Association between health literacy and risk of depression: A systematic review and meta-analysis of observational studies

Objectives

Depression, one of the most prevalent mental disorders, constitutes a pressing threat to global population health. In recent years, an increasing number of observational studies have explored the association between health literacy (HL) and depression risk; however, their results are inconsistent. Furthermore, no study has yet systematically synthesized this association based on findings from observational studies.

Study design

Systematic review and meta-analysis.

Methods

A systematic literature search was performed to identify eligible studies from five databases (PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library). The overall odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated to evaluate the role of HL in the development and progression of depression using random-effects models. Subgroup analyses were conducted to explore the potential sources of heterogeneity.

Results

Eleven observational studies, including nine cross-sectional and two longitudinal studies, were included in the current review. Meta-analysis revealed that higher levels of HL were associated with lower risk of depression (OR = 0.90, 95 % CI: 0.86–0.94). Subgroup analysis demonstrated that studies of adolescent individuals using the Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ) to quantify HL exhibited stronger associations (OR = 0.43, 95 % CI: 0.34–0.54).

Conclusions

Our meta-analysis demonstrated a statistically significant negative association between adequate levels of HL and the likelihood of depression, especially among adolescents. More longitudinal studies with rigorous design are needed to further explore the causal relationship and long-term associations.