Electronic health literacy, anxiety and depression symptoms in patients scheduled for combined orthodontic-orthognathic treatment: a cross-sectional study in China

Abstract Objective To investigate the level of electronic health literacy among patients scheduled for combined orthodontic-orthognathic treatment, and to explore its association with anxiety and depression, providing a basis for clinical interventions. Methods A cross-sectional study was conducted. Questionnaires including the eHealth Literacy Scale (eHEALS), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were administered to patients scheduled for combined orthodontic-orthognathic treatment at a tertiary stomatological hospital from June 2023 to April 2025. Results The mean eHealth literacy score among patients was 25.76 ± 5.46. The incidence rates for anxiety and depression symptoms were 16.2% and 13.5%, respectively. Logistic regression analysis revealed that lower per capita annual household income was significantly associated with an increased risk of anxiety (OR = 9.16, 95% CI [2.30-36.52], p = 0.002) and depression symptoms (OR = 8.83, 95% CI [1.08–72.46], p = 0.042). Additionally, eHealth literacy scores were negatively correlated with anxiety (OR = 0.82, 95% CI [0.73–0.93], p < 0.001) and depression symptoms (OR = 0.64, 95% CI [0.47–0.86], p = 0.003). Conclusion Our findings demonstrate that patients scheduled for combined orthodontic-orthognathic treatment experience significant psychological distress, with lower-income individuals exhibiting more severe symptoms. Better electronic health literacy appears to reduce emotional issues. These findings indicate that healthcare providers should assess patients' ehealth literacy before treatment and focus on low-income patients.