People with Suspected COVID-19 Symptoms Were More Likely Depressed and Had Lower Health-Related Quality of Life: The Potential Benefit of Health Literacy

Hoang C Nguyen, Minh H Nguyen, Binh N Do, Cuong Q Tran, Thao T P Nguyen, Khue M Pham, Linh V Pham, Khanh V Tran, Trang T Duong, Tien V Tran, Thai H Duong, Tham T Nguyen, Quyen H Nguyen, Thanh M Hoang, Kien T Nguyen, Thu T M Pham, Shwu-Huey Yang, Jane C-J Chao, Tuyen Van Duong, Hoang C Nguyen, Minh H Nguyen, Binh N Do, Cuong Q Tran, Thao T P Nguyen, Khue M Pham, Linh V Pham, Khanh V Tran, Trang T Duong, Tien V Tran, Thai H Duong, Tham T Nguyen, Quyen H Nguyen, Thanh M Hoang, Kien T Nguyen, Thu T M Pham, Shwu-Huey Yang, Jane C-J Chao, Tuyen Van Duong

Abstract

The coronavirus disease 2019 (COVID-19) epidemic affects people's health and health-related quality of life (HRQoL), especially in those who have suspected COVID-19 symptoms (S-COVID-19-S). We examined the effect of modifications of health literacy (HL) on depression and HRQoL. A cross-sectional study was conducted from 14 February to 2 March 2020. 3947 participants were recruited from outpatient departments of nine hospitals and health centers across Vietnam. The interviews were conducted using printed questionnaires including participants' characteristics, clinical parameters, health behaviors, HL, depression, and HRQoL. People with S-COVID-19-S had a higher depression likelihood (OR, 2.88; p < 0.001), lower HRQoL-score (B, -7.92; p < 0.001). In comparison to people without S-COVID-19-S and low HL, those with S-COVID-19-S and low HL had 9.70 times higher depression likelihood (p < 0.001), 20.62 lower HRQoL-score (p < 0.001), for the people without S-COVID-19-S, 1 score increment of HL resulted in 5% lower depression likelihood (p < 0.001) and 0.45 higher HRQoL-score (p < 0.001), while for those people with S-COVID-19-S, 1 score increment of HL resulted in a 4% lower depression likelihood (p = 0.004) and 0.43 higher HRQoL-score (p < 0.001). People with S-COVID-19-S had a higher depression likelihood and lower HRQoL than those without. HL shows a protective effect on depression and HRQoL during the epidemic.

Keywords: COVID-19; comorbidity; coronavirus; depression; epidemic; health literacy; health-related quality of life; healthy eating; physical activity; suspected COVID-19 symptoms.

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Ren L.-L., Wang Y.-M., Wu Z.-Q., Xiang Z.-C., Guo L., Xu T., Jiang Y.-Z., Xiong Y., Li Y.-J., Li X.-W., et al. Identification of a novel coronavirus causing severe pneumonia in human: A descriptive study. Chin. Med. J. (Engl.) 2020 doi: 10.1097/CM9.0000000000000722.
    1. Wang C., Horby P.W., Hayden F.G., Gao G.F. A novel coronavirus outbreak of global health concern. Lancet. 2020;395:470–473. doi: 10.1016/S0140-6736(20)30185-9.
    1. Thompson R. Pandemic potential of 2019-nCoV. Lancet Infect. Dis. 2020 doi: 10.1016/S1473-3099(20)30068-2.
    1. Wu J.T., Leung K., Leung G.M. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: A modelling study. Lancet. 2020 doi: 10.1016/S0140-6736(20)30260-9.
    1. World Health Organization (WHO) Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV) WHO; Geneva, Switzerland: [(accessed on 30 January 2020)]. Available online:
    1. World Health Organisation . Coronavirus Disease (COVID-2019) Situation Reports. WHO; Geneva, Switzerland: [(accessed on 24 March 2020)]. Available online:
    1. Ministry of Health Coronavirus Disease (COVID-19) Outbreak in Vietnam. [(accessed on 10 March 2020)]; Available online:
    1. World Health Organisation . WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19–11 March 2020. WHO; Geneva, Switzerland: [(accessed on 12 March 2020)]. Available online: .
    1. World Health Organisation . Coronavirus Disease (COVID-19) Outbreak. WHO; Geneva, Switzerland: [(accessed on 11 March 2020)]. Available online: .
