Depressive Symptoms Among Korean Adults? Implications for Mental Health Nursing

OBJECTIVE

This study investigated whether health literacy is associated with depressive symptoms among Korean adults, when adjusting for relevant risk factors for depression.

METHODS

Data were collected from a sample of 585 community-dwelling Korean adults living in Seoul and Kwangju, South Korea, using a quota sampling strategy. A cross-sectional, multivariate regression analysis was used to investigate the association between health literacy and depressive symptoms.

RESULTS

When controlled for covariates, a lower level of health literacy was significantly associated with a higher level of depressive symptoms.

CONCLUSION

Health literacy may play an important role in preventing and treating depression. Future research is needed to determine if improving health literacy, through health promotion interventions, can enhance community-dwelling Korean adults' understanding of depressive symptoms and relevant treatment options.

Age Differences in Health Literacy: Do Younger Korean Adults Have a Higher Level of Health Literacy than Older Korean Adults?

The purpose of this study was to investigate the level of health literacy of adults living in South Korea and identify factors associated with health literacy in different age groups. Using a quota sampling method, authors recruited 1,000 Korean adults age 20 years and older. Health literacy was measured by using three items selected from a 16-question self-report health literacy measure. In accordance with Andersen's behavioral model, predisposing, enabling, and need factors were included in the multiple regression model. Age differences were found in health literacy levels; specifically, lower health literacy was associated with older age. For the 20 through 44-year age group, health literacy was positively associated with having private health insurance and higher self-rated health status. For the 45 through 64 and the 65 and over age groups, education was positively associated with health literacy. For the oldest age group, gender also had a positive association with health literacy. Lower levels of depression were significantly linked to a higher level of health literacy across all ages. This study illustrates ways to increase health literacy among different age groups and prioritizes target intervention groups in an effort to reduce health disparities.

Recruiting and Assessing Recent Young Adult Latina Immigrants in Health Disparities Research

The authors interviewed 4 researchers to identify facilitators in recruiting and assessing Latina immigrants. The 4 researchers recruited 530 recent Latina immigrants (ages 18-23 years) for a study of social and cultural determinants of health. Consensual qualitative research methods revealed that respondent-driven sampling was an effective recruitment method. Fear of deportation was a barrier. Stigma about sensitive topics (e.g., sex, drug use) did not affect participation. Findings can help counselors conduct health disparities research.

Mental health literacy as a mediator in use of mental health services among older korean adults

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.

Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review

BACKGROUND

In order to address the needs of the growing Latino immigrant population, this study aimed to systematically review peer-reviewed articles of intervention studies that used cognitive behavioral therapy to treat depressive symptoms among Latino immigrants in the U.S.

METHODS

We searched PsycINFO, PubMed, and Medline databases from January 1995 through July 2016 as part of a registered review protocol (PROSPERO) following PRISMA guidelines. Inclusion criteria were intervention studies that used cognitive behavioral techniques to treat depressive symptoms among a predominantly U.S. Latino immigrant sample -- or subsample with disaggregated results, and the use of standardized measures of depression. We used the National Heart, Lung, and Blood Institute quality assessment tools for systematic reviews to assess risk of bias.

RESULTS

We identified 11 studies that met inclusion criteria. Nine of the included studies reported a reduction of depressive symptoms. Each study used a least one cultural adaptation to deliver the intervention. Using an existing content model, cultural adaptations were categorized as (a) cognitive-informational adaptations, (b) affective-motivational adaptations, and (c) environmental adaptations.

LIMITATIONS

Heterogeneity of articles in terms of sample size, cultural adaptations, methodological rigor, and setting limited comparability of effectiveness across studies.

CONCLUSIONS

Culturally adapted CBT to address depressive symptoms among Latino immigrants appears promising but further research is needed. The most commonly used cultural adaptations included language, inclusion of migration experience, and adjusting for literacy level. Study design elements and adaptations were often responsive to geographic characteristics and available resources.

Health literacy and fear of cancer progression in elderly women newly diagnosed with breast cancer--A longitudinal analysis

OBJECTIVE

This study aims to investigate the distribution of health literacy levels and the association of health literacy with fear of cancer progression (FoP) over the course of cancer treatment in a sample of elderly women newly diagnosed with breast cancer.

