{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:40:12Z","timestamp":1788496812592,"version":"build-2803163510"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Psychol"],"DOI":"10.1186\/s40359-026-04765-2","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:55:32Z","timestamp":1778658932000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of health literacy with depressive and anxiety symptoms in Korean adults: a dose\u2013response analysis"],"prefix":"10.1186","volume":"14","author":[{"given":"Myong-Won","family":"Seo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"10364","key":"4765_CR1","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1016\/S0140-6736(22)02301-7","volume":"400","author":"T Lancet","year":"2022","unstructured":"Lancet T. Why is health literacy failing so many? Lancet. 2022;400(10364):1655.","journal-title":"Lancet"},{"issue":"Suppl 6","key":"4765_CR2","doi-asserted-by":"publisher","first-page":"S258","DOI":"10.1097\/PHH.0000000000001324","volume":"27","author":"S Santana","year":"2021","unstructured":"Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, Kleinman D, Pronk N. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021;27(Suppl 6):S258\u201364.","journal-title":"J Public Health Manag Pract"},{"issue":"1","key":"4765_CR3","first-page":"e22","volume":"4","author":"J Cudjoe","year":"2020","unstructured":"Cudjoe J, Delva S, Cajita M, Han HR. Empirically Tested Health Literacy Frameworks. Health Lit Res Pract. 2020;4(1):e22\u201344.","journal-title":"Health Lit Res Pract"},{"issue":"2","key":"4765_CR4","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1177\/17423953211035472","volume":"18","author":"M van der Gaag","year":"2022","unstructured":"van der Gaag M, Heijmans M, Spoiala C, Rademakers J. The importance of health literacy for self-management: A scoping review of reviews. Chronic Illn. 2022;18(2):234\u201354.","journal-title":"Chronic Illn"},{"issue":"4","key":"4765_CR5","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1177\/00333549251322649","volume":"140","author":"B Beasant","year":"2025","unstructured":"Beasant B, Anderson K, Lee G, Lotfaliany M, Tembo M, McCoombe S, Vaughan V, Pasco JA, Hosking SM. Health Literacy and Primary Prevention of Cardiovascular Disease: A Scoping Review. Public Health Rep. 2025;140(4):342\u201357.","journal-title":"Public Health Rep"},{"issue":"2","key":"4765_CR6","doi-asserted-by":"publisher","first-page":"e48","DOI":"10.1161\/CIR.0000000000000579","volume":"138","author":"JW Magnani","year":"2018","unstructured":"Magnani JW, Mujahid MS, Aronow HD, Cen\u00e9 CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation. 2018;138(2):e48\u201374.","journal-title":"Circulation"},{"issue":"6","key":"4765_CR7","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1111\/jep.13554","volume":"27","author":"M Heine","year":"2021","unstructured":"Heine M, Lategan F, Erasmus M, Lombaard CM, Mc Carthy N, Olivier J, van Niekerk M, Hanekom S. Health education interventions to promote health literacy in adults with selected non-communicable diseases living in low-to-middle income countries: A systematic review and meta-analysis. J Eval Clin Pract. 2021;27(6):1417\u201328.","journal-title":"J Eval Clin Pract"},{"issue":"5","key":"4765_CR8","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/heapro\/day062","volume":"34","author":"C Stormacq","year":"2019","unstructured":"Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int. 2019;34(5):e1\u201317.","journal-title":"Health Promot Int"},{"issue":"1","key":"4765_CR9","doi-asserted-by":"publisher","first-page":"12837","DOI":"10.1038\/s41598-024-63607-6","volume":"14","author":"T Rahimi","year":"2024","unstructured":"Rahimi T, Hashemi SS, Rezaei F, Aune D. Association between health literacy and Framingham risk score. Sci Rep. 2024;14(1):12837.","journal-title":"Sci Rep"},{"issue":"29","key":"4765_CR10","doi-asserted-by":"publisher","first-page":"e38994","DOI":"10.1097\/MD.0000000000038994","volume":"103","author":"T Yardimci G\u00fcrel","year":"2024","unstructured":"Yardimci G\u00fcrel T, G\u00fcner \u00d6. Health literacy as a predictor of cardiovascular disease risk factor knowledge level among women in Turkey: A community-based cross-sectional study. Med (Baltim). 