Does Ehealth Literacy Mediate the Gender and Depression Relationship in Active-Duty Service-Members?: The Role of Contextual Variables

Background and Purpose: Depression impacts military readiness across all branches of the United States (U.S.) armed forces. Extant military research shows an association between gender and depression. Far less is known about the underlying process that explains the association among gender and depression. The purpose of this study was to examine eHealth literacy as a mediating factor in the relationship between gender and depression among active-duty service-members (SMs).

Methods: Six hundred and twenty participants including service members across multiple branches of the U.S. Active Duty, Reserve, and National Guard military from our parent study completed multiple scales including the health and wellbeing measures such as the eHealth literacy scale (eHEALS) and the patient health questionnaire (PHQ-9) for depression. From a mediation analysis using bootstrap resampling methods (10,000 bootstrap samples), we hypothesized that gender (male = 1, female = 2) indirectly influences depression through its effect on eHealth literacy with and without sociodemographic and health and wellbeing statistical controls such as age, race/ethnicity, relationship status, post-traumatic stress, and anxiety.

Results: Female service-members have significantly more eHealth literacy than male service-members (a = 1.19, p = .019) and female SMs who believed they have more eHealth literacy endorsed less depression (path b = -0.19, p = .000) than male SMs. The bootstrap 95% confidence interval (95% CI) for the indirect effect (ab = -.220) was entirely above zero (95% CI: -0.453 to -0.036), indicating eHealth literacy mediates the effect of gender on depression. The inclusion of covariates resulted in non-significant gender differences in eHealth literacy (a = 1.39, p = 0.09) and a non-significant association between eHealth literacy and depression (b = -0.06, p = 0.18). The bootstrap 95% CI for the indirect effect (ab = -.082) was not above zero (CI: -0.283 to 0.040), indicating eHealth literacy fails to mediate the effect of gender on depression when sociodemographic and health and wellbeing covariates were included in our model.

Conclusions and Implications: eHealth literacy may act as mediating mechanism linking gender to depression but perhaps only with certain SMs. More research is needed to extend our findings and to disentangle contextual model effects by testing boundary conditions. Military social work research investigating associations between gender, contextual variables, and depression among active-duty service-members is warranted.