Mortality and mental health: evidence from the Midtown Manhattan Restudy

Socioeconomic inequality in self-rated health and its determinants: an Oaxaca blinder decomposition in Ilam, West of Iran during 2023

AIM

To determine inequality and decompose it's in Self-Rated Health (SRH).

METHOD

This population-based cross-sectional study was undertaken on the entire population of the city of Ilam, Iran, in 2023. Multi-stage stratified cluster random sampling with proportion-to-size approach was used to select the participants. Oaxaca-Blinder decomposition technique was used to show the amount of inequity in SRH and to decompose of the gap of SRH between the poor and the rich group of participants.

RESULTS

1370 persons participated in the study. The 59.38% of participants stated good SRH status and just 8.86% of participants had poor SRH status. The results of the Oaxaca-Blinder decomposition revealed a considerable gap (15.87%) in the poor status of SRH between the rich and the poor. A large proportion (89.66%) of this difference was described by explained portion of the model. The results of decomposition showed that economic status was directly responsible for explaining 27.98% of overall inequality gap between rich and poor people. Moreover, hopelessness to future (32.64%), having an underlying disease (18.34%) and difference in the education level (10.71%) were associated with an increase in inequality disfavoring the poor.

CONCLUSION

For people suffering from underlying disease, it is suggested to devise policies to improve access to/and remove healthcare utilization barriers. To address hopelessness to future, it is recommended to carry out further studies to reveal factors which affect it in more details. This can help policy makers to formulate more realistic and evidence-informed policies on order to lessen the current socioeconomic inequity in SRH.

Mental Health During the First Year of the COVID-19 Pandemic: A Review and Recommendations for Moving Forward

COVID-19 has infected millions of people and upended the lives of most humans on the planet. Researchers from across the psychological sciences have sought to document and investigate the impact of COVID-19 in myriad ways, causing an explosion of research that is broad in scope, varied in methods, and challenging to consolidate. Because policy and practice aimed at helping people live healthier and happier lives requires insight from robust patterns of evidence, this article provides a rapid and thorough summary of high-quality studies available through early 2021 examining the mental-health consequences of living through the COVID-19 pandemic. Our review of the evidence indicates that anxiety, depression, and distress increased in the early months of the pandemic. Meanwhile, suicide rates, life satisfaction, and loneliness remained largely stable throughout the first year of the pandemic. In response to these insights, we present seven recommendations (one urgent, two short-term, and four ongoing) to support mental health during the pandemic and beyond.

An intersectional analysis providing more precise information on inequities in self-rated health

Background

Intersectionality theory combined with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can facilitate our understanding of health disparities. This enables the application of proportionate universalism for resource allocation in public health. Analyzing self-rated health (SRH) in Sweden, we show how an intersectional perspective allows for a detailed mapping of health inequalities while avoiding simplification and stigmatization based on indiscriminate interpretations of differences between group averages.

Methods

We analyzed participants (n=133,244) in 14 consecutive National Public Health Surveys conducted in Sweden in 2004–2016 and 2018. Applying AIHDA, we investigated the risk of bad SRH across 12 intersectional strata defined by gender, income and migration status, adjusted by age and survey year. We calculated odds ratios (with 95% confidence intervals) to evaluate between-strata differences, using native-born men with high income as the comparison reference. We calculated the area under the receiver operating characteristic curve (AU-ROC) to evaluate the discriminatory accuracy of the intersectional strata for identifying individuals according to their SRH status.

Results

The analysis of intersectional strata showed clear average differences in the risk of bad SRH. For instance, the risk was seven times higher for immigrated women with low income (OR 7.00 [95% CI 6.14–7.97]) than for native men with high income. However, the discriminatory accuracy of the intersectional strata was small (AU-ROC=0.67).

Conclusions

The intersectional AIHDA approach provides more precise information on the existence (or the absence) of health inequalities, and can guide public health interventions according to the principle of proportionate universalism. The low discriminatory accuracy of the intersectional strata found in this study warrants universal interventions rather than interventions exclusively focused on strata with a higher average risk of bad SRH.