METHODS

The analyses are part of a prospective, multicenter cohort-study (PIAT) that took place in Germany between 2013 and 2014. Elderly women (aged 65 years and older) newly diagnosed with breast cancer completed validated measures of health literacy and FoP directly after the breast cancer surgery and 40 weeks later. Multivariate random-effects regression analysis for longitudinal data was applied to estimate the association of health literacy with FoP considering socio-demographic, clinical and psychosocial characteristics of the patients.

RESULTS

About half of the elderly breast cancer patients in our sample were classified as having limited health literacy (inadequate and problematic levels). Inadequate and problematic health literacy were significantly associated with higher levels of FoP in the elderly breast cancer patients.

CONCLUSION

Limited health literacy is an independent risk factor for increased FoP.

PRACTICE IMPLICATIONS

Enhancing health literacy could contribute to reducing patients' cancer-related fears.

Exploratory Factor Analysis of the Strength of the Cultural Affiliation Scale

BACKGROUND

Within the United States, there are individuals who retain the traditions and beliefs of cultural groups that vary from the general majority population. Both healthcare providers and researchers have reported that many individuals who live in but are less affiliated with the dominant culture tend to have less positive health outcomes.

OBJECTIVE

The purpose of this study is to use factor analysis to assess the psychometric properties of Mood's 18-item Strength of Cultural Affiliation Scale (SCAS).

METHODS

The SCAS was administered to 604 participants from a randomized clinical trial of cancer patients who were treated with radiotherapy at a large central city hospital located in the Midwest.

RESULTS

Confirmatory Factor Analyses using Principal Component Analysis with Oblimin Rotation indicated a 16-item, 4-factor final solution with the following subscales: factor 1, lifestyle (7 items); factor 2, language and cultural-specific holidays (3 items); factor 3, relationships (4 items); and factor 4, cultural health practices (2 items).

CONCLUSION

The SCAS demonstrated high reliability and content, construct, discriminant, convergent, divergent, and predictive validity.

IMPLICATIONS FOR PRACTICE

The SCAS seems to be a reliable and valid tool for practitioners to use to assess a patient's strength of cultural affiliation to provide the best culturally sensitive care possible for the patient.

Development of the Stress of Immigration Survey: A Field Test Among Mexican Immigrant Women

The Stress of Immigration Survey (SOIS) is a screening tool used to assess immigration-related stress. The mixed methods approach included concept development, pretesting, field testing, and psychometric evaluation in a sample of 131 low-income women of Mexican descent. The 21-item SOIS screens for stress related to language, immigrant status, work issues, yearning for family and home country, and cultural dissonance. Mean scores ranged from 3.6 to 4.4 (a scale of 1-5, higher is more stress). Cronbach α values were more than 0.80 for all subscales. The SOIS may be a useful screening tool for detecting high levels of immigration-related stress in low-income Mexican immigrant women.

Qualitative Exploration of an Effective Depression Literacy Fotonovela with at Risk Latina Immigrants

While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013. doi: 10.1007/s10464-013-9587-1 ). Twenty-five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed.

Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California

BACKGROUND

Asian American immigrants have a lower level of health literacy than non-Latino whites, but their level of health literacy and its impact on health outcomes may differ among subgroups.

OBJECTIVE

We investigated the level of health literacy across five subgroups of Asian American immigrants and explored the association between health literacy and self-rated health status and symptoms of depression.

DESIGN

We utilized a cross-sectional survey research design and a population-based sampling strategy using the 2007 California Health Interview Survey (CHIS).

PARTICIPANTS

We sampled 30,615 non-Latino whites and 3,053 Asian American immigrants (1,058 Chinese, 598 Koreans, 534 Filipinos, 416 South Asians, and 447 Vietnamese).

MAIN MEASURES

We used two questions as proxy measures to assess the level of health literacy in non-Latino whites and in both aggregated and disaggregated Asian American immigrant groups. We then investigated the effect of health literacy on two main health outcomes: self-rated health status and depression symptoms.

