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Mental health literacy as a mediator in use of mental health services among older korean adults

Published online by Cambridge University Press:  20 October 2016

Young Sun Kim*
Affiliation:
Graduate School of East-West Medical Science, Kyung Hee University, Gyeonggi-Do, South Korea
T. Greg Rhee
Affiliation:
Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Twin Cities, MN, USA
Hee Yun Lee
Affiliation:
School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, MN, USA
Byung Hyun Park
Affiliation:
Department of Social Welfare, Pusan National University, Busan, South Korea
Monica L. Sharratt
Affiliation:
School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, MN, USA
*
Correspondence should be address to: Young Sun Kim, PhD, Assistant Professor, Graduate School of East-West Medical Science, Kyung Hee University, 1732 Deogyeong-Daero, Giheung-Gu, Yongin-Si, Gyeonggi-Do, 446-701, South Korea. Phone: 82-31-201-3719. Email: ysunkim@khu.ac.kr.
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Abstract

Background:

Existing literature suggests that mental health literacy is positively associated with mental health services utilization. Despite an aging population that faces significant mental health concerns in Korea, the role of mental health literacy on mental health services utilization is not known among older adults in Korea. This study aimed to (1) identify whether mental health literacy mediates the association between population characteristics and mental health services utilization and (2) identify an optimal path model for mental health services utilization among Korean older adults.

Methods:

Using a cross-sectional survey with a quota sampling strategy, we collected and analyzed responses from 596 community-dwelling individuals ages 65 years and older. We used structural equation modeling (SEM) to estimate the effect of mental health literacy as a mediator.

Results:

When controlling for other relevant covariates in the optimal path model, mental health literacy mediated the relationships between three socio-demographic factors (education, general literacy, and health status) and mental health services utilization. The model fit index shows that the SEM fits very well (CFI = 0.92, NFI = 0.90, RMSEA = 0.07).

Conclusions:

