Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

July 11, 2018
2 min read

Poor health literacy increases depression risk in IBD fourfold

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Patients with inflammatory bowel disease who struggle with health literacy experience worse patient-reported outcomes and symptoms of depression, according to research published in Inflammatory Bowel Diseases.

Lauren K. Tormey, MD, of the section of gastroenterology and hepatology at Dartmouth-Hitchcock Medical Center, and colleagues wrote that proper health literacy is an important factor in patient health and safety, particularly in IBD, which requires patients to juggle complex medications with the chronic, irregular course of their disease symptoms.

“Health literacy is context-dependent, which means that it is influenced by the demands of a health situation,” they wrote. “As health systems develop engagement strategies for patients with IBD, it is essential that we examine the role of health literacy to ensure the safety and quality of health outcomes for our patients.”

Tormey and colleagues recruited 99 patients receiving care for IBD at the Boston Medical Center and conducted in-person interviews to explore the association between health literacy and patient-reported quality of health outcomes. The patients answered IBD questionnaires, as well as the Patient-Reported Outcomes Measurement System (PROMIS) Short Form for depression. Investigators included patients with Crohn’s disease (n = 56) and ulcerative colitis (n = 43) in the study.

Tormey and colleagues evaluated health literacy using the Newest Vital Sign and Medication Use and Self-Efficacy Scale and determined that 40 of the study’s patients (40%) had limited health literacy.

Limited health literacy was associated with worse subjective health status (P = .03) and a greater likelihood of having a PROMIS depression T-score above the mean of the United States population (adjusted OR = 3.6; 95% CI, 1.3–10.1).

Patients with CD who had adequate health literacy were more likely to be in clinical remission compared with patients with limited health literacy (OR = 4.15; 95% CI, 1.37–13.45).

Researchers found no significant association between health literacy and disease activity in UC.

Tormey and colleagues wrote that their findings present a previously unrecognized, but modifiable risk factor for poor health outcomes in IBD. They suggested that gastroenterology practices should implement health literacy training for staff to help raise awareness among patients.

“Ultimately, meaningful and measurable changes in clinical practice should be guided by our patients,” they wrote. “Moving forward as an IBD community, we should consider how to incorporate health literacy end points into new and existing IBD population health safety and quality initiatives to improve patient care.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.