Self-rated health status in relation to aircraft noise exposure, noise annoyance or noise sensitivity: the results of a cross-sectional study in France

BACKGROUND

Noise is a major public health issue because of its negative impacts on health, including annoyance, sleep disturbance, cardiovascular diseases and altered cognitive performance among children. Self-rated health status (SRHS) can be considered as a reliable indicator of quality of life, morbidity and mortality but few studies have considered SRHS in relation to aircraft noise exposure. The present study aims to investigate the association between this exposure and SRHS of people living near airports in France, and to consider the mediating or moderating role of aircraft noise annoyance and noise sensitivity in this association.

METHODS

This cross-sectional study included 1242 participants older than 18 and living near three major French airports. Information on their SRHS, aircraft noise annoyance, noise sensitivity and demographic, socioeconomic and lifestyle factors was collected during a face-to-face interview performed at home. Outdoor aircraft noise levels were estimated for each participant's home address using noise maps. Logistic regressions with adjustment for potential confounders were used. The moderating and mediating effects of aircraft noise annoyance and noise sensitivity were investigated following Baron and Kenny's recommendations.

RESULTS

A significant association was shown between aircraft noise levels and a fair/poor SRHS, only in men (OR=1.55, 95%CI 1.01-2.39, for a 10 dB(A)-increase in L_den). This relationship was higher in men highly sensitive to noise (OR=3.26, 95%CI 1.19-8.88, for a 10 dB(A)-increase in L_den). Noise sensitivity was associated with a fair/poor SRHS significantly in women (OR=1.74, 95%CI 1.12-2.68) and at the borderline of significance in men (OR=1.68, 95% CI 0.94-3.00), whereas aircraft noise annoyance was associated with a fair/poor SRHS only in men (OR=1.81, 95%CI 1.00-3.27).

CONCLUSION

The present study confirms findings in the small number of available studies to date suggesting a positive association between aircraft noise levels and a fair/poor SRHS. These results also support the hypothesis that noise sensitivity would moderate this association. However, a mediating effect of annoyance cannot be excluded.

Effect of Health Literacy on Health Perception: An Application in Individuals at Age 65 and Older

This study has been conducted to look through the effects of health literacy levels of individuals age 65 years and older on their health perceptions. The application part of study is composed of persons being age 65 years or older who live in Burdur province and districts of Turkey. The sampling of study has been determined by a nonclustered, single-step random probability sampling method based on primary mass ratios. Thereby, totally 611 questionnaires have been implemented by means of the face-to-face interview method. As a result of the analyses carried out, the subdimensions of health literacy explain 16.3% of total variance on the importance of health, 6.4% of total variance on the center of control, 10.8% of total variance on the self-awareness, and 16.1% of total variance on the certainty. In addition, it has been identified that the correlations of health literacy subdimensions with the health perception subdimensions were statistically significant, in the same direction, at low and medium level. These results show that the health literacy sub-dimensions is an important determinant on the health perception dimensions.

Components of Self-Rated Health among Adults: Analysis of Multiple Data Sources

Four data sources were used to examine competing interpretations of self-rated health measures: whether they are best classified as summary indicators of both physical and psychological health status, or merely as surrogate measures of physical health. Multiple regression analysis revealed that, within each data source, measures of physical health and depression were each independently associated with general health status ratings after six socio-demographic indicators (sex, race, age, education, income, and residence) were held constant. These results were confirmed using both cross-sectional and longitudinal models, and using several different indicators of physical health. They suggest that researchers should be cautious in interpreting global health ratings, as they contain significant information regarding the psychological, as well as physical, health status of respondents.

The Association of Self-Rated Health with Two-Year Mortality in a Sample of Well Elderly

The 1984-1986 Longitudinal Study of Aging (LSOA) was used to investigate self-assessed health as a predictor of 2-year mortality in a subsample of 1,252 persons aged 70 and over. The LSOA sample was screened to exclude individuals reporting a high-risk medical condition or difficulty in instrumental activities of daily living. Logistic regression showed independent predictive effects with higher mortality for age (older), sex (male), less favorable self-rated health, and a family network variable (having no living children or siblings), and sex-specific body mass (highest quintile) was associated with lower mortality. Results therefore support prior studies showing that self-rated health predicts mortality, even in a very healthy elderly subsample, and with a follow-up period that is among the shortest reported to date.

