Two views of self-rated general health status

On classifying race in Brazil: example from a study of the functional ability of older people (60+)

How should race be categorized? This article investigates the usefulness of having three categories to describe a black-white racial continuum, focusing on Brazil and the functional ability of elderly (60+) people there. Ironically, even as the U.S. census has started to acknowledge mixed race again, much social research in Brazil has begun not to. Using 1998 national household survey microdata (PNAD) for Brazil, we find it advantageous to use a three-category scheme that separates a mixed black-white (pardo) status from black or white when examining the functional ability of elders. We also find the tantalizing possibility of a crossover in which browns actually have more functional ability than white counterparts after controlling for many demographic, geographic, and socioeconomic factors.

Immunoglobulin treatment for primary antibody deficiencies: advantages of the subcutaneous route

Adults and children with primary antibody deficiencies are prone to bacterial infections affecting the respiratory tract and gastrointestinal canal. To prevent or alleviate infections, replacement therapy with IgG is needed, usually on a lifelong basis. The IgG can be administered intramuscularly, intravenously, or subcutaneously. Subcutaneous IgG (SCIG) therapy, using small portable pumps for once-per-week self infusions, has shown many advantages compared with the two other routes of administration. This review highlights findings from international studies and demonstrates that: (i) SCIG therapy is safe, with very few adverse effects; (ii) the therapy can be used for patients with previous adverse effects to intravenous administration of IgG; (iii) the therapy leads to high serum IgG levels and good protection against infections; (iv) the therapy facilitates home therapy, as the infusion technique is easy for children, adults and elderly people to learn and there is no need for venous access; (v) SCIG home therapy leads to significantly improved life situations for the patients; (vi) the SCIG home therapy regimen in particular reduces the costs of treatment.

Risk factors for poor self-rated health in women at 2 months and 1 year after childbirth

OBJECTIVE

To investigate risk factors for poor self-rated health (SRH) in primiparous and multiparous women 2 months and 1 year after childbirth in a nationwide Swedish sample.

METHODS

Women were recruited at their first booking visit at 593 (97%) antenatal clinics in Sweden during 3 weeks evenly spread over 1 year (1999-2000). Data were collected by questionnaires in early pregnancy, 2 months and 1 year after childbirth, and from the Medical Birth Register. In total, 2424 women filled in all the questionnaires, including a global question on SRH. The representativity of the sample was assessed by comparison with the total Swedish birth cohort of 1999. Data were analyzed by logistic regression analysis.

RESULTS

Physical problems, such as tiredness, musculoskeletal symptoms, and abdominal pain, and emotional problems, such as depressive symptoms, increased the risk of poor SRH in both primiparas and multiparas at one or both time points. Infant-related risk factors in both groups were negative experience of breastfeeding (2 months) and infant sleeping problems (1 year), and prematurity was a risk factor in primiparas at 2 months. Insufficient social support increased the risk in multiparas. In primiparas, outcome of labor, such as negative birth experience after operative delivery, was associated with poor SRH at 1 year and perineal pain at 2 months.

CONCLUSIONS

A new mother's SRH is associated with her life situation. Ongoing physical and emotional problems, lack of support, and infant factors seem more important than sociodemographic background. Mode of delivery and childbirth experience may have a longterm effect on SRH.

The impact of lifestyle risk factors on female infertility

BACKGROUND

Over 2 million couples in the United States are infertile. The literature reflects a number of potential lifestyle risks that have been associated with the development of this condition; however, few studies have investigated these risks concurrently. With knowledge of the importance of behavioral threats to fertility, women's health care providers will be in a better position to screen and assist women to modify their fertility risks.

OBJECTIVES

The objectives of this study were (1) to identify lifestyle factors associated with infertility in women by comparing a sample of infertile women with a group of fertile women and (2) to offer recommendations to women's health providers, on counseling women at risk for infertility.

METHODS

A re-examination of the 1995 National Survey of Family Growth (NSFG) allowed for the investigation of lifestyle factors associated with infertility in women. Using a conceptual model of health behavior to guide the selection of variables, together with multiple logistic regression techniques, an explanatory model of infertility was estimated on a sample of 824 women between the ages of 16 and 45 years.

RESULTS

Factors directly related to infertility included increasing age, a history of an ectopic pregnancy, current smoking, obesity, and self reported health status. Protective effects were associated with a history of condom use and having had a Pap smear in the last year.

