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Article

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

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Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
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Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia
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Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
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FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 01 Kosice, Slovakia
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2nd Department of Internal Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
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Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenna 5, 040 01 Kosice, Slovakia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(21), 7913; https://doi.org/10.3390/ijerph17217913
Received: 31 August 2020 / Revised: 23 October 2020 / Accepted: 26 October 2020 / Published: 28 October 2020
Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21–3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26–2.98) or anxiety (OR/95% CI: 1.81/1.22–2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients’ psychological distress to ensure adequate adherence with recommended diet. View Full-Text
Keywords: health literacy; dialyzed patients; depression; anxiety; diet non-adherence; stage 5 CKD health literacy; dialyzed patients; depression; anxiety; diet non-adherence; stage 5 CKD
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MDPI and ACS Style

Skoumalova, I.; Geckova, A.M.; Rosenberger, J.; Majernikova, M.; Kolarcik, P.; Klein, D.; Winter, A.F.d.; van Dijk, J.P.; Reijneveld, S.A. Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence? Int. J. Environ. Res. Public Health 2020, 17, 7913. https://doi.org/10.3390/ijerph17217913

AMA Style

Skoumalova I, Geckova AM, Rosenberger J, Majernikova M, Kolarcik P, Klein D, Winter AFd, van Dijk JP, Reijneveld SA. Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence? International Journal of Environmental Research and Public Health. 2020; 17(21):7913. https://doi.org/10.3390/ijerph17217913

Chicago/Turabian Style

Skoumalova, Ivana; Geckova, Andrea M.; Rosenberger, Jaroslav; Majernikova, Maria; Kolarcik, Peter; Klein, Daniel; Winter, Andrea F.d.; van Dijk, Jitse P.; Reijneveld, Sijmen A. 2020. "Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?" Int. J. Environ. Res. Public Health 17, no. 21: 7913. https://doi.org/10.3390/ijerph17217913

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