    1. World Health Organization (WHO) Home Care for Patients with Suspected Novel Coronavirus (nCoV) Infection Presenting with Mild Symptoms and Management of Contacts: Interim Guidance. WHO; Geneva, Switzerland: [(accessed on 20 January 2020)]. Available online: .
    1. World Health Organization (WHO) Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection is Suspected: Interim Guidance. WHO; Geneva, Switzerland: [(accessed on 28 January 2020)]. Available online: .
    1. World Health Organization (WHO) Infection Prevention and Control during Health Care When Novel Coronavirus (nCoV) Infection Is Suspected: Interim Guidance. WHO; Geneva, Switzerland: [(accessed on 25 January 2020)]. Available online: .
    1. Zhou T., Liu Q., Yang Z., Liao J., Yang K., Bai W., Lu X., Zhang W. Preliminary prediction of the basic reproduction number of the Wuhan novel coronavirus 2019-nCoV. J. Evid. Based Med. 2020 doi: 10.1111/jebm.12376.
    1. World Health Organization . WHO Director-General’s Statement on IHR Emergency Committee on Novel Coronavirus (2019-nCoV) WHO; Geneva, Switzerland: [(accessed on 10 February 2020)]. Available online:
    1. Thompson R.N. Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations. J. Clin. Med. 2020;9:498. doi: 10.3390/jcm9020498.
    1. Deng S.-Q., Peng H.-J. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. J. Clin. Med. 2020;9:575. doi: 10.3390/jcm9020575.
    1. Bao Y., Sun Y., Meng S., Shi J., Lu L. 2019-nCoV epidemic: Address mental health care to empower society. Lancet. 2020 doi: 10.1016/S0140-6736(20)30309-3.
    1. Xu Z., Li S., Tian S., Li H., Kong L.-Q. Full spectrum of COVID-19 severity still being depicted. Lancet. 2020 doi: 10.1016/S0140-6736(20)30308-1.
    1. Jack A. Why the panic? South Korea’s MERS response questioned. BMJ (Clin. Res. Ed.) 2015;350:h3403. doi: 10.1136/bmj.h3403.
    1. Abdel-Moneim A.S. Middle-East respiratory syndrome coronavirus: Is it worth a world panic? World J. Virol. 2015;4:185–187. doi: 10.5501/wjv.v4.i3.185.
    1. Shimizu K. 2019-nCoV, fake news, and racism. Lancet. 2020 doi: 10.1016/S0140-6736(20)30357-3.
    1. Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020 doi: 10.1016/S0140-6736(20)30460-8.
    1. Lancet The health illiteracy problem in the USA. Lancet. 2009;374:2028. doi: 10.1016/S0140-6736(09)62137-1.
    1. Sørensen K., Van den Broucke S., Brand H., Fullam J., Doyle G., Pelikan J., Slonszka Z. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi: 10.1186/1471-2458-12-80.
    1. Watson R. Europeans with poor “health literacy” are heavy users of health services. BMJ. 2011;343 doi: 10.1136/bmj.d7741.
    1. Greenhalgh T. Health literacy: Towards system level solutions. BMJ. 2015;350:h1026. doi: 10.1136/bmj.h1026.
    1. Ishikawa H., Yano E. Patient health literacy and participation in the healthcare process. Health Expect. 2008;11:113–122. doi: 10.1111/j.1369-7625.2008.00497.x.
    1. The World Bank . Country Profile: Vietnam. World Bank Group; Washington, DC, USA: [(accessed on 8 August 2019)]. Available online: .
    1. Duong T.V., Aringazina A., Baisunova G., Pham T.V., Pham K.M., Truong T.Q., Nguyen K.T., Oo W.M., Mohamad E., Su T.T., et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. J. Epidemiol. 2017;27:80–86. doi: 10.1016/j.je.2016.09.005.
    1. Duong T.V., Aringazina A., Baisunova G., Nurjanah N., Pham T.V., Pham K.M., Truong T.Q., Nguyen K.T., Oo W.M., Su T.T., et al. Development and validation of a new short-form health literacy instrument (HLS-SF12) for the general public in six Asian countries. Health Lit. Res. Pract. 2019;3:e91–e102. doi: 10.3928/24748307-20190225-01.