CONCLUSIONS AND IMPLICATIONS

Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can utilize these visits to target appropriate interventions for initiating, repeating, and reinforcing messages on fertility risk.

Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial

BACKGROUND AND PURPOSE

Tai chi, a Chinese exercise derived from martial arts, while gaining popularity as an intervention for reducing falls in older adults, also may improve health status. The purpose of this study was to determine whether intense tai chi (TC) exercise could improve perceived health status and self-rated health (SRH) more than wellness education (WE) for older adults who are transitionally frail.

SUBJECTS

Study subjects were 269 women who were >or=70 years of age and who were recruited from 20 congregate independent senior living facilities.

METHODS

Participants took part in a 48-week, single-blind, randomized controlled trial. They were randomly assigned to receive either TC or WE interventions. Participants were interviewed before randomization and at 1 year regarding their perceived health status and SRH. Perceived health status was measured with the Sickness Impact Profile (SIP).

RESULTS

Compared with WE participants, TC participants reported significant improvements in the physical dimension and ambulation categories and borderline significant improvements in the body care and movement category of the SIP. Self-rated health did not change for either group.

DISCUSSION AND CONCLUSION

These findings suggest that older women who are transitionally frail and participate in intensive TC exercise demonstrate perceived health status benefits, most notably in ambulation.

Self-rated health and age: a cross-sectional and longitudinal study of 11,000 Danes aged 45-102

AIMS

The aim of this study was to explore and describe self-rated health in middle-aged and elderly Danes using both a cross-sectional and a longitudinal design. Global and (age) comparative self-rated health are examined and compared.

METHODS

This study is interview based and comprises data on 11,294 Danes aged 45-102 with more than 1,900 participants aged 90 years and older.

RESULTS

As expected, global self-rated health declines with age in both cross-sectional and longitudinal analyses. In contrast, comparative self-rated health either increases or remains stable with age in cross-sectional analyses while in longitudinal analyses there is a slight decline in comparative self-rated health.

CONCLUSIONS

The age-trajectory of global self-rated health is similar in individuals and populations. For comparative self-rated health, however, the individual on average experiences a slight decline, whereas on the population level comparative self-rated health either increases or remains stable. The explanation for this is likely to be higher mortality and higher non-response among the participants with the poorest self-rated health.

Replacement IgG therapy and self-therapy at home improve the health-related quality of life in patients with primary antibody deficiencies

PURPOSE OF REVIEW

This article describes the health-related quality of life and health of patients suffering from primary antibody deficiencies before and after the initiation of lifelong IgG replacement therapy, and before and after the introduction of home-therapy regime programmes. The importance of including patient-reported or parent-reported outcomes in evaluations of treatment and care of this group of patients is also discussed.

RECENT FINDINGS

Recently diagnosed adults suffering from primary antibody deficiencies and not yet on IgG therapy report poor health and poor health-related quality of life as compared with healthy individuals. Weekly subcutaneous IgG infusions (100 mg/kg) significantly improve health and normalize health-related quality of life. IgG self-infusions at home further improve the self-reported health and health-related quality of life of both adults and children. Being able to self-infuse at home instead of visiting the hospital two to four times per month has been shown to increase the treatment satisfaction of both adult patients and their families, and to result in increased flexibility, independence and sense of self-control.

SUMMARY

Adequate IgG replacement therapy means a dramatically improved life situation. Home-therapy programmes should be encouraged, as self-infusions at home further improve health-related quality of life and self-perceived health.

Gender and health care utilization: The role of mental distress and help-seeking propensity

Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences. The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect). Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N = 8698). This survey contained questions on somatic morbidity, mental distress and other mediating variables. Health care utilization was measured prospectively, using data extracted from a claims database held by the sickness fund that covers all types of general health services except general practitioner consultations. The model was tested using structural equation modelling. Women reported more somatic morbidity and mental distress than men did, as well as elevated levels of other mediating variables, which might explain-at least partly-gender related differences in utilization. Differences in propensity to use services were not found. The expected moderating effect of gender could not be demonstrated. That is, we did not find gender related differences in the strength of the relations between mental distress, other mediating variables and utilization. Mental distress is related to utilization in a way that is not gender specific, however, because women report higher levels of mental distress (as well as somatic morbidity), this results in a greater utilization of somatic health care services.

