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Impact of illiteracy on depression symptomatology in community-dwelling older adults

Published online by Cambridge University Press:  19 June 2014

Byung-Soo Kim
Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, South Korea
Dong-Woo Lee
Department of Psychiatry, Inje University College of Medicine, Seoul, South Korea
Jae Nam Bae
Department of Psychiatry, Inha University College of Medicine, Incheon, South Korea
Sung Man Chang
Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, South Korea
Shinkyum Kim
Department of Psychiatry, Yangsan Mental Hospital, Yangsan, South Korea
Ki Woong Kim
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea
Hyo-Deog Rim
Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, South Korea
Jee Eun Park
Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
Maeng Je Cho*
Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
Correspondence should be addressed to: Dr Maeng Je Cho, MD, PhD, Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea. Phone: +82-2-2072-3155; Fax: +82-2-744-7241. Email:



In many countries, illiteracy rates among aged people are quite high. However, only few studies have specifically investigated the impact of illiteracy on depression.


Data for 1,890 elderly individuals (aged ≥65 years) were obtained from a nationwide dementia epidemiological study conducted in South Korea. Based on their reading ability, the participants were divided into three groups: totally illiterate, partially illiterate, and literate. The Korean version of the Geriatric Depression Scale – Short Form (SGDS-K) was used to detect depression (cut-off score = 8). Multivariate logistic regression analyses were used to assess the association between illiteracy and depression. To explore clinical features of depression in illiterate people, we performed logistic regression to calculate odds ratios of positive responses (or negative responses to reverse-coded items) for each SGDS-K item using literate individuals as the reference group.


Totally illiterate participants had 2.41 times the odds and partially illiterate individuals had 1.59 times the odds of being depressed compared with literate participants after controlling for other variables. Compared with literate individuals, illiterate elderly persons were at increased odds for responding negatively to the majority of SGDS-K items, including “having memory problems,” “others are better off than me,” and “feeling worthless” even after controlling for various demographic and clinical factors.


Illiteracy in elderly individuals was associated with a higher rate and increased severity of depression. Illiteracy negatively affected depression symptomatology, especially factors associated with self-esteem. Therefore, clinicians should carefully monitor for the presence of depression in illiterate elderly adults.

Research Article
Copyright © International Psychogeriatric Association 2014 

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