    1. Rudd R.E. Health literacy skills of US adults. Am. J. Health Behav. 2007;31:S8–S18. doi: 10.5993/AJHB.31.s1.3.
    1. Mackert M. Introduction to a Colloquium: Challenges and Opportunities in Advancing Health Literacy Research. Health Commun. 2015;30:1159–1160. doi: 10.1080/10410236.2015.1037427.
    1. Qin L., Xu H. A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China. BMJ Open. 2016;6:e011077. doi: 10.1136/bmjopen-2016-011077.
    1. Raynor D.K. Health literacy. BMJ. 2012;344:e2188. doi: 10.1136/bmj.e2188.
    1. Hu Z., Qin L., Xu H. Association between diabetes-specific health literacy and health-related quality of life among elderly individuals with pre-diabetes in rural Hunan Province, China: A cross-sectional study. BMJ Open. 2019;9:e028648. doi: 10.1136/bmjopen-2018-028648.
    1. Kugbey N., Meyer-Weitz A., Oppong Asante K. Access to health information, health literacy and health-related quality of life among women living with breast cancer: Depression and anxiety as mediators. Patient Educ. Couns. 2019;102:1357–1363. doi: 10.1016/j.pec.2019.02.014.
    1. Kirk J.K., Grzywacz J.G., Arcury T.A., Ip E.H., Nguyen H.T., Bell R.A., Saldana S., Quandt S.A. Performance of health literacy tests among older adults with diabetes. J. Gen. Intern. Med. 2012;27:534–540. doi: 10.1007/s11606-011-1927-y.
    1. Editorial Team Overview of Novel Coronavirus (2019-nCoV). BMJ Best Practice. [(accessed on 10 February 2020)]; Available online: .
    1. Craig C.L., Marshall A.L., Sjöström M., Bauman A.E., Booth M.L., Ainsworth B.E., Pratt M., Ekelund U., Yngve A., Sallis J.F., et al. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Pham T., Bui L., Nguyen A., Nguyen B., Tran P., Vu P., Dang L. The prevalence of depression and associated risk factors among medical students: An untold story in Vietnam. PLoS ONE. 2019;14:e0221432. doi: 10.1371/journal.pone.0221432.
    1. Tran D.V., Lee A.H., Au T.B., Nguyen C.T., Hoang D.V. Reliability and validity of the International Physical Activity Questionnaire-Short Form for older adults in Vietnam. Health Promot. J. Aust. 2013;24:126–131. doi: 10.1071/HE13012.
    1. Lee P.H., Macfarlane D.J., Lam T.H., Stewart S.M. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review. Int. J. Behav. Nutr. Phys. Act. 2011;8:115. doi: 10.1186/1479-5868-8-115.
    1. Duong T.V., Nguyen T.T.P., Pham K.M., Nguyen K.T., Giap M.H., Tran T.D.X., Nguyen C.X., Yang S.-H., Su C.-T. Validation of the Short-Form Health Literacy Questionnaire (HLS-SF12) and Its Determinants among People Living in Rural Areas in Vietnam. Int. J. Environ. Res. Public Health. 2019;16:3346. doi: 10.3390/ijerph16183346.
    1. HLS-EU Consortium . Comparative Report of Health Literacy in Eight EU Member States. The European Health Literacy Project 2009–2012. Maastricht University; Maastricht, The Netherlands: [(accessed on 22 October 2012)]. Available online: .
    1. Kroenke K., Spitzer R.L., Williams J.B.W. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Nguyen T.Q., Bandeen-Roche K., Bass J.K., German D., Nguyen N.T.T., Knowlton A.R. A tool for sexual minority mental health research: The Patient Health Questionnaire (PHQ-9) as a depressive symptom severity measure for sexual minority women in Viet Nam. J. Gay Lesbian Ment. Health. 2016;20:173–191. doi: 10.1080/19359705.2015.1080204.
    1. Manea L., Gilbody S., McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen. Hosp. Psychiatry. 2015;37:67–75. doi: 10.1016/j.genhosppsych.2014.09.009.
    1. Levis B., Benedetti A., Thombs B.D. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ. 2019;365:l1476. doi: 10.1136/bmj.l1476.
    1. Hays R.D., Morales L.S. The RAND-36 measure of health-related quality of life. Ann. Med. 2001;33:350–357. doi: 10.3109/07853890109002089.