Physical activity and health in Canadian asthmatics

Asthma is a chronic respiratory disease affecting approximately 8% of the Canadian population. Being physically active may assist in management of the disease and lead to improvements in overall health. The purpose of this study was to determine whether involvement in physical activity (PA) influenced self-reported measures of health in asthmatics. The sample included 4272 asthmatic men and 6971 asthmatic women who participated in the Canadian Community Health Survey cycle 2.1. The median age for this group fell in the 40-44 age category. PA level was classified into three categories: active, moderately active, or inactive. In order to determine the relationship between PA levels and the five measures of health (self-perceived health, self-perceived mental health, additional chronic conditions, functional limitations, and satisfaction with life in general) Kruskal-Wallis ANOVAs were conducted and pairwise comparisons were used when significant main effects occurred. For all five measures of health, being physically active increased the likelihood of better health, and greater levels of PA were associated with higher values. In summary, PA was consistently associated with better health in Canadians with asthma. Future research is required to confirm a linear dose-response relationship between PA and health in asthmatics.

Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models?

OBJECTIVE

Effort-reward imbalance at work is an established psychosocial risk factor but there are also newer conceptualisations, such as procedural injustice (decisions at work lack consistency, openness and input from all affected parties) and relational injustice (problems in considerate and fair treatment of employees by supervisors). The authors examined whether procedural injustice and relational injustice are associated with employee health in addition to, and in combination with, effort-reward imbalance.

METHODS

Prospective survey data from two cohorts related to public-sector employees: the 10-Town study (n = 18 066 (78% women, age range 19-62) and the Finnish Hospital Personnel study (n = 4833, 89% women, age range 20-60). Self-rated poor health, minor psychiatric morbidity and doctor-diagnosed depression were assessed at baseline (2000-2) and at follow-up (2004). To determine incident morbidity, baseline cases were excluded.

RESULTS

In multivariate models including age, sex, occupational status and all three psychosocial factors as predictors, high effort-reward imbalance and either high procedural injustice or high relational injustice were associated with increased morbidity at follow-up in both cohorts. After combining procedural and relational injustice into a single measure of organisational injustice, high effort-reward imbalance and high injustice were both independently associated with health. For all outcome measures, a combination of high effort-reward imbalance and high organisational injustice was related to a greater health risk than high effort-reward imbalance or injustice alone.

CONCLUSION

Evidence from two independent occupational cohorts suggests that procedural and relational components of injustice, as a combined index, and effort-reward imbalance are complementary risk factors.

Factors associated with poor general health after stem-cell transplantation

AIMS

To describe functional status (FS), general health (GH) and symptom distress (SD) from admission to 1 year post-SCT and to identify medical, demographic, and/or patient-reported outcome variables associated with patient-perceived GH.

MATERIAL AND METHODS

Forty-one patients (27 women) with a median age of 44 (18-65) years answered three questionnaires (SIP, SWED-QUAL, and SFID-SCT) from admission to 1 year post-SCT.

RESULTS

At discharge, 59% of the patients reported poor FS and GH, and 24% reported > 10 simultaneous symptoms. After 1 year post-SCT, 22% still reported poor FS, 32% poor GH, and 12% > 10 simultaneous symptoms. Compared with admission, significantly larger proportions of the patients reported poor GH at discharge (20 vs 59%, p = .001), poor FS at 6 months (24 vs 59%, p = .004), and poor GH [The number of symptoms was found to be significantly associated with poor GH at discharge (OR 1.330, p = .009) and at 1 year post-SCT (OR 2.000, p = .010)]. Patients reporting "poor GH" at discharge and at 1 year post-SCT reported a median of 7 and 10 symptoms, respectively. Patients with "good GH" reported a median of three symptoms both at T1 and T4. "Tiredness", "anxiety", "mouth dryness", "loss of appetite", and "diarrhoea" were reported by a larger proportion of the patients reporting "poor GH".

CONCLUSIONS

The results confirm that some patients who have undergone a SCT have a negatively affected life situation. The study indicates that actively asking for symptoms and applying the best treatment for symptom alleviation are among the most important measures that SCT teams can take to help the patients perceive better general health and an improved life situation.

Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois

This article investigates the relationship among objectively assessed neighborhood socio-economic status (SES), subjective perceptions of neighborhood environment, individual SES and psychosocial factors, and self-rated health among middle-aged and older adults. Analysis of data from a representative sample of adults, aged 50-67 years in Cook County, Illinois, shows a significant association between objective neighborhood SES and self-rated health after controlling for age, gender, and race/ethnicity, but the effect is substantially explained by individual SES and neighborhood perceptions. By contrast, perceived neighborhood quality (i.e., subjective ratings of neighborhood physical, social, and service environments) exhibits a significant effect after controlling for individual socio-demographic factors as well as neighborhood SES. In turn, the effects of perceived neighborhood environment on health are partially explained by the psychosocial factors of loneliness, depression, hostility, and stress, but not by perceived social support or social networks. In sum, the research supports a model in which the effects of neighborhood SES on self-rated health act through sequential pathways of individual SES, perceptions of neighborhood quality, and psychosocial status.

The validity of self-rated health as a measure of health status among young military personnel: evidence from a cross-sectional survey

Background

Single item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals.

Methods

The current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent.

Results

Ratings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001).

Conclusion

Given the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops.

Self-rated health appraisal as cultural and identity process: African American elders' health and evaluative rationales

PURPOSE

We explored self-rated health by using a meaning-centered theoretical foundation. Self-appraisals, such as self-rated health, reflect a cultural process of identity formation, whereby identities are multiple, simultaneously individual and collective, and produced by specific historical formations. Anthropological research in Philadelphia determined (a) how African American elders appraise their health, and (b) how health evaluations reflect cultural and historical experiences within a community.

DESIGN AND METHODS

We interviewed and observed 35 adults aged 65 to 80, stratified by gender and self-rated health. We validated theme analysis of focused interview questions against the larger data set of field notes and transcripts.

RESULTS

Health appraisal reflected a complex process of adaptation and identity. Criteria for health included: independent functioning, physical condition, control and responsibility for health, and overall feeling. Evaluative rationales that shaped health appraisals were comparisons, restricted possibilities for self-evaluation, and ways of handling adversity. Evaluative rationales mitigated undesirable health identities (including low self-reported health) and provided mechanisms for claiming desired health identities despite adversity.

IMPLICATIONS

Describing the criteria and evaluative rationales underlying self-appraisals of health extends current understandings of self-rated health and illustrates the sociohistorical context of individual assessments of well-being.

Predictors of self-rated health: a 12-month prospective study of IT and media workers

Objective

The aim of the present study was to determine health-related risk and salutogenic factors and to use these to construct prediction models for future self-rated health (SRH), i.e. find possible characteristics predicting individuals improving or worsening in SRH over time (0–12 months).

Methods

A prospective study was conducted with measurements (physiological markers and self-ratings) at 0, 6 and 12 months, involving 303 employees (187 men and 116 women, age 23–64) from four information technology and two media companies.

Results

There were a multitude of statistically significant cross-sectional correlations (Spearman's Rho) between SRH and other self-ratings as well as physiological markers. Predictors of future SRH were baseline ratings of SRH, self-esteem and social support (logistic regression), and SRH, sleep quality and sense of coherence (linear regression).

Conclusion

The results of the present study indicate that baseline SRH and other self-ratings are predictive of future SRH. It is cautiously implied that SRH, self-esteem, social support, sleep quality and sense of coherence might be predictors of future SRH and therefore possibly also of various future health outcomes.

Social networks and self-rated health: a cross-cultural examination among older Israelis

OBJECTIVE

This article examines the relationship of social network and self-rated health among different cultural groups.

METHODS

This study examined associations between network structure, interaction, support and social engagement and self-rated health, controlling for sociodemographic background and psychobiological pathways among veteran Jewish-Israelis (n = 2,043), Arab-Israelis (n = 609), and new immigrants from the former Soviet Union (n = 751). Hierarchical multiple regression analysis was performed.

RESULTS

Three different patterns emerged. The association of social network and self-rated health among the majority veteran Jewish culture in Israel was similar to that found in Western societies. Among Arab-Israelis, self-rated health was explained by more traditional, familial, and communal network dynamics. The characteristic association between social network and self-rated health among the new immigrants was explained by migration-induced factors.

DISCUSSION

The findings demonstrate that social networks impact health differently in different cultural groups and under conditions of social change, such as migration in later-life.