2024;103(29):e38994.","journal-title":"Med (Baltim)"},{"key":"4765_CR11","doi-asserted-by":"publisher","first-page":"e2025037","DOI":"10.4178\/epih.e2025037","volume":"47","author":"S Choi","year":"2025","unstructured":"Choi S, Kang Y, Kim H, Oh K. Health literacy in Korea: findings from the 2023 Korea National Health and Nutrition Examination Survey. Epidemiol Health. 2025;47:e2025037.","journal-title":"Epidemiol Health"},{"key":"4765_CR12","doi-asserted-by":"crossref","unstructured":"JE K, Y B, IH S. Factors influencing health literacy among South Korean adults: a nationwide. Eur J Public Health. 2024;34(Suppl 3).","DOI":"10.1093\/eurpub\/ckae144.1699"},{"issue":"1","key":"4765_CR13","doi-asserted-by":"publisher","first-page":"13639","DOI":"10.1038\/s41598-024-64656-7","volume":"14","author":"A Haeri-Mehrizi","year":"2024","unstructured":"Haeri-Mehrizi A, Mohammadi S, Rafifar S, Sadighi J, Kermani RM, Rostami R, Hashemi A, Tavousi M, Montazeri A. Health literacy and mental health: a national cross-sectional inquiry. Sci Rep. 2024;14(1):13639.","journal-title":"Sci Rep"},{"issue":"1","key":"4765_CR14","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s12889-024-21202-4","volume":"25","author":"A Alinejad-Tilaki","year":"2025","unstructured":"Alinejad-Tilaki A, Omidvar S, Kheirkhah F, Bakhtiari A, Gholinia H. Health literacy and its relationship with mental health and quality of life in freshmen students. BMC Public Health. 2025;25(1):106.","journal-title":"BMC Public Health"},{"issue":"12","key":"4765_CR15","doi-asserted-by":"publisher","first-page":"e061623","DOI":"10.1136\/bmjopen-2022-061623","volume":"12","author":"Y Zurynski","year":"2022","unstructured":"Zurynski Y, Ellis LA, Pomare C, Meulenbroeks I, Gillespie J, Root J, Ansell J, Holt J, Wells L, Braithwaite J. Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study. BMJ Open. 2022;12(12):e061623.","journal-title":"BMJ Open"},{"issue":"4","key":"4765_CR16","first-page":"e224","volume":"4","author":"C Coleman","year":"2020","unstructured":"Coleman C. Health Literacy and Clear Communication Best Practices for Telemedicine. Health Lit Res Pract. 2020;4(4):e224\u20139.","journal-title":"Health Lit Res Pract"},{"issue":"6","key":"4765_CR17","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1177\/00207640231166628","volume":"69","author":"D Wang","year":"2023","unstructured":"Wang D, Sun X, He F, Liu C, Wu Y. The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China. Int J Soc Psychiatry. 2023;69(6):1490\u2013500.","journal-title":"Int J Soc Psychiatry"},{"key":"4765_CR18","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.puhe.2025.03.001","volume":"242","author":"X Li","year":"2025","unstructured":"Li X, Yin X, Guan Z, Qian Y, Loux T. Association between health literacy and risk of depression: A systematic review and meta-analysis of observational studies. Public Health. 2025;242:179\u201385.","journal-title":"Public Health"},{"key":"4765_CR19","unstructured":"Yoon J, Kang SJ, Lee M, Cho J. Development and validation of the health literacy index for the community for the Korean National health and nutrition and examination survey. Epidemiol Health. 2024;46."