Life Satisfaction and Morbidity among Postmenopausal Women

OBJECTIVE

To investigate associations between morbidity and global life satisfaction in postmenopausal women taking into account type and number of diseases.

MATERIALS AND METHODS

A total of 11,084 women (age range 57-66 years) from a population-based cohort of Finnish women (OSTPRE Study) responded to a postal enquiry in 1999. Life satisfaction was measured with a 4-item scale. Self-reported diseases diagnosed by a physician and categorized according to ICD-10 main classes were used as a measure of morbidity. Enquiry data on health and lifestyle were used as covariates in the multivariate logistic models.

RESULTS

Morbidity was strongly associated with life dissatisfaction. Every additional disease increased the risk of life dissatisfaction by 21.1% (p < .001). The risk of dissatisfaction was strongest among women with mental disorders (OR = 5.26; 95%CI 3.84-7.20) and neurological disorders (OR = 3.62; 95%CI 2.60-5.02) compared to the healthy (each p < .001). Smoking, physical inactivity and marital status were also associated with life dissatisfaction (each p < .001) but their introduction to the multivariate model did not attenuate the pattern of associations.

CONCLUSIONS

Morbidity and life dissatisfaction have a disease-specific and dose-dependent relationship. Even if women with mental and neurological disorders have the highest risk for life dissatisfaction, monitoring life satisfaction among aging women regardless of disorders should be undertaken in order to intervene the joint adverse effects of poor health and poor well-being.

Childhood Environment as a Predictor of Perceived Health Status in Late Life

Prior studies have shown that perceived health status is a consistent and reliable predictor of morbidity and mortality. Because perceived health status and objective health are not highly correlated, we sought to identify additional factors that shape self-perceptions of health. Research suggests that childhood experience is an important predictor of health in adulthood, but most studies are retrospective. Using data from a 70-year prospective study of psychosocial development, we examined the quality of childhood environment as a predictor of perceived health in late life. This study utilizes questionnaire data from a longitudinal study of adult development to examine predictors of perceived health across seven decades. Participants were members of the Study of Adult Development, a longitudinal study of men followed for seven decades beginning in late adolescence. Childhood environment characteristics were assessed during home visits and interviews with respondents' parents at entry into the study. At ages 63, 73, and 78, current health status was measured by an internist not affiliated with the Study, and perceived health was assessed via self-report questionnaires. Linear regression analyses were conducted to examine childhood environment as a predictor of perceived health status at these 3 time points while controlling for concurrent objective health and young adult neuroticism. Childhood environment predicted perceived health at all 3 time points. This study supports the hypothesis that the quality of childhood environment makes a unique contribution above and beyond personality traits and objective health status to perceptions of health in late life.

[Average and healthy life expectancies and self-rated health in the European country]

AIM

When considering the health of elderly individuals, extending a healthy lifespan as well as the average life expectancy has been discussed. In general, life expectancy is determined by biological health, socioeconomic factor, and social disparities. However, the effects of fatal diseases, such as cancer, socioeconomic factor, and self-rated health on the average life expectancy and healthy life expectancy have not been fully elucidated.

METHODS

In the present study, a multiple regression analysis was used to clarify the relationships between the lifespan and socio-economic conditions, such as the GDP, GiNi index, age-adjusted mortality from cancer, suicide rate and self-rated health in 27 European countries.

RESULTS

According to the multiple regression analysis, the average life expectancy was significantly correlated with mortality from cancer (β=-0.816, P=0.001), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.759, p=0.001) in males. In females, the average life expectancy was significantly correlated with mortality from cancer (β=-0.470, p=0.004), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.605, p=0.001).

CONCLUSIONS

These findings indicate that there is a significant correlation between cancer and life expectancy. Meanwhile, self-rated health is an important factor for increasing the longevity of a healthy life expectancy.

Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance

BACKGROUND

The Study on Global Ageing and Adult Health (SAGE) aims to improve empirical understanding of health and well-being of adults in developing countries. We examine the role of self-rated health (SRH) in predicting mortality and assess how socio-demographic and other disability measures influence this association.

METHODS

In 2007, a shortened SAGE questionnaire was administered to 5087 adults aged ≥50 years under the Health Demographic Surveillance System in rural Pune district, India. Respondents rated their own health with a single global question on SRH. Disability and well-being were assessed using the WHO Disability Assessment Schedule Index, Health State Score and quality-of-life score. Respondents were followed up every 6 months till June 2011. Any change in spousal support, migration or death during follow-up was updated in the SAGE dataset.

RESULTS

In all, 410 respondents (8%) died in the 3-year follow-up period. Mortality risk was higher with bad/very bad SRH [hazard ratio (HR) in men: 3.06, 95% confidence interval (CI): 1.93-4.87; HR in women: 1.64, 95% CI: 0.94-2.86], independent of age, disability and other covariates. Disability measure (WHO Disability Assessment Schedule Index) and absence of spousal support were also associated with increased mortality risk.

CONCLUSION

Our findings confirm an association between bad/very bad SRH and mortality for men, independent of age, socio-demographic factors and other disability measures, in a rural Indian population. This association loses significance in women when adjusted for disability. Our study highlights the strength of nesting cross-sectional surveys within the context of the Health Demographic Surveillance System in studying the role of SRH and mortality.

Correlates and predictors of self-rated health and ambulatory status among elderly women - Cross-sectional and 10 years population-based cohort study

AIM

To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women.

SUBJECTS AND METHODS

A random sample of 1620 postmenopausal women aged 53-66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) - study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB.

RESULTS

Full AMB was correlated with and predicted by good SRH (OR=4.3, p<0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR=2.0, p<0.001) and full AMB (OR=2.6, p<0.001). Low BMI was associated with good SRH (OR=0.97, p<0.049) and full AMB (OR=0.92, p<0.001), good grip strength with good SRH (OR=2.7, p<0.001) and ability to squat down with full AMB (OR=1.7, p=0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p<0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p<0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index=0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index=0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p<0.001 in univariate Z-score test).

CONCLUSIONS

Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.

Mortality associated with depression: a forty-year perspective from the Stirling County Study

BACKGROUND

This report concerns long-term mortality risks associated with depression, and the potentially confounding factors of alcoholism and cigarette smoking, as experienced by a general population assessed at a baseline in 1952, followed for re-assessment of survivors in 1968, and for death by 1992.

METHODS

Self-report and physician-report information was gathered in 1952 and again in 1968 about a sample of 1,079 adults. At the end of follow-up in 1992, the vital status of all subjects was known. Comorbidity among depression, alcoholism, and smoking was investigated. Cox regression models were employed to estimate hazard ratios (HRs) as indicators of mortality risk. Models including age, gender, and depression were fit for the complete sample at baseline as well as for re-assessed survivors. Models simultaneously controlling for the mortality risks associated with depression, alcoholism, and heavy smoking were fit for men.

RESULTS

At the baseline in 1952, depression was somewhat more common among women than men (4% compared to 6%) but was found to carry a significant mortality risk only among men (HR 2.7, 95% CI 1.6-4.7). Based on re-assessments made in 1968, depression was associated with mortality risk among both men (HR 2.2, 95% CI 1.0-4.5) and women (HR 2.1, 95% CI 1.2-3.8). In 1952, more than 20% of men smoked cigarettes excessively and 8% abused alcohol, but very few of these groups of men were also depressed. In the original sample and also among the survivors, depression, alcoholism, and heavy smoking were separately associated with mortality among men. Depression and alcoholism carried a more immediate mortality risk while heavy smoking a more delayed one.

CONCLUSIONS

At the baseline of the Stirling County Study, the mortality risk associated with depression among men was not enhanced or explained by abuse of alcohol or nicotine, mainly because comorbidity was rare at that time. The longitudinal research of the study has pointed to a number of psychiatrically-relevant time-trends such as the fact that an association between depression and cigarette smoking did not appear until the 1990s. It is hypothesized that a similar trend may emerge over time regarding the comorbidity of depression and alcoholism. A trend reported here was that, while depressed women in the original sample did not carry a significant mortality risk, the surviving women who were depressed at the time of re-assessment exhibited a mortality risk that was as significant as that for men. Such information may provide a useful back-drop for future investigations.