Predictors of physical activity in older adults with borderline hypertension

BACKGROUND

Physical activity (PA) is effective in controlling blood pressure (BP) and is important in the treatment and prevention of hypertension in the elderly. Reasons for engaging in regular PA are complex and are influenced by personal, interpersonal, and environmental factors.

OBJECTIVE

To test a predictive model of PA in older adults with borderline hypertension.

METHODS

Data were collected from a multiethnic nonprobability sample of 267 men and women 60-75 years of age. The predictor variables were gender, ethnicity, income, previous exercise experience, self-efficacy for PA, perceived health status, awareness of BP, barriers to PA, intrinsic motivation for health, motivation for PA, interpersonal influence, and environmental influence.

RESULTS

The hypothesized model was tested and modified using path analysis. The final model explained 44% of the variance in PA. The variables that directly predicted PA were gender, income, previous exercise experience, self-efficacy for PA, and motivation for PA. Variables that indirectly predicted PA were perceived health status, barriers to PA, self-efficacy for PA, intrinsic motivation for health, and environmental influence.

CONCLUSIONS

The significant associations between the cognitive appraisal and motivation concepts extend previous research and add to the understanding of the complex factors that influence regular PA. The PA model can be a foundation for further research and practice.

Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden, especially for the lower educated

BACKGROUND

There is an ongoing debate about the importance of biomedical and sociodemographic risk factors in the prediction of self-rated health.

OBJECTIVES

To compare the association of sociodemographic and cardiovascular risk factors and self-rated health in Sweden and the US.

DESIGN

Data from two population-based cross-sectional health surveys, one in Sweden and one in the US.

SUBJECTS

The surveys included questionnaire and measured data from 5,461 adults in Sweden and 7,643 in the US. Participants were between 35 and 65 years of age.

RESULTS

The odds ratios for poor self-rated health for the included cardiovascular risk factors were greater in the US. Low education was significantly more prevalent among those with self-rated poor health in the US, but not in Sweden. Using Swedes with high education as reference group (OR = 1), adults in the US with low education and 2+ risk factors had a greater than threefold risk (OR = 6.3) of self-rated poor health compared with Swedish low-educated adults with the same risk factor burden (OR = 1.9). The better-educated US adults with 2+ risk factors were significantly more likely to report poor health (OR = 3.4) compared with their Swedish counterparts (OR = 2.4).

CONCLUSIONS

The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people's overall evaluation of their health into account when assessing total health risk is important.

Self-rated health among U.S. adolescents

PURPOSE

This article investigates the meaning of subjective health assessments for younger respondents by examining the temporal stability of self-rated health (SRH) among adolescents. Two competing understandings of SRH are tested: SRH as a spontaneous health assessment or as an enduring self-concept.

METHODS

Using data from two waves of the National Longitudinal Study of Adolescent Health (n = 13,511), an intra-class correlation coefficient and a weighted Kappa estimate are calculated to assess the test-retest reliability for SRH. Self-rated health (T2) is then modeled as a function of SRH (T1), physical health (T1), and mental health (T1), and changes in physical and mental health (T2-T1).

RESULTS

SRH is found to be moderately stable over repeated observations (K = .40; rho = .55) among adolescents. Findings from multivariate analyses suggest that SRH (T2) is largely determined by SRH (T1) and less so by changes in physical or psychological health status (T2-T1).

CONCLUSIONS

SRH among adolescents is in part a spontaneous health assessment but it is best understood as an enduring self-concept.

Assessing Measurement Properties of Two Single-item General Health Measures

BACKGROUND

Multi-item health status measures can be lengthy, expensive, and burdensome to collect. Single-item measures may be an alternative. We compared measurement properties of two single-item, general self-rated health (GSRH) questions to assess how well they captured information in a validated, multi-item instrument.

METHODS

We administered a general health survey (SF-12V) that included "standard" and "comparative" forms of a GSRH. We repeated the survey two weeks later to the same 75 medically stable outpatients to test for GSRH reproducibility, reliability, and validity using SF-12V Physical Functioning and Emotional Health subscales as a reference.

