DEPRESSION AND HEALTH LITERACY OVER THE LIFESPAN
DEPRESSION ANDHEALTH LITERACYOVER THE LIFESPANTetine Sentell, University of Hawai‘iJennifer Manganello, University at AlbanyAlessio Farcomeni, University of RomeYan Yan Wu, University of Hawai‘iHARC 2014November 3, 2014
DEPRESSION Depression is a common psychiatric disorder in children,adolescents, adults, and the elderly. Depression is associated with higher risk of illness, unhealthybehavior, and interpersonal and psychosocial dif ficulties thatcan persist long after the depressive episode is over.
HEALTH LITERACY AND DEPRESSION Health literacy has been associated with depression in manystudies. However the strength of evidence “low” (Berkman et al, 2011) “Despite the general consistency of results, only 1 depression studyrigorously controlled for potential confounders.” Studies in very specific populations.
HEALTH LITERACY OVER TIME Few studies have explored the relationship of health literacyto health status over the lifespan. Health literacy skills most relevant to adolescent health mayvary from those most critical in young adulthood, middleadulthood, and older age.
PREVIOUS RESEARCH Previous study found that the relationshipbetween self-reported health and domainsrelated to low health literacy varied Over domains Over the lifespan Data was from adolescence to mid-adulthood What about depression over the lifespan?Sentell, Farcomeni, Manganello. Adolescent Educational Domains and Self-Reported Health Over 20-Years: Results from the NationalLongitudinal Study of Adolescent Health. Under Review.
STUDY GOAL Consider the relationship betweendepression and health literacy overthe life course.
THREE DATA SETS 2012 Hawai‘i BRFSS 2007 CHIS ADDHealth7
2012 HAWAI‘I BRFSS Behavioral Risk Factor Surveillance System(BRFSS) is the world’s largest ongoingtelephone survey of adults. The BRFSS is coordinated by the Centers forDisease Control and Prevention (CDC). 2012 Hawai‘i BRFSS N 7,5828
BRFSS: VARIABLES Low health literacy How confident are you filling out medical forms? Not at all, a little bit,somewhat, quite a bit, extremely 19.2% Depression Were you ever told you had a depressive disorder? 13.1% Age Groups 18-24, 25-34, 35-45 75-84, 85 9
% DEPRESSION BY AGE GROUP ANDHEALTH %Depression LHL55-6465-7475-8485 %Depression Not LHL10
MULTIVARIABLE MODELSORLUp-value1.651.352.01 0.00118-24REFREFREFREF25-342.601.693.99 0.00135-442.911.904.47 0.00145-544.022.666.07 0.00155-643.632.425.46 0.00165-742.771.814.23 0.00175-841.490.912.420.11185 1.090.522.280.823Low Health LiteracyAge GroupAdjusting for gender, marital status, insurance, education, income, race, island, contextual factors by zip(family poverty, individual poverty, education)Interaction Age*HL were not significant!11
2007 CHIS California Health Interview Survey (CHIS) Population-based sample of California adults Questions in multiple languages. 2007 CHIS N 51,04812
2007 CHIS Low health literacy When you get written information at a doctor’s office , would you saythat it is very easy, somewhat easy, somewhat difficult, or verydifficult to understand?When you read the instructions on a prescription bottle , would you saythat it is very easy, somewhat easy, somewhat difficult, or verydifficult to understand? 18.2% (vs. 19.2 in BRFSS) Mental Health “Had psychological distress past month” 3.8% (vs. 13.1 in BRFSS for depression) Age Groups 18-24, 25-34, 35-45 75-84, 85 13
% DISTRESS BY AGE GROUP AND 4445-54% Distress in last month LHL55-6465-7475-84% Distress in last month Not LHL85 14
% DISTRESS BY AGE GROUP AND HEALTHLITERACY%Depression LHL18-2425-3435-44%Depression Not LHL45-54% Distress in last month LHL55-6465-7475-84% Distress in last month Not LHL85 15
MULTIVARIABLE 2.661.783.97 0.00155-642.601.664.07 5 0.530.300.930.028Low Health LiteracyAge GroupAdjusting for gender, marital status, insurance, education, income, race, rural,born in the US.Interaction Age*HL were not significant!16
LIMITATIONS Dataset specific limitations States Variables not available Cohort effects? Only one health literacy measure
ADDHEALTH National Longitudinal Study of AdolescentHealth (AddHealth) data from four timeintervals across 20 years. From adolescence to mid-adulthood N 3,333Time 1Time 21994- 1995Grades 7 to 121996Time 3Time 42001- 2002Ages 18 and 262008Ages 24 to 32
DOMAINS Vocabulary Math Health information learned in school19
“HEALTH LITERACY” DOMAINVARIABLES All obtained from the first time interval Subjects were in grades 7-12. Vocabulary was measured by the AddHealth PeabodyPicture Vocabulary Test Low vs not low vocabulary Math skills were measured from math grades inschool High vs. not high Health information was measured as a continuousvariable created from 17 items regarding whether thetopic had been covered in school. Continuous in models Dichotomized in descriptive statistics
DEPRESSION Depression Measured by the CES-D (0-60) Gender specific cut points Measured at four time intervals
% DISTRESS BY AGE GROUP AND HEALTHLITERACY%Depression LHL18-2425-3435-44%Depression Not LHL45-54% Distress in last month LHL55-6465-7475-84% Distress in last month Not LHL85 22
HEALTH LITERACY DOMAINS30%30%25%25%20%20%15%High Math10%Not High Math5%15%Not LowVocabulary10%LowVocabulary5%0%0%Wave Wave Wave Wave1234Wave Wave Wave Wave123425%20%High HealthInformation15%10%Not HighHealthInformation5%0%Wave Wave Wave Wave123423
MULTIVARIABLE MODELSNot Low VocabularyOR0.638L0.454U0.896p-value0.0095Health Information0.9751.1162.2030.0563High Numeracy0.6630.9501.0010.0001refrefWaveWave 1refWave 21.2090.9591.5190.1090Wave 32.0451.6522.531 0.0001Wave 45.6174.6146.838 0.0001Adjusting for education, race, access to care, English household. Gender specificcut points.24
RESULTS Math and vocabulary (and, marginally, healthinfo in school) were significantly associatedwith depression across the whole time period. Health information is strongest at waves 1and 2 and then mitigates to a null effect inlater waves.25
LIMITATIONS Challenges in measurement Not standard health literacy measures Other domains in health literacy Health literacy measures only in Time 1 Points in time Varied ages Different life events
CONCLUSIONS Health literacy variation over lifespan May help explain differences across studies Further research!
ACKNOWLEDGEMENTSThis research uses data from Add Health, a programproject directed by Kathleen Mullan Harris and designedby J. Richard Udry, Peter S. Bearman, and Kathleen MullanHarris at the University of North Carolina at Chapel Hill,and funded by grant P01-HD31921 from the EuniceKennedy Shriver National Institute of Child Health andHuman Development, with cooperative funding from 23other federal agencies and foundations. Specialacknowledgment is due Ronald R. Rindfuss and BarbaraEntwisle for assistance in the original design. Informationon how to obtain the Add Health data files is available onthe Add Health website(http://www.cpc.unc.edu/addhealth). No direct supportwas received from grant P01-HD31921 for this analysis.
THANK YOU! MAHALO!
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