Health Literacy and Health Disparities
Major depressive episodes (MDEs) are one of the most common mental disorders in the United States. Statistics from 2017 revealed that 17.3 million adults in the United States had at least one major depressive episode. This number represented 7.1% of all U.S. adults. (“Major Depression,” 2019) Between 2005 and 2010, the economic burden of major depressive disorders (MDDs) in the United States increased by 21.5% from $173.2 billion to $210.5 billion inflation-related dollars. (Chow et al., 2019) These statistics reveal the vital need for the government and health communities to further collaborate and increase resources to educate and provide programs and innovative strategies to decrease the crippling effects and or fatal effects of major depressive episodes. The health disparities that will be highlighted will be geographical location, veteran status, and educational attainment. This analysis will also elaborate on the different types of interdisciplinary healthcare strategies that can enhance health literacy and decrease health disparities among adults who suffer from major depressive episodes.
Health Disparities and Healthy People 2020
Health Disparities and Healthy People 2020 identified the reduction of the proportion of adults aged 18 years and older who experience MDEs as one of its objectives under mental health and mental disorders. It identified three disparities for MDEs in the United States by geographic location, veteran status, and educational attainment. The vision of Healthy People 2020 is to provide a plan to help all people in the U.S. Their vision requires complex research to identify factors that influence health disparities and health outcomes within the geographic location, educational attainment, and veteran status. The data provided by Healthy People 2020, which was revised in 2018, estimated that people living in a non-urban area ranked better for their objective. The worse group was people living in an urban area. The difference in percentage was 1.1%. Studies have revealed that the risk for mental illness is generally higher in cities compared to rural areas. Social risk factors for mental health in cities include dense concentrations of low-income neighborhoods, low social support, and perceived segregation from different cultures and minorities; concerning the veterans, there was a study where data was analyzed from approximately 29,200 veterans and 470,900 nonveteran adults aged 18 years or older who participated in the 2002 to 2012 National Surveys. The objectives of this study were to examine differences between veterans and nonveterans for substance use and mental health issues and to determine whether these disorders differed by veteran status versus nonveterans. They found that primarily female veterans had an increased percentage of major depressive episodes than civilians. They also found veterans that had symptoms of MDD, but only half of them sought out treatment. Risk factors for veterans are if they have post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and fear of seeking treatment because they believe that it will affect their military career. (Pemberton & Forman-Hoffman, 2016) According to Healthy People 2020, veterans versus civilians had a 4.3% difference, with the veteran being the worse group. (Healthy People, 2019). The last disparity was educational attainment. The best group rate that was attained was by people over 25 years old with an advanced degree, and the worst group rate was people over the age of 25 with a high school education. The difference was 11.1%. (Healthy People, 2019). An association between lower educational attainment (EA) and increased risk for Major Depressive Disorder (MDD) has been confirmed in the United States. The association of lower EA and increased MDD risk could result from social reasons because of increased stress when having a low income, poor coping skills, and unhealthy lifestyles that tend to be common with lower EA. If a younger person develops MDD before they can complete their educational goals, this mood disorder could become a barrier that would become a health disparity. (Peyrot, et al., 2015)
Interdisciplinary Health Care Strategies
Nurses have an important role in helping educate clients since we are a part of the collaborating medical team that interacts with them the most. The admission assessment is the opportune time to identify their mental health goals, health beliefs, and knowledge deficits. This would be referred to as Patient-Centered Communication. Medication is one of the common healthcare strategies to help clients with Major Depressive Disorder. FDA has approved 25 medications for the treatment of major depression. Education on medication adherence would be a vital part of their treatment plan. (Unützer, & Park, M. (2012). Reinforcement is another strategy that has been proven to increase knowledge. Since many clients could be visual learners, the nurse can provide written materials like brochures, graphs, and pictures or share a video. It is necessary that the written materials or illustrations are just as clear and are in plain language. (Sudore & Schillinger, 2009)
Strategies to Improve Health Literacy
The National Assessment of Adult Literacy (NAAL) was a tool that consists of 28 health tasks that were developed by The National Center for Education Statistics in the Department of Education.