},{"issue":"4","key":"4765_CR20","doi-asserted-by":"publisher","first-page":"920","DOI":"10.2337\/dc09-1825","volume":"33","author":"MC Amato","year":"2010","unstructured":"Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920\u20132.","journal-title":"Diabetes Care"},{"issue":"7","key":"4765_CR21","doi-asserted-by":"publisher","first-page":"3347","DOI":"10.1210\/jc.2010-0288","volume":"95","author":"F Guerrero-Romero","year":"2010","unstructured":"Guerrero-Romero F, Simental-Mend\u00eda LE, Gonz\u00e1lez-Ortiz M, Mart\u00ednez-Abundis E, Ramos-Zavala MG, Hern\u00e1ndez-Gonz\u00e1lez SO, Jacques-Camarena O, Rodr\u00edguez-Mor\u00e1n M. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347\u201351.","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"4765_CR22","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1373\/clinchem.2016.257436","volume":"62","author":"K Paulmichl","year":"2016","unstructured":"Paulmichl K, Hatunic M, H\u00f8jlund K, Jotic A, Krebs M, Mitrakou A, Porcellati F, Tura A, Bergsten P, Forslund A, et al. Modification and Validation of the Triglyceride-to-HDL Cholesterol Ratio as a Surrogate of Insulin Sensitivity in White Juveniles and Adults without Diabetes Mellitus: The Single Point Insulin Sensitivity Estimator (SPISE). Clin Chem. 2016;62(9):1211\u20139.","journal-title":"Clin Chem"},{"issue":"9","key":"4765_CR23","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","volume":"16","author":"K Kroenke","year":"2001","unstructured":"Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606\u201313.","journal-title":"J Gen Intern Med"},{"key":"4765_CR24","doi-asserted-by":"publisher","first-page":"n2183","DOI":"10.1136\/bmj.n2183","volume":"375","author":"ZF Negeri","year":"2021","unstructured":"Negeri ZF, Levis B, Sun Y, He C, Krishnan A, Wu Y, Bhandari PM, Neupane D, Brehaut E, Benedetti A, et al. Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis. BMJ. 2021;375:n2183.","journal-title":"BMJ"},{"key":"4765_CR25","doi-asserted-by":"publisher","first-page":"3625","DOI":"10.2147\/PRBM.S479975","volume":"17","author":"J Ding","year":"2024","unstructured":"Ding J, Wu Y, Li H, Wang S, Cai J, Cheng H, Liang S. Using Network Analysis to Subgroup Risk Factors for Depressive Symptoms in College Students. Psychol Res Behav Manag. 2024;17:3625\u201336.","journal-title":"Psychol Res Behav Manag"},{"issue":"10","key":"4765_CR26","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","volume":"166","author":"RL Spitzer","year":"2006","unstructured":"Spitzer RL, Kroenke K, Williams JB, L\u00f6we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092\u20137.","journal-title":"Arch Intern Med"},{"issue":"6","key":"4765_CR27","doi-asserted-by":"publisher","first-page":"e0293993","DOI":"10.1371\/journal.pone.0293993","volume":"19","author":"RM Bulamba","year":"2024","unstructured":"Bulamba RM, Nalugoda F, Nkale J, Kigozi G, Ochieng AM, Kyasanku E, Watya S, Olwa VO, Daama A, Nkwanzi V, et al. Examining associations between mental health and Chronic Non-Communicable Diseases (C-NCDs) among older adults in Wakiso, Uganda. PLoS ONE. 2024;19(6):e0293993.","journal-title":"PLoS ONE"},{"key":"4765_CR28","doi-asserted-by":"crossref","unstructured":"Magi CE, El Aoufy K, Amato C, Longobucco Y, Bambi S, Vellone E, Bonaccorsi G, Lorini C, Rasero L, Iovino P. The association between self-care and health literacy in patients with chronic diseases: a systematic review and meta-analysis. J Clin Nurs. 2026.","DOI":"10.1093\/eurjcn\/zvaf122.046"},{"issue":"3","key":"4765_CR29","doi-asserted-by":"publisher","first-page":"910","DOI":"10.12669\/pjms.41.3.10639","volume":"41","author":"T Mukhtar","year":"2025","unstructured":"Mukhtar T, Babur MN, Abbas R, Irshad A, Kiran Q. Digital Health Literacy: A systematic review of interventions and their influence on healthcare access and sustainable development Goal-3 (SDG-3). Pak J Med Sci. 2025;41(3):910\u20138.","journal-title":"Pak J Med Sci"},{"issue":"43","key":"4765_CR30","doi-asserted-by":"publisher","first-page":"e40260","DOI":"10.1097\/MD.0000000000040260","volume":"103","author":"N Elkin","year":"2024","unstructured":"Elkin N. The relationship between health literacy and healthy lifestyle behaviors: A meta-analysis. Med (Baltim). 