Psychological distress and mortality: are women more vulnerable?

Does psychological distress increase mortality risk? If it does, are women more vulnerable than men to the effect of distress on mortality? Drawing from cumulative disadvantage theory, these questions are addressed with data from a 20-year follow-up of a national sample of adults ages 25-74. Event history analyses were performed to examine mortality from general and specific causes for men and women. Findings reveal that the effect of psychological distress on all-cause mortality was nonlinear for men. Moderate amounts of distress were associated with lower mortality risk, but high levels of distress raised men's mortality risk. Moreover the curvilinear relationship between distress and mortality varied by cause of death for men and women. Men with high levels of psychological distress were more vulnerable to ischemic heart disease mortality. Women with high levels of distress were more vulnerable to cancer mortality.

Psychological distress and premature mortality in the general population: a prospective study

PURPOSE

To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship.

METHODS

We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models.

RESULTS

Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22).

CONCLUSIONS

The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.

Measuring health inequality using qualitative data

Many questions in health policy require an understanding of the distribution of health status across a given population and how it changes as a result of policy interventions. Since objective data on individual health status are often unavailable or incomplete, especially for populations with very low mortality, increasing use has been made of self-reported health status (SRHS) data, which record people's own perceptions of their health status. SRHS has been shown to be a strong predictor of objective health outcomes and indications, including mortality. Nevertheless, the qualitative or categorical nature of SRHS data prevents the straightforward use of traditional tools of distributional analysis, such as the Lorenz curve, in evaluating inequality. This paper presents a methodology for evaluating inequality when the data are qualitative rather than quantitative in nature. A partial inequality ordering is defined to indicate when a distribution is more "spread out" than another; a second partial ordering (first order dominance) is used to indicate when the overall health level rises. Both are applicable to qualitative data, such as SRHS, in that results do not depend on the numerical scaling assigned to the categories. The approach is illustrated using SRHS data from the National Health Interview Survey (NHIS) State Data Files for 1994, focusing on the distribution of SRHS within states.

Burnout and self-perceived health among Finnish psychiatrists and child psychiatrists: a national survey

AIMS

This study investigated burnout and related health matters among a sample of Finnish physicians working within the field of psychiatry.

METHODS

A postal questionnaire was sent to one in three licensed physicians randomly selected from the register of the Finnish Medical Association (FMA). The response rate was 74% (n = 3133).

RESULTS

Psychiatrists and child psychiatrists reported burnout, threat of severe burnout, depression, and mental disorder more commonly than other physicians. Moreover, psychiatrists and child psychiatrists reported less often "good" or "rather good" self-perceived health. Depression had a moderate positive correlation with overall MBI score. Lack of possibilities to consult a colleague, and supervision of work, experience of threat of violence, and self-reported depression were significantly associated with overall burnout level and emotional exhaustion.

CONCLUSIONS

Emotional exhaustion as a symptom of burnout was common among psychiatrists, especially among those working in community care, and child psychiatrists. Problems of general health, as well as mental health, among psychiatrists and child psychiatrists are in need of attention.

The effect of point of reference on the association between self-rated health and mortality

This study examines the effect of point of reference on the predictive validity of self-rated health for mortality in a 5-year follow-up period. Two self-rated health measures are examined: an age group comparative question and a global question with no explicit point of reference. The baseline data (SweOld) is a nationally representative interview survey among Swedish people aged 77+ in 1992. Mortality for the 1992-1996 period was analysed using Cox proportional hazards regression models. Age-referential self-rated health was found to be a better predictor of elderly men's mortality both in non-adjusted models and in models adjusting for age and both self-rated health measures. In separate analyses, both measures were found to be equally strong predictors of women's mortality. When adding both measures into the model simultaneously, the age-referential question lost much of its predictive power. The findings suggest that self-rated health measures are not insensitive to differences in question wording.