    1. Ngo-Metzger Q., Sorkin D.H., Mangione C.M., Gandek B., Hays R.D. Evaluating the SF-36 Health Survey (Version 2) in Older Vietnamese Americans. J. Aging Health. 2008;20:420–436. doi: 10.1177/0898264308315855.
    1. Hays R.D., Kallich J., Mapes D., Coons S., Amin N., Carter W.B., Kamberg C. Kidney Disease Quality of Life Short Form (KDQOL-SF), Version 1.3: A Manual for Use and Scoring. RAND Corporation; Santa Monica, CA, USA: 1997.
    1. Hays R.D., Sherbourne C.D., Mazel R.M. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2:217–227. doi: 10.1002/hec.4730020305.
    1. National Center for Immunization and Respiratory Diseases (NCIRD) What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible 2019-nCoV Infection. Centers for Disease Control and Prevention; Atlanta, GA, USA: [(accessed on 7 February 2020)]. Available online: .
    1. World Health Organization (WHO) Novel Coronavirus (2019-nCoV) Technical Guidance. WHO; Geneva, Switzerland: [(accessed on 10 February 2020)]. Available online: .
    1. Maldonado G., Greenland S. Simulation Study of Confounder-Selection Strategies. Am. J. Epidemiol. 1993;138:923–936. doi: 10.1093/oxfordjournals.aje.a116813.
    1. IBM SPSS . IBM SPSS Statistics for Windows, Version 20.0. IBM Corp; New York, NY, USA: 2011.
    1. Gostin L.O., Hodge J.G., Jr. US Emergency Legal Responses to Novel Coronavirus: Balancing Public Health and Civil Liberties. JAMA. 2020;323:1131–1132. doi: 10.1001/jama.2020.2025.
    1. Wang C.J., Ng C.Y., Brook R.H. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. 2020 doi: 10.1001/jama.2020.3151.
    1. Chen J. Pathogenicity and Transmissibility of 2019-nCoV-A Quick Overview and Comparison with Other Emerging Viruses. Microbes Infect. 2020 doi: 10.1016/j.micinf.2020.01.004.
    1. The Government of the Socialist Republic of Vietnam Government in Action. Hanoi, Vietnam, Online Newspaper of the Government. [(accessed on 24 January 2020)]; Available online: .
    1. Smith N., Fraser M. Straining the System: Novel Coronavirus (COVID-19) and Preparedness for Concomitant Disasters. Am. J. Public Health. 2020:e1–e2. doi: 10.2105/AJPH.2020.305618.
    1. Adalja A.A., Toner E., Inglesby T.V. Priorities for the US Health Community Responding to COVID-19. JAMA. 2020 doi: 10.1001/jama.2020.3413.
    1. Duong T.V., Sørensen K., Pelikan J., Van den Broucke S., Lin I.F., Lin Y.-C., Huang H.-L., Chang P.W. Health-related behaviors moderate the association between age and self-reported health literacy among Taiwanese women. Women Health. 2017;58:632–646. doi: 10.1080/03630242.2017.1333074.
    1. Sun X., Yang S., Fisher E.B., Shi Y., Wang Y., Zeng Q., Ji Y., Chang C., Du W. Relationships of Health Literacy, Health Behavior, and Health Status Regarding Infectious Respiratory Diseases: Application of a Skill-Based Measure. J. Health Commun. 2014;19:173–189. doi: 10.1080/10810730.2014.946112.
    1. Castro-Sánchez E., Chang P.W.S., Vila-Candel R., Escobedo A.A., Holmes A.H. Health literacy and Infectious Diseases: Why does it matter? Int. J. Infect. Dis. 2016;43:103–110. doi: 10.1016/j.ijid.2015.12.019.
    1. Huong N.T., Ha L.T.H., Tien T.Q. Determinants of Health-Related Quality of Life Among Elderly: Evidence From Chi Linh Town, Vietnam. Asia Pac. J. Public Health. 2017;29:84S–93S. doi: 10.1177/1010539517704041.
    1. Hoi L.V., Chuc N.T., Lindholm L. Health-related quality of life, and its determinants, among older people in rural Vietnam. BMC Public Health. 2010;10:549. doi: 10.1186/1471-2458-10-549.