RESULTS

At each survey administration, the two GSRH questions demonstrated good alternate forms reliability (first administration: r = 0.74, p < 0.001; second administration: r = 0.74, p < 0.001) and good reproducibility ("standard": ICC 0.69; "comparative": ICC 0.85). Both GSRH items correlated with physical functioning ("standard": r = 0.66; "comparative": r = 0.56) and emotional health measures ("standard": r = 0.65; "comparative": r = 0.59). Mean subscale measures associated with responses in each GSRH category were significantly different (ANOVA, p < 0.001), indicating strong discriminant scale performance.

CONCLUSIONS

Our single-item, GSRH questions demonstrated good reproducibility, reliability, and strong concurrent and discriminant scale performance with an established health status measure.

Predictors of perceived health status of tuberculosis-infected homeless

This study examines the predictors of perceived health status among homeless adults with latent tuberculosis (TB) in Los Angeles, especially in relation to gender differences. Total, 415 men and women enrolled in a TB-adherence trial completed baseline assessments concerning health status. Results indicated that women were more likely than men to report being in fair or poor health and to have experienced health problems. More women than men self-reported daily drug use and poor mental health. Homeless women were also more likely than their male counterparts to receive support from non-drug-users. Homeless adults who reported fair or poor health were also more likely than those who reported better health to have used injection drugs, to report experiencing depressive symptoms and poor mental health, and to have been homeless more than 3 years. Predictors of fair or poor health included being female and experiencing more depressive symptoms.

The nature and correlates of unmet health care needs in Ontario, Canada

Using data from the Canadian Community Health Survey (CCHS) Cycle 1.2, we examine the nature of unmet mental health care needs in Ontario, Canada and how this is associated with socio-demographic, social support, health status and mental health service use factors. Unmet mental health care needs result from experiencing barriers to three issues: acceptability, accessibility and availability. Unmet needs due to acceptability issues are the most frequent type; the largest proportion of people within this category report experiencing unmet needs because they "preferred to manage the problem themselves". Unmet needs are greater among the young and among females. Surprisingly, service users report higher rates of unmet needs than non-users. Some social support variables have associations with unmet needs. Based upon these results, unmet needs pose a major challenge to the health care system since they cannot be resolved solely by enhancing access to and availability of mental health services. Thus, to address unmet mental health care needs, efforts should be focused on the acceptability barriers that women and young people in particular face. Enhancing education and certain social support mechanisms are potential strategies.

Emotional and self-evaluative effects of social comparison information in later life: How are they moderated by collective self-esteem?

This study examined how the emotional and self-evaluative effects of social comparison in 162 community-dwelling older people were moderated by individual differences in their collective self-esteem (CSE), a trait that reflects valuing and identifying with reference groups. In our experimental simulation, administered 6 years after participants' CSE was measured, those with higher CSE reported significantly more positive emotions and self-evaluations only after downward comparison (i.e., with a worse-off peer), and significantly more negative emotions only after upward comparison (i.e., with a better-off peer). These findings contradict the possibility that an adaptive advantage of high CSE might result from the propensity to identify strategically with upward comparison targets. However, contrast with downward targets presents a viable alternative explanation for this advantage.

Optimistic social comparisons of older adults low in primary control: a prospective analysis of hospitalization and mortality

Social comparison can be used strategically to bolster the self-concept. Such use may constitute secondary striving for control, when primary striving through action is unattainable. On the basis of the life span theory of control, the authors hypothesized and found that social comparison judgments would predict physical health outcomes among older adults with low primary control perceptions in the health domain. Only among such respondents, after age, sex, activities of daily living, chronic conditions, and prior hospitalization were adjusted for, did more positive social comparison judgments predict significantly lower odds of hospitalization and death over the next 2--6 years as reported in provincial health records. In later life, optimistic social comparisons may contribute to better health by providing secondary control.

Self-rated general health and psychiatric disorders in a general population sample

The purpose of this study was to explore the relationships between nicotine and alcohol dependence, depressive, anxiety and somatoform disorders with self-rated general health (GH). A cohort study of a random sample of the non-institutionalised general population aged 18-64 with a participation rate of 70.2% was carried out in a German area (n = 4075 at baseline). A follow-up of tobacco smokers or heavy drinkers (n = 1083, 79.4% of those who had given consent to be followed-up) was conducted 30 months after baseline measurement. The assessments included self-ratings of GH and Diagnostic and Statistical Manual (DSM-IV) diagnoses based on the Composite International Diagnostic Interview. The results show that nicotine dependence, anxiety disorders and somatoform disorders moderately predicted self-rated GH at follow-up (general linear model, R(2) = 0.12). We conclude that psychiatric disorders may contribute to the prediction of a low self-rated GH.