The health effects of rural-urban residence and concentrated poverty

This research quantifies the extent to which excess morbidity in rural areas is associated with individual characteristics, county income, and neighborhood poverty. Census geographic codes were assigned to people 25 to 64 years old (n = 176,930) from the National Health Interview Survey, 1989 to 1991, in order to link individuals to the U.S. Department of Agriculture's county urban-rural classification scheme and to 1990 county per capita income and poverty concentration in Census tracts. General health status and limitation of activity were analyzed in logistic and multinomial logit models. Residents of rural counties were at greater risk for health problems compared to residents of metropolitan and central core counties. In adjusted models, the health disadvantage of rural areas was partly explained by differences in population composition. The residual rural disadvantage was concentrated in people with less than a high school education. Tract poverty and county per capita income were also important independent predictors of morbidity. The results of this study suggest that special attention should be paid to improving education in disadvantaged places and to better understanding the ways in which economic growth and its benefits are distributed.

Proposition of an aging indicator from general health examination in France

We present an indicator of aging based on eight quantitative variables, measured during the periodical health examination offered by French social security to the general population in France. The used sample derived from the population examined each year. We selected a reference group of 24,510 adults older than 25 years (non-smokers, drinking less than 44 g alcohol per day, with body mass index less than 35, and not using medication). A multiple regression analysis by gender was used to select significant variables to predict age from all quantitative variables measured during the health examination. The resulting biological age could be calculated from the measured variables and the aging indicator was defined as the difference between the calculated age and the chronological age. By definition, this indicator is independent of age in the reference population and gives an indication of the difference between an individual's status in the process of aging and the mean status of people of the same chronological age. Associations between this indicator and life style habits such as tobacco and alcohol use, and occupational status were observed. A geographical analysis also exhibited significant variation over France. Such an indicator can be used at the individual level as a pedagogical tool to explain the observed individual health status. It is also of interest for the epidemiological studies, where it could contribute to a better understanding of the aging process and associated factors.

Associations of income with self-reported ill-health and health resources in a rural community sample of Austria

OBJECTIVES

Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health.

METHODS

This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females.

RESULTS

The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data.

CONCLUSIONS

Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.

Conceptualization and measurement of the spiritual and psychological dimensions of wellness in a college population

Wellness is commonly conceptualized as having many dimensions, but little effort has been made to evaluate how spiritual and psychological dimensions are related to overall wellness. To explore the relationship between measures of spiritual and psychological wellness and perceived wellness in a college student population, the authors administered a series of survey instruments to 112 undergraduate students under quiet classroom conditions. They used the Life Attitude Profile to measure spiritual wellness, the Life Orientation Test and the Sense of Coherence Scale to measure psychological wellness, and the Perceived Wellness Survey to measure overall wellness. Path analysis performed with a proposed theoretical model revealed that the effect of life purpose on perceived wellness was mediated by optimism and sense of coherence, which had independent effects on perceived wellness beyond that of life purpose. The findings suggested that an optimistic outlook and sense of coherence must be present for life purpose to enhance a sense of overall well-being.

Illness and treatment perceptions of Ethiopian immigrants and their doctors in Israel

OBJECTIVES

Patient-provider misunderstandings arising from disparate medical and cultural concepts can impede health care among immigrant populations. This study assessed the extent of disagreement and identified the salient problems of communication between Israeli doctors and Ethiopian immigrant patients.

METHODS

Semistructured interviews were conducted with 59 Ethiopian immigrants. Self-reports of health status and effectiveness of treatment were compared with evaluations by the primary care physician and supplemented by qualitative data from descriptions of illness, observations of medical visits, informant interviews, and participant observations conducted by the anthropologist.

RESULTS

Health status and effectiveness of treatment were rated significantly higher by the doctor than by the patients. Low doctor-patient agreement occurred mainly for illnesses with stress-related or culture-specific associations. Qualitative data suggested that more long-term immigrants may alter their expectations of treatment but continue to experience symptoms that are culturally, but not biomedically, meaningful.