KEY RESULTS

The level of health literacy varied across the five subgroups of Asian American immigrants. Chinese, Korean, and Vietnamese groups had the lowest levels of health literacy, while Filipinos showed the highest level. Health literacy was positively correlated with health status in Chinese and Korean immigrants, and negatively correlated with depression symptoms in Korean and South Asian immigrants.

CONCLUSION

We found heterogeneity in health literacy among Asian American immigrants and found that health literacy had varying associations with health outcomes. The aggregated Asian American immigrant group results may mask the true health disparities that each Asian American immigrant group faces. Koreans were the only group found to have a significant association between the proxy for health literacy and both health outcomes. Further research is needed to better understand the causes of heterogeneity and to investigate health literacy as a critical determinant of immigrant health.

Tools to measure health literacy among Spanish speakers: An integrative review of the literature

OBJECTIVE

Health literacy measurement can help inform healthcare service delivery. The objective of this study is to identify validated tools to measure health literacy among Spanish speakers and to summarize characteristics that are relevant when selecting tools for use in clinical or research settings.

METHODS

An English and Spanish search of 9 databases was conducted between October 2014 and May 2015. Inclusion criteria were peer-reviewed articles presenting initial validation and psychometric properties of a tool to measure health literacy among Spanish speaking patients. Characteristics relevant to tool selection were reviewed and presented.

RESULTS

Twenty articles validating 19 instruments met inclusion criteria. Instruments were designed for use with Spanish speakers in numerous contexts and measured different health literacy skills such as reading comprehension or numeracy. Methods used to validate tools were inconsistent across instruments.

CONCLUSION

Although tools have inconsistencies and inefficiencies, many can be used for assessment of health literacy among Spanish speakers.

PRACTICE IMPLICATIONS

Healthcare providers, organizations, and researchers can use this review to select effective health literacy tools to indicate patient's ability to understand and use health information so that services and materials can be more appropriately tailored to Spanish speaking patients.

Associations between health literacy and health outcomes in a predominantly low-income african american population with type 2 diabetes

Inadequate health literacy has been associated with poorer health behaviors and outcomes in individuals with diabetes or depression. This study was conducted to examine the associations between inadequate health literacy and behavioral and cardiometabolic parameters in individuals with type 2 diabetes and to explore whether these associations are affected by concurrent depression. The authors used cross-sectional data from a study of 343 predominantly African Americans with type 2 diabetes. Inadequate health literacy was significantly and modestly associated with diabetes knowledge (r = -0.34) but weakly associated with self-efficacy (r = 0.16) and depressive symptoms (r = 0.24). In multivariate regression models, there were no associations between health literacy and A1c, blood pressure, or body mass index or control of any of these parameters. There was no evidence that depression was an effect-modifier of the associations between health literacy and outcomes. Although inadequate health literacy was modestly associated with worse knowledge and weakly associated with self-efficacy, it was not associated with any of the cardiometabolic parameters the authors studied. Because this study showed no association between health literacy and behavioral and cardiometabolic outcomes, it is unseemly and premature to embark on trials or controlled interventions to improve health literacy for the purposes of improving patient-related outcomes in diabetes.

Health Literacy, Smoking, and Health Indicators in African American Adults

We examined cross-sectional associations of health literacy (HL) with smoking and other established health indicators among 1,467 African American adults. Data emanated from a longitudinal cohort study designed to investigate cancer risk factors among church-going African American adults. We conducted linear and logistic regression analyses to assess associations between HL and health indicators. HL was assessed using an established single-item screening question. Outcomes included indicators of poor physical health (cigarette smoking, self-rated general and physical health) and mental health (self-rated mental health, depressive symptoms, perceived stress). Nearly 19% of participants had low HL. Low HL was significantly associated with current smoking, poorer self-rated general and physical health, and higher perceived stress (ps < .05) even after we controlled for demographic variables (i.e., age, gender, relationship status) and indicators of socioeconomic status (i.e., education, income, insurance status). Low HL appears to be an independent risk factor for smoking and other indicators of poor physical and mental health in a large sample of African American adults. Future directions and clinical implications are discussed.