2024;103(43):e40260.","journal-title":"Med (Baltim)"},{"issue":"1","key":"4765_CR31","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1186\/s12889-025-21354-x","volume":"25","author":"C Barbati","year":"2025","unstructured":"Barbati C, Maranesi E, Giammarchi C, Lenge M, Bonciani M, Barbi E, Vigezzi GP, Dragoni M, Bailoni T, Odone A, et al. Effectiveness of eHealth literacy interventions: a systematic review and meta-analysis of experimental studies. BMC Public Health. 2025;25(1):288.","journal-title":"BMC Public Health"},{"key":"4765_CR32","doi-asserted-by":"publisher","first-page":"108168","DOI":"10.1016\/j.pec.2024.108168","volume":"122","author":"A Romanova","year":"2024","unstructured":"Romanova A, Rubinelli S, Diviani N. Improving health and scientific literacy in disadvantaged groups: A scoping review of interventions. Patient Educ Couns. 2024;122:108168.","journal-title":"Patient Educ Couns"},{"issue":"Suppl 1","key":"4765_CR33","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1080\/10810730.2015.1131776","volume":"21","author":"H Levy","year":"2016","unstructured":"Levy H, Janke A. Health Literacy and Access to Care. J Health Commun. 2016;21(Suppl 1):43\u201350.","journal-title":"J Health Commun"},{"issue":"1","key":"4765_CR34","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12905-022-01652-x","volume":"22","author":"AR Yusefi","year":"2022","unstructured":"Yusefi AR, Barfar E, Daneshi S, Bayati M, Mehralian G, Bastani P. Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic. BMC Womens Health. 2022;22(1):77.","journal-title":"BMC Womens Health"},{"issue":"5","key":"4765_CR35","doi-asserted-by":"publisher","first-page":"e0267782","DOI":"10.1371\/journal.pone.0267782","volume":"17","author":"L Murugesu","year":"2022","unstructured":"Murugesu L, Heijmans M, Rademakers J, Fransen MP. Challenges and solutions in communication with patients with low health literacy: Perspectives of healthcare providers. PLoS ONE. 2022;17(5):e0267782.","journal-title":"PLoS ONE"},{"key":"4765_CR36","doi-asserted-by":"crossref","unstructured":"Lee EK, Eo YS. The effects of health literacy, social support, and health-promoting behaviors on metabolic syndrome among middle-aged and older women living in Rural Areas of Republic of Korea. Healthcare (Basel). 2025;13(24).","DOI":"10.3390\/healthcare13243279"},{"key":"4765_CR37","doi-asserted-by":"publisher","first-page":"103260","DOI":"10.1016\/j.pmedr.2025.103260","volume":"59","author":"EJ Bae","year":"2025","unstructured":"Bae EJ, Chung J, Son H. Health literacy and adherence to physical activity guidelines among adults with hypertension: evidence from a Korean National Survey. Prev Med Rep. 2025;59:103260.","journal-title":"Prev Med Rep"}],"container-title":["BMC Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40359-026-04765-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-026-04765-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-026-04765-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:36:50Z","timestamp":1783384610000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40359-026-04765-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4765"],"URL":"https:\/\/doi.org\/10.1186\/s40359-026-04765-2","relation":{},"ISSN":["2050-7283"],"issn-type":[{"value":"2050-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"20 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the principles of the Declaration of Helsinki. The KNHANES study protocol was approved by the Institutional Review Board of the Korea Disease Control and Prevention Agency (KDCA) (Approval No. 2022-11-16-R-03). Written informed consent was obtained from all participants by KDCA prior to participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"992"}}