The NAAL data that was accumulated revealed that lower health literacy would Predict health disparities related to poor access to information and limited health insurance coverage. (Raingruber, 2017, p.238) As a nurse, it would be a consistent goal to improve health literacy. By giving Clear Health Communication. It is recommended when a nurse is educating a client that they will be mindful of slowing down their speech and use “living-room language.” The key points should be limited to 3 or less. The next strategy to consider is known as Confirmation of Understanding. After sharing three or fewer key points, the client is given an opportunity to ask questions or repeat what was taught. A couple of examples are when a client would be able to list three tips proven to decrease the likelihood of having a major depressive episode after the nurse had educated them or when the nurse gave instructions on medication indication, dosage, and time. When the client is able to repeat it back, this is known as the taught-back method. Learning at the level of remembering is the lowest cognitive level upon which further information can build (Adams, 2015). In this day and age, most people own a smartphone, and this resource is readily available for the client to help improve health literacy by giving them information to apps or patient portals. They are mood logs, medication reminders, blogs, and websites like Depression Bipolar Support Alliance to help clients stay compliant and current with their health goals. Giving them the empowerment to be responsible for their mental health can improve their health outcome.
Summary
As 2020 has brought increased adversities, stress, isolation, and fears, it is even more imperative that health professionals take this role very seriously and effectively know how to educate because it is known that people tend to only remember 50% of what is taught. One of the most dangerous outcomes following a major depression episode is that the client may decide to commit suicide. “In 2013, there were over 41,000 suicides in the United States – an average of 113 daily.” (“Preventing Suicide: A Comprehensive Public Health Approach,” 2018) This was in 2013, and it is understandable today why suicide has increased since then. Health professionals right now are known as heroes, and heroes sacrifice and work hard. The extra time it takes to be an excellent nurse is worth it because people are valuable, beautiful, and worth it! What an honor it is to be a part of improving health outcomes and saving lives.
REFERENCES:
Adams, N. E. (2015, July). Bloom’s taxonomy of cognitive learning objectives. Retrieved June 6, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/26213509
Chow, W., Doane, M., Sheehan, J., & Alfs, L. (2019, February 14). Economic Burden Among Patients With Major Depressive Disorder: An Analysis of Healthcare Resource Use, Work Productivity, and Direct and Indirect Costs by Depression Severity. Retrieved June 6, 2020, from https://www.ajmc.com/journals/supplement/2019/economic-burden-mdd- analysis-healthcare/economic-burden-mdd
Healthy People (2019) Mental Health and Mental Disorders. Retrieved June 6, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental- disorders/objectives
Gruebner, O., Rapp, M. A., Adli, M., Kluge, U., Galea, S., & Heinz, A. (2017, February 24). Cities and Mental Health. Retrieved June 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374256/
Major Depression. (2019, February). Retrieved June 6, 2020, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
Pemberton, M., & Forman-Hoffman, V. (2016, November). Prevalence of Past Year Substance Use and Mental Illness by Veteran Status in a Nationally Representative Sample. Retrieved June 6, 2020, from https://www.samhsa.gov/data/sites/default/files/NSDUH- DR-VeteranTrends-2016/NSDUH-DR-VeteranTrends-2016.htm
Peyrot, W. J., Lee, S. H., Milaneschi, Y., Abdellaoui, A., Byrne, E. M., Esko, T., … Social Science Genetic Association Consortium Corporate Collaborator. (2015, June). The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. Retrieved June 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610719/
Preventing Suicide: A Comprehensive Public Health Approach. (2018, February 28). Retrieved June 7, 2020, from https://www.cdc.gov/grand-rounds/pp/2015/20150915-suicide- prevention.html
Raingruber, B. (2017). Contemporary health promotion: in nursing practice. (p. 238)Burlington: Jones & Bartlett Learning.doihttps://read.amazon.com/? asin=B01KB62X6G
Sudore, R. L., & Schillinger, D. (2009, January 1). Interventions to Improve Care for Patients with Limited Health Literacy. Retrieved June 3, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799039/
Unützer, J., & Park, M. (2012, June). Strategies to improve the management of depression in primary care. Retrieved June 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127627/
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250 WORDS, NOT INCLUDING 1 REFERENCE. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately.
Health Literacy and Health Disparities
Define health disparity.
Identify a specific health disparity using scholarly evidence.
Discuss the social determinants of health that influence this disparity.
Please be sure to validate your opinions and ideas with citations and references in APA format.