    1. Ha N.T., Duy H.T., Le N.H., Khanal V., Moorin R. Quality of life among people living with hypertension in a rural Vietnam community. BMC Public Health. 2014;14:833. doi: 10.1186/1471-2458-14-833.
    1. Pham T., Nguyen N.T.T., ChieuTo S.B., Pham T.L., Nguyen T.X., Nguyen H.T.T., Nguyen T.N., Nguyen T.H.T., Nguyen Q.N., Tran B.X., et al. Sex Differences in Quality of Life and Health Services Utilization among Elderly People in Rural Vietnam. Int. J. Environ. Res. Public Health. 2018;16:69. doi: 10.3390/ijerph16010069.
    1. Nguyen H.V., Tran T.T., Nguyen C.T., Tran T.H., Tran B.X., Latkin C.A., Ho C.S.H., Ho R.C.M. Impact of Comorbid Chronic Conditions to Quality of Life among Elderly Patients with Diabetes Mellitus in Vietnam. Int. J. Environ. Res. Public Health. 2019;16:531. doi: 10.3390/ijerph16040531.
    1. Nguyen L.H., Tran B.X., Hoang Le Q.N., Tran T.T., Latkin C.A. Quality of life profile of general Vietnamese population using EQ-5D-5L. Health Qual. Life Outcomes. 2017;15:199. doi: 10.1186/s12955-017-0771-0.
    1. Ngo C.Q., Phan P.T., Vu G.V., Pham Q.L.T., Nguyen L.H., Vu G.T., Tran T.T., Nguyen H.L.T., Tran B.X., Latkin C.A., et al. Effects of Different Comorbidities on Health-Related Quality of Life among Respiratory Patients in Vietnam. J. Clin. Med. 2019;8:214. doi: 10.3390/jcm8020214.
    1. Ministry of Education and Training Postpone the New Semester to Prevent Covid-19 Outbreak in 63/63 Cities and Provinces. [(accessed on 11 March 2020)]; Available online: .
    1. Mammen G., Faulkner G. Physical activity and the prevention of depression: A systematic review of prospective studies. Am. J. Prev. Med. 2013;45:649–657. doi: 10.1016/j.amepre.2013.08.001.
    1. Kvam S., Kleppe C.L., Nordhus I.H., Hovland A. Exercise as a treatment for depression: A meta-analysis. J. Affect. Disord. 2016;202:67–86. doi: 10.1016/j.jad.2016.03.063.
    1. Santos M.V.F.D., Campos M.R., Fortes S.L.C.L. Relationship of alcohol consumption and mental disorders common with the quality of life of patients in primary health care. Cien. Saude Colet. 2019;24:1051–1063. doi: 10.1590/1413-81232018243.01232017.
    1. Daeppen J.-B., Faouzi M., Sanchez N., Rahhali N., Bineau S., Bertholet N. Quality of life depends on the drinking pattern in alcohol-dependent patients. Alcohol Alcohol. 2014;49:457–465. doi: 10.1093/alcalc/agu027.
    1. Levola J., Aalto M., Holopainen A., Cieza A., Pitkänen T. Health-related quality of life in alcohol dependence: A systematic literature review with a specific focus on the role of depression and other psychopathology. Nord. J. Psychiatry. 2014;68:369–384. doi: 10.3109/08039488.2013.852242.
    1. Molendijk M., Molero P., Ortuño Sánchez-Pedreño F., Van der Does W., Angel Martínez-González M. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J. Affect. Disord. 2018;226:346–354. doi: 10.1016/j.jad.2017.09.022.
    1. Li Y., Lv M.-R., Wei Y.-J., Sun L., Zhang J.-X., Zhang H.-G., Li B. Dietary patterns and depression risk: A meta-analysis. Psychiatry Res. 2017;253:373–382. doi: 10.1016/j.psychres.2017.04.020.
    1. Opie R.S., Itsiopoulos C., Parletta N., Sanchez-Villegas A., Akbaraly T.N., Ruusunen A., Jacka F.N. Dietary recommendations for the prevention of depression. Nutr. Neurosci. 2017;20:161–171. doi: 10.1179/1476830515Y.0000000043.
    1. Martínez-González M.A., Sánchez-Villegas A. Food patterns and the prevention of depression. Proc. Nutr. Soc. 2016;75:139–146. doi: 10.1017/S0029665116000045.

Source: PubMed

3
Sottoscrivi