Relationship between Rural, Low-Income Mothers’ Health Literacy and Depressive Symptoms in the Family Context
Main Article Content
Abstract
Rural, low-income mothers face higher risk for poor health literacy and depression compared to the general population. While the association between health literacy and depression has been documented, the underlying mechanism of this relationship is not clear. Focusing on 304 low-income mothers in rural communities, this study examined the role of family context—alliance between parents and prevalence of healthful eating and physical activity in the home—in this association. Hierarchical regression followed by mediation analyses were conducted on mother’s depressive symptoms controlling for mothers’ demographic characteristics and access to healthcare. Lower health literacy was significantly associated with higher risk for depressive symptoms with parenting alliance partially mediating the relationship between health literacy and depressive symptoms. The finding suggests that alliance between parents is a critical aspect of mothers’ social support system that may offset the negative impacts of poor health literacy on their mental health. Possible discrepancies between mothers’ knowledge and their actual behaviors as well as mothers’ awareness of low health literacy and their sense of need for assistance are presented along with implications for healthcare professionals and social workers.
Article Details
How to Cite
SANO, Yoshie; GREDER, Kimberly; MAMMEN, Sheila.
Relationship between Rural, Low-Income Mothers’ Health Literacy and Depressive Symptoms in the Family Context.
Medical Research Archives, [S.l.], v. 5, n. 1, jan. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/948>. Date accessed: 27 dec. 2024.
Keywords
Health Literacy; Maternal Depression; Family Context; Rural Poverty
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Abidin, R.R, & Konold, T.R. (1999). Parenting Alliane Measure: Professional Manual. Lutz, FL: PAR, INC.
Andresen, E. M., Malmgren, J.A., Carter, W.B., & Patrick, D.L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10(2), 77-84.
Beck, C. T. (2007). Postpartum depression. American Journal of Nursing, 106(5), 40–50.
Bennett, I. M., Culhane, J. F., McCollum, K. F., Mathew, L., & Elo, I. T. (2007). Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency. The American Journal of Orthopsychiatry, 77, 243–248. doi:10.1037/0002-9432.77.2.243
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97–107. doi:10.7326/0003-4819-155-2-201107190-00005
Center for Disease Control and Prevention (2016). Mental health: Depression. Retrieved from http://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm
Coffman, M. J., & Norton, C. K. (2010). Demands of immigration, health literacy, and depression in recent Latino immigrants. Home Health Care Management & Practice, 22, 116–122. doi:10.1177/1084822309347343
Economic Research Service. (2013). Rural classifications. United States Department of Agriculture, Economic Research Service. http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx#.VDMWAfldWSq
England, M. J., & Sim, L. J. (Eds.) (2009). Depression in parents, parenting, and children: opportunities to improve identification, treatment and prevention. (p. 14) Committee on Depression, Parenting Practices, and the Healthy Development of Children. National Research Council; Institute of Medicine. National Academy of Science. doi: 10.17226/12565
Greenberg, P. E., Fournier, A. A, Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States. Journal of Clinical Psychiatry, 76(2), 155-162. doi: 10.4088/JCP.14m09298
Hatcher, J., Rayens, M. K., Peden, A. R., & Hall, L. A. (2008). Predictors of depression for low-income African American single mothers. Journal of Health Disparities Research and Practice, 2(3) Article 6. http://digitalscholarship.unlv.edu/jhdrp/vol2/iss3/6
Ihmels M. A, Welk G. J, Eisenmann J. C, Nusser S. M. (2009). Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool. International Journal of Behavioral Nutrition and Physical Activity, 6(14). doi: 10.1186/1479-5868-6-14
Institute of Medicine (2004) Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.
