Mental illness and limited literacy

Approx­i­mately 47 per­cent of the U.S. pop­u­la­tion reads below an eighth-​​grade level, but the per­centage is sig­nif­i­cantly greater among people using public mental-​​health ser­vices, according to Alisa Lin­coln, an asso­ciate pro­fessor of soci­ology and health sci­ences at North­eastern University.

In spite of this sta­tistic, as well as a growing body of lit­er­a­ture on the impact of reading ability on gen­eral health out­comes, scant research is avail­able on the impact of lim­ited lit­eracy on mental health.

Lin­coln, the interim director of Northeastern’s Insti­tute for Urban Health Research, hopes to change that. She recently received a three-​​year, $1.3 mil­lion grant from the National Insti­tute of Mental Health to explore the con­nec­tion between lit­eracy and mental health.

“You can’t approach this from just one dis­ci­pline,” said Lin­coln, who has joint appoint­ments in the Bouvé Col­lege of Health Sci­ences and the Col­lege of Social Sci­ences and Human­i­ties.

For example, she said, “As a soci­ol­o­gist, I don’t have the skills to assess cog­ni­tive func­tioning. I need a neu­ropsy­chol­o­gist to do that.”

Lin­coln has assem­bled a team that com­prises public-​​health experts, a med­ical anthro­pol­o­gist, two cog­ni­tive psy­chol­o­gists, a psy­chi­a­trist, two lit­eracy spe­cial­ists and a biostatistician.

Together, she said, the team will be better able to estab­lish a com­pre­hen­sive analysis of the impact of lim­ited lit­eracy on the mental health community.

The team first estab­lished lim­ited lit­eracy as a key factor in the lives of mental-​​health patients through a pilot study that sur­veyed a small group of patients. Those with higher reading abil­i­ties tended to use their skills in a variety of ways to nav­i­gate the health­care system and cope with their symp­toms. Sev­eral coping strate­gies were not acces­sible to patients with lim­ited lit­eracy, how­ever, from searching the Internet for more infor­ma­tion about their con­di­tion to jour­naling about their struggles.

With the grant funding, Lincoln’s team will expand its research study to include 300 people using public mental-​​health ser­vices in Boston. “They’ll be par­tic­i­pating in struc­tured inter­views that will assess their levels of reading lit­eracy, numeracy, and aural lit­eracy, as well as many fac­tors related to the social con­text of their lives,” Lin­coln explained.

She noted the sig­nif­i­cant body of research focused on neg­a­tive expe­ri­ences caused by mental ill­ness and the small but growing number of research studies on the shame asso­ci­ated with lim­ited literacy.

“If you’re living with mental ill­ness and strug­gling with lim­ited lit­eracy, you’re dealing with a double whammy,” Lin­coln said. “It’s no wonder these folks are cut off from many soci­etal resources.”

In addi­tion to the prac­tical parts of life that lim­ited lit­eracy inhibits — such as reading med­ica­tion bot­tles or filling out forms — it may also feed into the symp­toms of patients’ orig­inal con­di­tions. “We know that the social stigma of mental ill­ness worsens mental health,” Lin­coln said. “We assume, and now will learn about, whether the shame and stigma asso­ci­ated with lit­eracy prob­lems does the same.”

– by Angela Herring