Clustering of behavioural risk factors and their association with subjective health

OBJECTIVES

To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health.

METHODS

Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor).

RESULTS

Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women).

CONCLUSIONS

Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.

The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study

BACKGROUND

Survey research including multiple health indicators requires brief indices for use in cross-cultural studies, which have, however, rarely been tested in terms of their psychometric quality. Recently, the EUROHIS-QOL 8-item index was developed as an adaptation of the WHOQOL-100 and the WHOQOL-BREF. The aim of the current study was to test the psychometric properties of the EUROHIS-QOL 8-item index.

METHODS

In a survey on 4849 European adults, the EUROHIS-QOL 8-item index was assessed across 10 countries, with equal samples adjusted for selected sociodemographic data. Participants were also investigated with a chronic condition checklist, measures on general health perception, mental health, health-care utilization and social support.

RESULTS

Findings indicated good internal consistencies across a range of countries, showing acceptable convergent validity with physical and mental health measures, and the measure discriminates well between individuals that report having a longstanding condition and healthy individuals across all countries. Differential item functioning was less frequently observed in those countries that were geographically and culturally closer to the UK, but acceptable across all countries. A universal one-factor structure with a good fit in structural equation modelling analyses (SEM) was identified with, however, limitations in model fit for specific countires.

CONCLUSIONS

The short EUROHIS-QOL 8-item index showed good cross-cultural field study performance and a satisfactory convergent and discriminant validity, and can therefore be recommended for use in public health research. In future studies the measure should also be tested in multinational clinical studies, particularly in order to test its sensitivity.

The effect of a telephone counseling intervention on self-rated health of cardiac patients

OBJECTIVE

The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness.

METHODS

We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group. Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears. Control patients received usual care. For both groups, we collected patients' responses to the HADS and to the Global Improvement (CGI-I) subscale of the Clinical Global Impressions (CGI) Scale at baseline and at 2, 3, and 6 months postbaseline using Interactive Voice Recognition (IVR) technologies. We used mixed-effects analysis to estimate patients' changes in CGI-I measures over the three time points of data collection postbaseline.

RESULTS

We enrolled 100 patients, and complete CGI-I measures were collected for 79 study patients. The mean age was 60 years (standard deviation = 10), and 67% of the patients were male. A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health (SRH) between baseline and month 3 than the control group (p = .01). Between month 3 and month 6, no significant differences in SRH improvements were observed between the control and intervention groups.

CONCLUSIONS

Study patients reported greater SRH improvement resulting from the telephone-based intervention compared with control subjects. Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders.

Social network diversity and risks of ischemic heart disease and total mortality: findings from the Copenhagen City Heart Study

Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991-1994, and participants were followed until the end of 1997. Contacts with parents, children, family members, and friends were associated with better health. The presence of a spouse or partner was protective for men. Contacts with neighbors showed a trend toward a reversed pattern, and the effects of contacts with work colleagues and children differed by gender. Most types of contacts that occurred at least monthly were just as protective as those occurring more frequently. An index of intimate social contact diversity with family and friends had graded relations with both outcomes. Comparisons of persons reporting three or more types of contacts with those reporting fewer types yielded age- and gender-adjusted hazard ratios of 0.73 (95% confidence interval (CI): 0.64, 0.82) for mortality and 0.75 (95% CI: 0.61, 0.91) for ischemic heart disease. Comparable fully adjusted hazard ratios were 0.83 (95% CI: 0.73, 0.95) and 0.82 (95% CI: 0.67, 1.00). These data suggest that health benefits are derived from the diversity of social roles, especially those involving intimate relationships.

Who is more likely to experience common disorders: men, women, or both equally? Lay perceptions in the West of Scotland

BACKGROUND

Gender differences in health are commonly observed by epidemiologists. Little is known about lay beliefs concerning the gender patterning of common conditions.

METHODS

Using the West of Scotland Twenty-07 Study, we analysed responses to a question in a postal questionnaire asking whether respondents thought men or women (or both equally) were more likely to have heart disease, cancer, mental illness, and accidents, to be fit, and to live longer. This question was answered by 466 females and 353 males, then aged 25, 45, and 65 yr.