Health literacy among refugees in Sweden - a cross-sectional study

Background

Refugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden.

Method

A cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences.

Results

The majority of the participating refugees had inadequate or limited functional health literacy and comprehensive health literacy. About 60% of them had inadequate functional health literacy and 27% had inadequate comprehensive health literacy. Low education and/or being born in Somalia were factors associated with an increased risk of having inadequate functional health literacy. Having inadequate functional health literacy was associated with an increased risk of having inadequate comprehensive health literacy.

Conclusions

The majority of refugees in the language schools had limited or poor health literacy. Health literacy should be taken into consideration in contexts and in activities addressing migrants. More research is needed to better understand health literacy among refugees and to develop strategies and methods to increase health literacy and make life easier for those with low health literacy.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1030) contains supplementary material, which is available to authorized users.

Gender Differences in Health Literacy Among Korean Adults: Do Women Have a Higher Level of Health Literacy Than Men?

The role of gender in determining the level of health literacy in Korean adults is unclear. This study aimed to investigate the level of health literacy in Korean adults and identify factors associated with health literacy by gender. This study employed a cross-sectional survey design with a convenient sample of 585 community-dwelling Korean adults age19 years and older. Health literacy was measured by using eight items selected from Chew et al.'s 16-question self-reported health literacy measure. In accordance with Andersen's health behavior model, predisposing, enabling, and need factors were included in the multiple regression model. Women indicated a higher level of health literacy than men in understanding medical forms, directions on medication bottles, and written information offered by health care providers. Additionally, for Korean women, a higher level of health literacy was associated with attaining a higher education level and having a consistent place to receive care. Unmarried men and men who had higher self-rated health reported a higher level of health literacy compared with their counterparts. Lower level of depression and higher monthly income were significantly linked to a higher level of health literacy in both men and women. This study has established the importance of gender differences in health literacy and suggests gender-specific intervention may be warranted to reduce the existing gap in health literacy in both Korean men and women. Future research should replicate this study to confirm whether or not our finding is an international phenomenon.

Occupational stress and adaptation of immigrant nurses from the Philippines

Immigrant nurses face multiple challenges that create vulnerability to stress. The purpose of this study was to explore the stresses and work experiences of Filipino immigrant nurses. Specific aims were to identify the perceived sources of work-related and non-work-related stress and describe the factors that influence stress. A cross-sectional qualitative research design was used to gain a holistic understanding of the participants’ experiences. Twenty women, 28–48 years old, working as registered nurses in the Chicago metropolitan area were interviewed. The findings showed that participants faced resettlement demands because of unexpected social and living environments. They also experienced communication problems, discrimination and alienation, which interacted with and intensified work-related stressors. In addition, challenges arose from encountering cultural differences. Overall, this study illustrated that stress is dynamic, multidimensional and highly influenced by culture. These findings increase awareness of the types of stressors encountered by immigrant health care providers and urge health care administrators to develop and implement programmes to improve their quality of life. Recommendations for future studies include focusing on the outcomes of cumulative stress among immigrant health care providers.

Social support mediates the association of health literacy and depression among racially/ethnically diverse smokers with low socioeconomic status

Nearly half of U.S. adults have health literacy (HL) difficulties, and lack the ability to effectively obtain, process, and understand health information. Poor HL is associated with depression, yet mechanisms of this relation are unclear. This study examined whether social support mediated the relation between HL and depressive symptoms in 200 low-socioeconomic status (SES), racially/ethnically diverse smokers enrolled in cessation treatment. Mediation analyses were conducted using bootstrapping and controlling for SES and nicotine dependence. In simple mediation models, social support [Interpersonal Support Evaluation List (ISEL) total, subscales (Appraisal, Belonging, Tangible)] mediated the effect of HL on depression, such that lower HL was associated with lower perceived support, which predicted higher depressive symptoms (ps < .05). A multiple mediation model, with ISEL subscales entered simultaneously as mediators, was significant (p < .05) but only the Belonging subscale demonstrating independent significance (p < .05). Thus, social support may be a critical factor underlying the HL-depression relationship in low-SES, racially/ethnically diverse smokers.