CONCLUSIONS

Misunderstandings between immigrant patients and their doctors emerge from the biomedical system's limitations in addressing stress-related illnesses and from culture-based discrepancies in concepts of illness and healing. Including trained translators in medical teams can reduce medical misunderstandings and increase patient satisfaction among immigrant populations.

Mortality among discharged psychiatric patients in Finland

No comprehensive study has yet been made of mortality among psychiatric patients in Finland. According to studies conducted in other parts of the world, the mortality rates of psychiatric patients are higher than those of the general population. The study population here consisted of all patients discharged from psychiatric hospitals during the year 1988 (n = 22940). The register follow-up of these patients extended up to the year 1992. In the course of the follow-up a total of 3936 discharged psychiatric patients died (17.2%). The standardized mortality ratio (SMR) of the patients discharged from psychiatric hospitals was almost four times higher than that of the general population. The proportion of unnatural causes of death, including accidents in the young age groups and especially the much higher suicide SMR among young women, is a particularly striking finding. Natural causes of death were also more prevalent among the study population than in the general population, the major causes being acute myocardial infarction and unspecified pneumonia. The results of this study confirm previous findings of increased mortality among psychiatric patients compared to the general population. On the basis of this study one cannot, however, conclude that the reason for the high mortality rate would be premature discharge. More attention needs to be paid to the care of young patients and to supporting the patient during the transition from the hospital to community care.

Self-rated health among cardiovascular drug users in a study of Swedish twins

The aim of this study was to analyse the relationship between self-perceived health and cardiovascular disease with and without drug treatment. Mental health and genetic effects were controlled for in the analyses. The data for these analyses were collected in 1984 as part of the Swedish Adoption/Twin Study of Aging (SATSA). In the first set of analyses, 1147 persons (mean age 60 years, 72% older than 50 years) were included. In the second part of the study, twin pairs discordant with respect to having a cardiovascular disease and/or drug use were included in the analyses. Cardiovascular disease was related to poor, self-rated health among both men and women. The proportion with bad health was largest among those with a drug-treated disease. In multivariate analyses, a strong relationship between cardiovascular disease, drug therapy and low self-rated health remained after controlling for mental health. The co-twin control analyses indicate that cardiovascular drugs have at most a marginal negative effect on health beyond the effects of the disease and genetic liability to self-perceived poor health.

Long-term outcome of psychiatric disorders in the community: a 13-year follow-up study in a nonclinical population

In 1980, a two-stage cross-sectional study on the prevalence of mental disorders was performed on a probability sample of 1,574 adult residents of two boroughs in Greater Athens served by a Community Mental Health Center (CMHC). After completion of the interviews, a "case" identification procedure was applied through the use of clinical criteria allocating each respondent to one of five categories ranging from "well" to definite "cases" (stage A). In stage B time 1 (1980 to 1981), two psychiatrists interviewed a sample of 360 respondents consisting of all the probable and definite cases together with randomly selected individuals from the other three mental status categories. In 1994 (time 2), a follow-up study was conducted to reinterview the sample of 360 respondents through the use of the Structured Clinical Interview for DSM-III-R (SCID). The follow-up search resulted in 182 baseline respondents being located alive, plus 38 certified as dead and a residual 140 (38.8% of the baseline sample) categorized as definitely unlocatable. We report results for the outcome of specific nosological entities over the 13-year period. Among the main findings, of the previously (1980 to 1981) identified cases, 42.8% were similarly diagnosed as cases in the follow-up study at time 2; 92.4% of the baseline stage B (1980 to 1981) noncases were also found to be noncases in 1994. "Caseness" was found to be associated with high mortality. Of the subjects interviewed at both cross-sections and diagnosed as having a psychiatric nosological entity at time 1 (1980 to 1981), 67.5% were found to be mentally healthy at time 2 (1994).

