Can Poor Literacy Have a Negative Impact on Mental Health?

Few people would argue with the statement that literacy is an essential component of success in the United States and most other nations.

As so many aspects of personal and professional life move online, the ability to use and understand various forms of written language is increasingly vital for academic success, career progress, and healthy interactions with friends and family.

But can literacy also have a significant impact on a person’s mental health?

Recent research indicates that it may.

Before we delve into these studies, let’s take a moment to clarify exactly what we mean when we use the term literacy. Let’s discuss how and why literacy may affect mental health.

What Is Literacy?

In broad terms, literacy is the ability to read and write. But organizations that assess and promote literacy define the term more thoroughly.

For example, the Program for the International Assessment of Adult Competencies (PIAAC) defines literacy as “understanding, evaluating, using and engaging with written text to participate in society, to achieve one’s goals, and to develop one’s knowledge and potential.”

This definition, the PIAAC notes, acknowledges literacy includes multiple cognitive processes and requires active engagement with a variety of text types. These include both print and digital documents.

The PIAAC established six literacy proficiency levels. Here’s a quick look at the level of literacy in the United States and throughout the world. This data appears in a PIAAC global assessment conducted in 2017:

• US citizens ranking:
  • Level 1 or below: 7%
    • That’s the lowest ranking on the PIAAC’s evaluation framework
  • Level 2: 33%
  • 3 or above: 50%

 In other words 83% of the adult population in the U.S. has at least basic literacy skills.

• Of all nations  included in the PIAAC’s literacy assessment, Japan performed best:
  • Level 1 or below: 5%
  • Level 2: 23%
  • 3 or above: 72%
• The international averageL
  • Level 1 or below: 23&
  • Level 2: 35%
  • 3 or above: 42%

This means that the global literacy rate, as measured against the PIAAC’s standards is about 77%.

Since literacy is defined and measured in different ways by different organizations, various sources cite different levels. However, most align with the numbers reported by the PIAAC. This means:

• Most people throughout the world have basic literacy skills.
• Over 1.8 billion people have poor literacy skills.

Given these numbers, it’s easy to see how a connection between poor literacy and poor mental health may be a significant public health concern.

Global Study Links Poor Literacy, Poor Mental Health

In February 2023, a research team from England’s University of East Anglia published a study on the connection between literacy and mental health.

“To the best of the authors’ knowledge, this is the first systematic review to look at the global picture of literacy and mental health,” the researchers wrote. “It suggests there is a relationship between literacy abilities and mental health outcomes, highlighting the importance of healthcare professionals and services including identification of literacy needs within routine mental health practice.”

According to a Neuroscience News article about this research, the team reviewed 19 studies that collected data on literacy and mental health from nearly 2 million people in the following nine nations:

• Brazil
• China
• Ghana
• India
• Iran
• Nepal
• Pakistan
• Thailand
• United States

The University of East Anglia research team found that 17 of the 19 studies indicated “a significant association between literacy and mental health.”

“People with lower literacy had greater mental health difficulties such as anxiety and depression,” lead author Lucy Hunn said in the Neuroscience News article. “We can’t say for sure that poor literacy causes poor mental health, but there is a strong association.”

The research team acknowledged that other factors, such as living in poverty or in areas that have historically been impacted by military conflicts, can also have an effect on mental health. However, they noted, even in impoverished or war-torn locations, people who had lower literacy skills had higher rates of mental illness.

Literacy, Poverty, & Mental Health

As indicated by the number of studies that were included in the University of East Anglia’s review, many researchers have been interested in the potential connection between literacy and mental illness.

One such effort took place in 1997,when two mental health experts in Florida conducted a small study of literacy rates among low-income psychiatric patients.

Their study, which was published by the journal Psychiatric Studies, assessed the reading level of 45 patients who were receiving care at Helping Hands Clinic for the Homeless in Gainesville, Florida.

The Florida researchers found the following:

• 76% of the people they studied read at or below the seventh grade level.
• 10% of those in the study read at no higher than the third grade level.
• Among those in the low-literacy group, 29% told the researchers they read “very well,” with another 47% claiming that they read “well.”
• The mean level of educational achievement among the study’s subjects was grade 11.

In addition to documenting the prevalence of poor literacy within this population of psychiatric patients, the researchers also offered the following words of advice for treatment providers:

• Mental health professionals need to be cognizant of the likelihood that patients may struggle with poor literacy.
• Professionals should not rely on their patients’ ability to self-assess their literacy skills.
• Professionals should not assume that a certain level of educational advancement correlates with a similar level of literacy.
• Routine literacy screening may be necessary to ensure that patients can benefit from mental health services.

“Access to and utilization of effective and compassionate mental health services may be contingent on providers’ recognizing the presence of this clinically significant, but potentially surmountable, obstacle to care,” the researchers wrote.

Can Improved Literacy Lead to Better Mental Health?

The study in the previous section suggested that access to appropriate care may be continent on how well treatment providers accommodate their patients’ literacy shortcomings. In August 2006, a study was published that investigated the mental health benefits of literacy education.

The August 2006 study, which was published by the Journal of General Internal Medicine, focused on literacy skills and depressive disorders. This study involved 70 adult patients who met the criteria for depression via the Patient Health Questionnaire (PHQ-9) and also scored poorly on the Rapid Estimate of Adult Literacy in Medicine (REALM) assessment.

The researchers noted that they focused on the connection between poor literacy skills and depression because people from both groups share characteristics such as:

• Low self-esteem
• External locus of control
• Poor self-efficacy
• Sense of worthlessness
• Guilt and shame

Highlights of this study included the following:

• 38 of the study’s subjects received standard depression treatment plus literacy education. The other 32 took part only in standard depression treatment.
• The mean time that subjects participated in literacy education sessions was 18.1 hours.
• Subjects were tested at baseline and three additional times up to one year.

As determined by the PHQ-9, the health of patients in both groups improved during the study period. However, the group that also received literacy education had a “significantly larger” improvement.

“If borne out by larger and more rigorous trials, the results have implications for treatment of depression for millions of Americans,” the study’s authors wrote.