Health Literacy Is Associated with Depression in Orthopaedic Trauma Patients

Abstract

Introduction: Patients with poor health literacy are at increased risk of adverse outcomes when under medical care. Little is known how health literacy affects outcomes in orthopaedic trauma patients. This study aimed to evaluate the prevalence of poor health literacy in the orthopaedic trauma population, as well as any association with health outcomes and healthcare use. Methods: Patients included were enrolled as part of a larger, comprehensive prospective study at a level 1 trauma center from 2019-2020. Health literacy status (poor/adequate) was assessed using three validated screening questions answered on a multi-item Likert Scale. The Patient Health Questionnaire 2-item depression screen (PHQ-2), criminal background, education level, housing status and access to transportation were also included. Chart review provided demographic data, comorbidities, in-hospital complication, and resource-use. Chi-squared and logistic regression analyses were performed to evaluate associations between health literacy and other data. Results: 166 consecutive patients were included (female: 60%, age:42±17). Poor health literacy was identified in 17%. Patients with poor health literacy had higher odds of major depression (OR:3.97, 95%CI:1.01-15.3), limited access to transportation for medical appointments (OR:4.51, 95%CI:1.4-14.9), limited access to personal transportation (OR:3.93, 95%CI:1.2-3.2). Comorbidities, in-hospital complication and length of stay were not significantly associated with poor health literacy (p>0.05). Conclusion: Findings demonstrate that orthopaedic trauma patients are at risk for poor health literacy, with associations with depression and poor access to transportation for medical appointments. This highlights the need to identify at-risk patients during the initial hospitalization, to allow for targeted navigation in post-trauma care needs.