Efforts to improve mental health literacy through community-based education programs may need to particularly target Korean older adults with the relevant socio-demographic characteristics to enhance their utilization of appropriate mental health services.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Ahn, J. (2012). Depression, suicide, and Korean society. Journal of Korean Medical Association, 55, 320321.Google Scholar
Alegria, M., Bijl, R. V., Lin, E., Walters, E. E. and Kessler, R. C. (2000). Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Archives of General Psychiatry, 57, 383391.Google Scholar
Al-Nsour, M. et al. (2013). Frequent mental distress, chronic conditions, and adverse health behaviors in the behavioral risk factor surveillance survey, Jordan, 2007. Preventing Chronic Disease, 10, 18.Google Scholar
Amone-P'Olak, K., Ormel, J., Oldehinkel, A. J., Reijneveld, S. A., Verhulst, F. C. and Burger, H. (2010). Socioeconomic position predicts specialty mental health service use independent of clinical severity: the TRAILS study. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 647655.Google Scholar
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36, 110.Google Scholar
Andersen, E. M., Cater, W. B., Malmgren, J. A. and Patrick, D. L. (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10, 7784.Google Scholar
Araya, R., Lewis, G., Rojas, G. and Fritsch, R. (2003). Education and income: which is more important for mental health? Journal of Epidemiology and Community Health, 57, 501505.Google Scholar
Arbuckle, J. L. (2012). IBM® SPSS® Amos™ 21 User's Guide. Meadville, PA: Amos Development Corporation.Google Scholar
Babitsch, B., Gohl, D. and von Lengerke, T. (2012). Re-revisiting Andersen's behavioral model of health services use: a systematic review of studies from 1998–2011. Psycho-social Medicine, 9, 115.Google Scholar
Baker, D. W., Gazmararian, J. A., Sudano, J. and Patterson, M. (2000). The association between age and health literacy among elderly persons. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55, S368–S374.Google Scholar
Baker, D. W., Wolf, M. S., Feinglass, J., Thompson, J. A., Gazmararian, J. A. and Huang, J. (2007). Health literacy and mortality among elderly persons. Archives of Internal Medicine, 167, 15031509.Google Scholar
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238246.Google Scholar
Bentler, P. M. and Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588606.Google Scholar
Chapman, D. P., Perry, G. S. and Strine, T. W. (2005). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease, 2, A14–A23.Google Scholar
Coffman, M. J. and Norton, C. K. (2010). Demands of immigration, health literacy, and depression in recent Latino immigrants. Home Health Care Management & Practice, 22, 116122.Google Scholar
Cohen, D. J., White, S. and Cohen, S. B. (2012). Mind the gap: the black-white literacy gap in the national assessment of adult literacy and its implications. Journal of Literacy Research, 44, 123148.Google Scholar
Dahlberg, K. M., Waern, M. and Runeson, B. (2008). Mental health literacy and attitudes in a Swedish community sample–Investigating the role of personal experience of mental health care. BMC Public Health, 8, 110.Google Scholar
Davis, C. S., Massey, O. T., Smith, R. B., Armstrong, M., Vergon, K. S. and McNeish, R. (2008). Refinement of An Instrument to Measure Mental Health Literacy and Examination of Interventions to Enhance Mental Health Literacy. (Agency for Health Care Administration series, 220-113). Tampa, FL: University of South Florida Louis de la Parte Florida Mental Health Institute.Google Scholar
Epps, C. S., Armstrong, M., Davis, C. S., Massey, O. T., McNeish, R. and Smith, R. B. (2007). Development and Testing of An Instrument to Measure Mental Health Literacy. (Agency for Health Care Administration series, 220-99). Tampa, FL: University of South Florida Louis de la Parte Florida Mental Health Institute.Google Scholar
Farrer, L., Leach, L., Griffiths, K. M., Christensen, H. and Jorm, A. F. (2008). Age differences in mental health literacy. BMC Public Health, 8, 125132.Google Scholar
Feldt, L. S. (1969). A test of the hypothesis that Cronbach's alpha or Kuder-Richardson reliability coefficient twenty. Psychometrika, 30, 357370.Google Scholar
Fisher, L. J. and Goldney, R. D. (2003). Differences in community mental health literacy in older and younger Australians. International Journal of Geriatric Psychiatry, 18, 3340.CrossRefGoogle ScholarPubMed
Hoeymans, N., Garssen, A. A., Westert, G. P. and Verhaak, P. F. (2004). Measuring mental health of the dutch population: a comparison of the GHQ-12 and the MHI-5. Health Quality Life Outcomes, 2, 2328.Google Scholar
Hovey, J. D., Kim, S. E. and Seligman, L. D. (2006). The influences of cultural values, ethnic identity, and language use on the mental health of Korean American college students. The Journal of Psychology, 140, 499511.Google Scholar
Howard, D. H., Sentell, T. and Gazmararian, J. A. (2006). Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine, 21, 857861.Google Scholar
Jang, Y., Chiriboga, D. A. and Okazaki, S. (2009). Attitudes toward mental health services: age-group differences in Korean American adults. Aging & Mental Health, 13, 127134.Google Scholar
Jang, Y., Kim, G., Hansen, L. and Chiriboga, D. A. (2007). Attitudes of older Korean Americans toward mental health services. Journal of American Geriatric Society, 55, 616620.Google Scholar
Jeon, H. (2012). Epidemiologic studies on depression and suicide. Journal of Korean Medical Association, 55, 322328.Google Scholar
Jorm, A. F. (2000). Mental health literacy: public knowledge and beliefs about mental disorders. British Journal of Psychiatry, 177, 396401.Google Scholar
Jorm, A. F. (2012). Mental health literacy: empowering the community to take action for better mental health. American Psychologist, 67, 231243.CrossRefGoogle ScholarPubMed
