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Impact of health literacy on depressive symptoms and mental health-related quality of life among adults with addiction

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Abstract

BACKGROUND: Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse.

OBJECTIVE: We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive symptoms, and worse mental health functioning compared with those with higher literacy in adults with alcohol and drug dependence.

METHODS: The association of literacy with multiple mental health outcomes was assessed using multivariable analyses. Measurement instruments included the Rapid Estimate of Adult Literacy in Medicine (REALM), the Center for Epidemiologic Studies-Depression (CES-D) scale, the Mental Component Summary scale of the Short Form Health Survey, and the Addiction Severity Index for drug and alcohol addiction. Subjects included 380 adults recruited during detoxification treatment and followed prospectively at 6-month intervals for 2 years. Based on the REALM, subjects were classified as having either low (≤8th grade) or higher (≥9th grade) literacy levels.

RESULTS: In longitudinal analyses, low literacy was associated with more depressive symptoms. The adjusted mean difference in CES-D scores between low and high literacy levels was 4 (P <.01). Literacy was not significantly associated with mental health-related quality of life or addiction severity.

CONCLUSIONS: In people with alcohol and drug dependence, low literacy is associated with worse depressive symptoms. The mechanisms underlying the relationship between literacy and mental health outcomes should be explored to inform future intervention efforts.

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Alisa Lincoln PhD MPH, Christine Caruso MA, MPH & Jeffrey H. Samet MD, MA, MPH

  2. Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz MD, MPH

  3. Section of General Internal Medicine (Clinical Addiction Research and Education Unit), Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Michael K. Paasche-Orlow MD, Richard Saitz MD, MPH & Jeffrey H. Samet MD, MA, MPH

  4. Department of Biostatistics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Debbie M. Cheng ScD & Christine Lloyd-Travaglini MPH

  5. Department of Epidemiology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Richard Saitz MD, MPH

  6. Data Coordinating Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA

    Alisa Lincoln PhD MPH, Michael K. Paasche-Orlow MD, Debbie M. Cheng ScD, Christine Lloyd-Travaglini MPH, Christine Caruso MA, MPH, Richard Saitz MD, MPH & Jeffrey H. Samet MD, MA, MPH

  7. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Alisa Lincoln PhD MPH

Authors
  1. Alisa Lincoln PhD MPH
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  2. Michael K. Paasche-Orlow MD
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  3. Debbie M. Cheng ScD
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  4. Christine Lloyd-Travaglini MPH
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  5. Christine Caruso MA, MPH
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  6. Richard Saitz MD, MPH
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  7. Jeffrey H. Samet MD, MA, MPH
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Corresponding author

Correspondence to Alisa Lincoln PhD MPH.

Additional information

None of the authors have any conflicts of interest to declare.

This work was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (RO1-AA10870) and the National Institute on Drug Abuse (RO1-DA10019) (R25-DA13582). This work was supported in part by the Boston University General Clinical Research Center from the National Center for Research Resources (MO1-RR00533).

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Lincoln, A., Paasche-Orlow, M.K., Cheng, D.M. et al. Impact of health literacy on depressive symptoms and mental health-related quality of life among adults with addiction. J GEN INTERN MED 21, 818–822 (2006). https://doi.org/10.1111/j.1525-1497.2006.00533.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00533.x

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