Risk and Protective Factors for Three Major Mental Health Problems Among Latino American Men Nationwide

The present study investigated psychosocial predictors for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) of Latino American men identified in the first national mental health epidemiological survey of Latinos. Three separate sets of logistic regression analyses were performed for 1,127 Latinos, following preplanned two steps (Model 1—Known Demographic and Acculturation Predictors as controls, Model 2—Psychosocial Risk and Protective Factors). Results show that Negative Interactions with family members significantly predicted the likelihood of both MDD and SI, while SI was also associated with Discrimination. Acculturation Stress was associated with that of GAD (alongside more Income, Education of 12 years, and Years in the United States for less than 11 years). Other potential protective factors (social support, racial/ethnic identity, religious involvement) were not influential. The differential predictors for mental health issues among Latino men imply that assessment and intervention for them may need certain gender-specific foci in order to improve mental health disparities in this population.

Entertainment-education? A fotonovela? A new strategy to improve depression literacy and help-seeking behaviors in at-risk immigrant Latinas

Research shows high risk for depression among immigrant Latinas known to increase during the acculturation process. Several barriers such as stigma and low health literacy result in an under-utilization of needed treatment among these women. In response, this study replicated the effectiveness of a Spanish language fotonovela, a form of Entertainment-Education (E-E), designed to increase depression literacy, decrease stigma, and increase help-seeking knowledge and behavior in Latinos. Specifically, this study evaluated a fotonovela delivered in a multifaceted approach to health education used by promotoras. A pretest-posttest randomized control group experimental design with 142 immigrant Latinas at risk for depression was employed. Results indicate significant posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma in experimental as compared to control group participants. Findings support the application of E-E health literacy tools such as fotonovelas, delivered in multifaceted approaches to health education used by promotoras, to Latinas at risk for mental health concerns.

Latin-American Immigrant Women and Mental Health: Differences according to their Rural or Urban Origin

Spain is one of the EU countries that receive most immigrants, especially from Latin America. The process of migration implies a high level of stress what may have repercussions for the mental health of immigrants. The purposes of this study were: (a) to determine whether the degree of mental health of immigrant women differs according to their rural or urban origin, (b) to compare the mental health of immigrant women with that of the female normative sample of host population (Spain). A sample of 186 Latin American immigrant women (142 from urban areas and 44 from rural areas) was recruited in Barcelona by means of a consecutive case method. A structured interview and the SCL-90-R were administered. The results indicated that the immigrant women from rural origin reported higher levels of psychological symptomatology than those from urban areas. Immigrants reported higher levels of psychological symptomatology than the native female population and in most of the psychological symptoms exceeded 90% of the native Spanish population. Migration is a powerful stressor which may lead to psychological distress. Being female of rural origin and being in an illegal situation is related with an increase in symptomatology.

Migration, Socio-cultural Factors, and Local Cultural Worlds among Fuzhounese Chinese Immigrants: Implications for Mental Health Interventions

The last two decades have seen a rapid increase of Fuzhounese immigrants (from Fujian Province, China) to the U.S. This group spurred the interest of researchers because of their new immigrant status and their demographic and sociocultural background that places them at a significant disadvantage compared with the majority of already-established Chinese immigrants. This paper synthesizes existing research on the Fuzhounese's historical/cultural and migration experiences and examines ways in which socio-cultural forces interact with post-migration stressors to impact the onset, manifestation, diagnosis, and treatment of symptoms in this group. From prior ethnographic work, we suggest that the pursuit of four core social goals plays a key role in interfering with psychiatric treatment adherence: 1) To pay off their smuggling debt (often >$80,000); 2) To send money to their natal families to improve social standing; 3) To save money for a dowry to perpetuate the familial lineage by marrying and producing offspring; and 4) To attain legal status. To offer more insight on how these core social motivations impact psychiatric disability, we present a case vignette of a Fuzhounese man diagnosed with schizophrenia. We relate his treatment issues to specific fundamental values that infuse both the lived experience of mental illness and inform clinical and community treatment strategies for this group. We also extend relevant treatment recommendations to migratory workers from other ethnic groups.