Johnson, V. R., Jacobson, K. L., Gazmararian, J. A., & Blake, S. C. (2010). Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study. Patient Education and Counseling, 79, 14–24. doi:10.1016/j.pec.2009.07.002
Kamimura, A., Christensen, N., Tabler, J., Ashby, J., & Olson, L. M. (2013). Patients utilizing a free clinic: Physical and mental health, health literacy, and social support. Journal of Community Health, 38, 716-723. doi 10.1007/s10900-013-9669-x
Lee, S. Y., Arozullah, A. M., & Cho, Y. I. (2004). Health literacy, social support, and health: A research agenda. Social Science and Medicine, 58(7), 1309-1321. doi:10.1016/S0277-9536(03)00329-0
Lincoln, A., Paasche-Orlow, M. K., Cheng, D. M., Lloyd-Travaglini, C., Caruso, C., et al. (2006). Impact of health literacy on depressive symptoms and mental health-related: Quality of life among adults with addiction. Journal of General Internal Medicine, 21, 818–822. doi:10.1111/j.1525-1497.2006.00533.x
Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., et al. (2003). Socioeconomic inequalities in depression: A metaanalysis. American Journal of Epidemiology, 157, 98–112. doi:10.1093/aje/kwf182
Mammen, S., & Sano, Y. (2012). Gaining access to economically marginalized rural populations: Lessons learned from non-probability sampling. Rural Sociology, 77(3), 462-482. doi: 10.1111/j.1549-0831.2012.00083.x
National Center for Education Statistics (2006). The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. U.S. Department of Education. Washington D.C.
National Institute of Mental Health (2016). Major depression among adults. https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
Nolen-Hoeksema, S. (2001). Gender differences in depression. Current Directions in Psychological Science, 10(5), 173-176. doi: 10.1111/1467-8721.00142
Ontai, L., Sano, Y., Pong, H. N., Conger, K. (2008). Low-income rural mothers’ perceptions of parent confidence: Role of family health problems and partner status. Family Relations, 57, 324-334. doi: 10.1111/j.1741-3729.2008.00503.x
ssion in the United States household population, 2005-2006. National Center for Health Statistics Data Brief, 7. http://www.cdc.gov/nchs/data/databriefs/db07.pdf
Radloff, L. S. (1977). The CESD-D scale: A self-report depression scale for research in the population. Applied Psychological Measurement, 1, 385-401.
Sano, Y., Manoogian, M., & Ontai, L. (2012). “The kids still come first:” Creating family stability during partnership instability in rural, low-income families. Journal of Family Issues, 33, 942-965. doi: 10.1177/0192513X11430820
Stanford Rural Health (2010). Rural health factsheet: Healthcare disparities and barriers to healthcare. Stanford School of Medicine. http://ruralhealth.stanford.edu/health-pros/factsheets/downloads/rural_fact_sheet_5.pdf
Stewart, D. W., Reitzel, L. R., Correa-Fernandez, V., Cano, M. A., Adams, C. E., Cao, Y., …Vidrine, J. I. (2014). Journal of Behavioral Medicine, 37, 1169-1179. doi:10.1007/s10865-014-9566-5
U.S. Department of Health and Human Services. 2001. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC: Office of Minority Health.
Andresen, E. M., Malmgren, J.A., Carter, W.B., & Patrick, D.L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10(2), 77-84.
Beck, C. T. (2007). Postpartum depression. American Journal of Nursing, 106(5), 40–50.
Bennett, I. M., Culhane, J. F., McCollum, K. F., Mathew, L., & Elo, I. T. (2007). Literacy and depressive symptomatology among pregnant Latinas with limited English proficiency. The American Journal of Orthopsychiatry, 77, 243–248. doi:10.1037/0002-9432.77.2.243
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97–107. doi:10.7326/0003-4819-155-2-201107190-00005
Center for Disease Control and Prevention (2016). Mental health: Depression. Retrieved from http://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm
Coffman, M. J., & Norton, C. K. (2010). Demands of immigration, health literacy, and depression in recent Latino immigrants. Home Health Care Management & Practice, 22, 116–122. doi:10.1177/1084822309347343
Economic Research Service. (2013). Rural classifications. United States Department of Agriculture, Economic Research Service. http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx#.VDMWAfldWSq
England, M. J., & Sim, L. J. (Eds.) (2009). Depression in parents, parenting, and children: opportunities to improve identification, treatment and prevention. (p. 14) Committee on Depression, Parenting Practices, and the Healthy Development of Children. National Research Council; Institute of Medicine. National Academy of Science. doi: 10.17226/12565
Greenberg, P. E., Fournier, A. A, Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States. Journal of Clinical Psychiatry, 76(2), 155-162. doi: 10.4088/JCP.14m09298
Hatcher, J., Rayens, M. K., Peden, A. R., & Hall, L. A. (2008). Predictors of depression for low-income African American single mothers. Journal of Health Disparities Research and Practice, 2(3) Article 6. http://digitalscholarship.unlv.edu/jhdrp/vol2/iss3/6
Ihmels M. A, Welk G. J, Eisenmann J. C, Nusser S. M. (2009). Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool. International Journal of Behavioral Nutrition and Physical Activity, 6(14). doi: 10.1186/1479-5868-6-14
Institute of Medicine (2004) Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.