Judd, F. et al. (2006). Help-seeking by rural residents for mental health problems: the importance of agrarian values. Australian and New Zealand Journal of Psychiatry, 40, 769776.Google Scholar
Kelly, C. M., Jorm, A. F. and Wright, A. (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Medical Journal of Australia, 187, S26–S30.Google Scholar
Kim, Y. S., Khatiwoda, P., Park, B. H. and Lee, H. Y. (2016). Health literacy and its link to healthcare service utilization among older adults in Korea. Social Work in Public Health, 31, 467473.Google Scholar
Kim, Y. S., Lee, H. Y., Lee, M. H., Park, B. H. and Simms, T. (under review). Levels of and factors associated with mental health literacy in Korean older adults. Submitted to Journal of Psychiatric and Mental Health Nursing.Google Scholar
Kitchener, B. A. and Jorm, A. F. (2004). Mental health first aid training in a workplace setting: a randomized controlled trial. BMC Psychiatry, 4, 2330.Google Scholar
Kripalani, S., Henderson, L. E., Chiu, E. Y., Robertson, R., Kolm, P. and Jacobson, T. A. (2006). Predictors of medication Self‐management skill in a low‐literacy population. Journal of General Internal Medicine, 21, 852856.Google Scholar
Ko, K. D. et al. (2012). Association of health risk behaviors with mental health among elderly Koreans. Journal of Korean Geriatric Society, 16, 6673.Google Scholar
Korea Institute for Health and Social Affairs (KIHASA). (2007). 2007 Poverty Statistics Yearbook. Seoul, South Korea: Korea Institute for Health and Social Affairs.Google Scholar
Lauber, C. and Rossler, W. (2007). Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry, 19, 157178.Google Scholar
Lee, H. K. and Chang, C. G. (2012). The relationship of health-related quality of life, mental health, and suicidal ideation among Korean elderly. Korean Public Health Research, 38, 6979.Google Scholar
Lee, J. Y. and Moon, J. W. (2011). The effect of elderly mental health on the life satisfaction. Korean Public Health Research, 37, 4557.Google Scholar
Lee, H. Y., Rhee, T. G., Kim, N. K. and Ahluwalia, J. S. (2015). Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. Journal of General Internal Medicine, 30, 11181124.Google Scholar
Lleras-Muney, A. (2005). The relationship between education and adult mortality in the United States. The Review of Economic Studies, 72, 189221.Google Scholar
Lindamer, L. A. et al. (2012). Predisposing, enabling, and need factors associated with high service use in a public mental health system. Administration and Policy in Mental Health, 39, 200209.Google Scholar
Morrow, D. et al. (2006). Correlates of health literacy in patients with chronic heart failure. The Gerontologist, 46, 669676.Google Scholar
National Statistical Office of Korea (NSO). (2009). 2008 Causes of Death Statistics. Seoul, South Korea: National Statistical Office of Korea.Google Scholar
Neuman, L. (1994). Social Research Methods: Qualitative and Quantitative Approaches. Boston, MA: Allyn and Bacon.Google Scholar
Pandit, A. U. et al. (2009). Education, literacy, and health: mediating effects on hypertension knowledge and control. Patient Education and Counseling, 75, 381385.Google Scholar
Park, H. and Kyei, P. (2011). Literacy gaps by educational attainment: a cross-national analysis. Social Forces, 89, 879904.Google Scholar
Parslow, R. A. and Jorm, A. F. (2000). Who uses mental health services in Australia? An analysis of data from the national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 34, 9971008.Google Scholar
Radloff, L. (1997). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.Google Scholar
Ratzan, S. C. and Parker, R. M. (2000). Introduction. In Selden, C. R., Zorn, M., Ratzan, S. C. & Parker, R. M. (eds.), National Library of Medicine Current Bibliographies in Medicine: Health Literacy. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.Google Scholar
Rhee, T. G., Lee, H. Y., Kim, N. K., Han, G., Lee, J. and Kim, K. (2016). Is health literacy associated with depressive symptoms among Korean adults? Implications for mental health nursing. Perspectives in Psychiatric Care, Epublished ahead of print. doi: 10.1111/ppc.12162.Google Scholar
Ross, C. E. and Wu, C. L. (1995). The links between education and health. American Sociological Review, 60, 719745.Google Scholar
Schillinger, D., Barton, L. R., Karter, A. J., Wang, F. and Adler, N. (2006). Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Reports, 121, 245254.Google Scholar
Seo, M. K. and Kim, C. N. (2005). A comparison of public's stigma against the mental patients and mental patients' perceived stigma. Journal of Korean Neuropsychiatric Association, 44, 371375.Google Scholar
Silles, M. A. (2009). The causal effect of education on health: evidence from the United Kingdom. Economics of Education Review, 28, 122128.Google Scholar
Steele, L. S., Dewa, C. S., Lin, E. and Lee, K. L. (2007). Education level, income level and mental health services use in Canada: associations and policy implications. Healthcare Policy, 3, 96106.Google Scholar
Steiger, J. H. and Lind, J. C. (1980). Statistically-based tests for the number of common factors. Paper presented at the Annual Meeting of the Psychometric Society, Iowa City, IA.Google Scholar
Sudore, R. L. et al. (2006). Limited literacy in older people and disparities in health and healthcare access. Journal of the American Geriatrics Society, 54, 770776.Google Scholar
Wolf, M. S., Gazmararian, J. A. and Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165, 19461952.Google Scholar
Yen, C. F., Chen, C. C., Lee, Y., Tang, T. C., Ko, C. H. and Yen, J. Y. (2005). Insight and correlates among outpatients with depressive disorders. Comprehensive Psychiatry, 46, 384389.Google Scholar
Yoo, S. K., Goh, M. and Yoon, E. (2005). Psychological and cultural influences on Koreans' help-seeking attitudes. Journal of Mental Health Counseling, 27, 266281.Google Scholar
Yoon, J. and Bernell, S. L. (2013). The role of adverse physical health events on the utilization of mental health services. Health Services Research, 48, 175194.Google Scholar