RESULTS

Responses were in general in accord with epidemiological findings, but females had significantly lower odds than males of perceiving men as being at greater risk of accidents and heart disease, and higher odds than males of perceiving women as being at greater risk of mental illness.

CONCLUSIONS

There was a tendency for each gender to think risks were higher for their own sex than did the other gender. This observation needs further exploration, particularly in the light of the research showing 'optimistic bias' in relation to health, and research suggesting that socioeconomically disadvantaged people may be least likely to perceive socially structured health inequalities.

The effects of reminiscence in promoting mental health of Taiwanese elderly

This study examined the effects of reminiscence on four selected mental health indicators, including depressive symptoms, mood status, self-esteem, and self-health perception of elderly people residing in community care facilities and at home. A longitudinal quasi-experimental design was conducted, using two equivalent groups for pre-post test and purposive sampling with random assignment. Each subject was administered pre- and post- tests at a 4 month interval but subjects in the experimental group underwent weekly intervention. Ninety-four subjects completed the study, with 48 in the control group and 46 in the experimental group. In the experimental group, a statistically significant difference (p = 0.041) was found between the pre-post tests on the dependent variable, depressive symptoms. However, no statistical significance was found in subjects' level of mood status, self-esteem, and self-health perception after the intervention in the experimental group, but slightly improvement was found. Reminiscence not only supports depression of the elderly but also empower nurses to become proactive in their daily nursing care activities.

Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment

Using data from the 1995 Detroit Area Study (N=1106) this paper finds that black adults report significantly worse self-rated health when compared to whites with similar levels of self-reported morbidity. This relationship, called health pessimism, persists despite statistical controls for age, gender, socioeconomic status, health care access, and health related behaviors. Interpersonal maltreatment is found to be positively associated with health pessimism and more importantly, when comparing adults who perceive similar levels of maltreatment, white and black adults do not differ with respect to health pessimism. This suggests that the increased risk of health pessimism among black adults is due in part to race differences in the perception of interpersonal maltreatment.

Insights into the 'healthy immigrant effect': health status and health service use of immigrants to Canada

This paper combines multiple cross-sections of data drawn from the National Population Health Survey and Canadian Community Health Survey to confirm the existence of the 'healthy immigrant effect', specifically that immigrants are in relatively better health on arrival in Canada compared to native-born Canadians, and that immigrant health converges with years in Canada to native-born levels. The paper finds robust evidence that the healthy immigrant effect is present for the incidence of chronic conditions for both men and women, and results in relatively slow convergence to native-born levels. There is only weak evidence in terms of self-assessed health status. The inclusion of controls for region of origin and year of arrival does not account for the observed effects, although region of origin is an important determinants of immigrant health. The paper then considers some alternative explanations for the observed differences, and support is found for the idea that the healthy immigrant effect reflects convergence in physical health rather than convergence in screening and detection of existing health problems.

Does Self-Rated Health Predict Survival in Older Persons with Cognitive Impairment?

OBJECTIVES

To determine whether baseline self-rated health (SRH) independently predicted survival in an older Canadian population and to investigate the role of cognition on the SRH-mortality relationship.

DESIGN

Population-based prospective cohort study.

SETTING

Ten Canadian provinces, community-based.

PARTICIPANTS

A total of 8,697 community-dwelling participants aged 65 and older.

MEASUREMENTS

Self-reported measures of overall health, physical function, comorbidities, and demographic characteristics were obtained by interview. Cognitive ability was ascertained using the Modified Mini-Mental State Examination (3MS). Participants were followed for their survival status from the initial interview in 1991 until October 31, 1996.

RESULTS

Subjects with reports of poor SRH were significantly more likely to die during follow-up than those reporting good SRH, after adjusting for relevant covariates (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI)=1.24-1.53). SRH was also related to other measures of health status across levels of cognitive impairment. SRH remained a significant predictor of mortality in subjects with mild to moderate cognitive impairment (AHR=1.26, 95% CI=1.01-1.59) but not in those with severe cognitive impairment (AHR=1.00, 95% CI=0.76-1.31).

CONCLUSION

This study supports the utility of SRH assessments in predicting survival of individuals with mild to moderate cognitive impairment. The findings highlight the potential role of complex cognitive processes underlying the SRH-mortality relationship.