Johnson, V. R., Jacobson, K. L., Gazmararian, J. A., & Blake, S. C. (2010). Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study. Patient Education and Counseling, 79, 14–24. doi:10.1016/j.pec.2009.07.002
Kamimura, A., Christensen, N., Tabler, J., Ashby, J., & Olson, L. M. (2013). Patients utilizing a free clinic: Physical and mental health, health literacy, and social support. Journal of Community Health, 38, 716-723. doi 10.1007/s10900-013-9669-x
Lee, S. Y., Arozullah, A. M., & Cho, Y. I. (2004). Health literacy, social support, and health: A research agenda. Social Science and Medicine, 58(7), 1309-1321. doi:10.1016/S0277-9536(03)00329-0
Lincoln, A., Paasche-Orlow, M. K., Cheng, D. M., Lloyd-Travaglini, C., Caruso, C., et al. (2006). Impact of health literacy on depressive symptoms and mental health-related: Quality of life among adults with addiction. Journal of General Internal Medicine, 21, 818–822. doi:10.1111/j.1525-1497.2006.00533.x
Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., et al. (2003). Socioeconomic inequalities in depression: A metaanalysis. American Journal of Epidemiology, 157, 98–112. doi:10.1093/aje/kwf182
Mammen, S., & Sano, Y. (2012). Gaining access to economically marginalized rural populations: Lessons learned from non-probability sampling. Rural Sociology, 77(3), 462-482. doi: 10.1111/j.1549-0831.2012.00083.x
National Center for Education Statistics (2006). The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. U.S. Department of Education. Washington D.C.
National Institute of Mental Health (2016). Major depression among adults. https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
Nolen-Hoeksema, S. (2001). Gender differences in depression. Current Directions in Psychological Science, 10(5), 173-176. doi: 10.1111/1467-8721.00142
Ontai, L., Sano, Y., Pong, H. N., Conger, K. (2008). Low-income rural mothers’ perceptions of parent confidence: Role of family health problems and partner status. Family Relations, 57, 324-334. doi: 10.1111/j.1741-3729.2008.00503.x
ssion in the United States household population, 2005-2006. National Center for Health Statistics Data Brief, 7. http://www.cdc.gov/nchs/data/databriefs/db07.pdf
Radloff, L. S. (1977). The CESD-D scale: A self-report depression scale for research in the population. Applied Psychological Measurement, 1, 385-401.
Sano, Y., Manoogian, M., & Ontai, L. (2012). “The kids still come first:” Creating family stability during partnership instability in rural, low-income families. Journal of Family Issues, 33, 942-965. doi: 10.1177/0192513X11430820
Stanford Rural Health (2010). Rural health factsheet: Healthcare disparities and barriers to healthcare. Stanford School of Medicine. http://ruralhealth.stanford.edu/health-pros/factsheets/downloads/rural_fact_sheet_5.pdf
Stewart, D. W., Reitzel, L. R., Correa-Fernandez, V., Cano, M. A., Adams, C. E., Cao, Y., …Vidrine, J. I. (2014). Journal of Behavioral Medicine, 37, 1169-1179. doi:10.1007/s10865-014-9566-5
U.S. Department of Health and Human Services. 2001. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC: Office of Minority Health.