Depression, diagnostic sub-type and death: a 25 year follow-up study

We assessed mortality rates over 25 years in 212 patients admitted for depression or depressive symptoms. More patients had died than expected (80 including 13 suicides; SMR = 1.40, P < 0.01). Females, but not males, experienced significantly higher mortality than the general population. When suicides were excluded, neither the group as a whole, nor females solely, demonstrated excess mortality. Rigorously diagnosed depressive sub-type did not predict mortality. Mortality, particularly from suicide, was disproportionately greater in the first 2 years after index admission, suggesting that the follow-up of patients hospitalised with depression must be especially assiduous during the years immediately after admission.

Does aging mean a better life for women?

OBJECTIVE

To study 10-year changes in selected quality of life dimensions in a cohort of aging Eastern Finnish women.

DESIGN

Ten-year follow-up of a representative population sample.

SETTING

The county of Kuopio in Eastern Finland.

PARTICIPANTS

In 1982, a representative sample (n = 296) of 50 to 60-year-old women was examined in the FIN-MONICA study. Ten years later, 241 of the participants were re-examined.

MEASUREMENTS

Self-administered questionnaires were used to collect the data. Self-rated health, self-rated physical fitness, frequency of leisure time physical activity, functional capacity, reported symptoms, occurrence of diseases, and satisfaction with family life and economic situation were measured. In 1992, total life satisfaction at that moment and 5 years earlier were also assessed.

RESULTS

The self-rated health assessment remained unchanged. During the 10 years from 1982 to 1992, the proportion of women who reported diagnosed cardiopulmonary diseases increased; angina pectoris, in particular, increased from 6% to 20%. However, even though their running ability had decreased, the number of women rating their physical fitness as good or fairly good increased from 23% to 32%. The participants reported significantly less headache and feelings of exhaustion than they had 10 years earlier. Average satisfaction with their economic situation increased, and satisfaction with family life remained the same. Thirty-seven percent of the women rated their current life situation as better than 5 years previously, 29% felt that it had remained the same, and 34% indicated that it had become worse during the past 5 years.

CONCLUSION

These data suggest that some quality of life dimensions may improve during aging in postmenopausal women.

The conceptualization and measurement of perceived wellness: integrating balance across and within dimensions

PURPOSE

The impact of individual perceptions on health is well-established. However, no valid and reliable measure of individual wellness perceptions exists. Therefore, the purpose was to introduce a measure called the Perceived Wellness Survey (PWS).

DESIGN

Convenience sampling facilitated recruitment of a sample large enough to perform factor analysis with adequate power (.85). The appropriateness of factor analysis is supported by Bartlett's test (chi 2 = 7110, p < or = .01) and the Kaiser-Meyer-Olkin measure of sampling adequacy (.91).

SETTING

The sample (n = 558) was composed of 3M Inc. employees from multiple sites in Austin, Texas (n = 393); employees from MuRata Electronics, Inc., College Station, Pennsylvania (n = 53); and students enrolled at the University of Texas at Austin (n = 112).

SUBJECTS

Racial, gender, and age distribution was, respectively, 6.3% African-American (n = 35), 8.2% Asian (n = 46), 73.3% Caucasian (n = 409), 9.5% Hispanic (n = 53), and 2.7% other (n = 15); 47.8% male (n = 267), and 52.2% female (n = 291); and 36.8 years.

MEASURES

Measures included the Perceived Wellness Survey, and two additional versions of the Perceived Wellness Survey designed to measure both discriminant and face validity. Perceived Wellness Survey subscales include physical, spiritual, intellectual, psychological, social, and emotional dimensions.

RESULTS

All subscales were correlated (p < or = .05) with the Perceived Wellness Survey composite and with each other. Evidence of internal consistency (alpha = .88 to .93), and discriminant, face, and factorial validity was provided. Finally, the Perceived Wellness Survey appears to be a unidimensional scale.

CONCLUSION

The unidimensional nature of the Perceived Wellness Survey suggests that perceptions of wellness in various dimensions are intertwined by their affective nature. The Perceived Wellness Survey appears to be reasonably valid and reliable; however, further research is needed.

Global self-ratings of health and mortality: hazard in the North Carolina Piedmont

We analyzed the first 5 years of surveillance data from the Established Population for the Epidemiologic Studies of the Elderly (EPESE) in the Piedmont of North Carolina (n = 4162) to estimate the effect of a global self-rating of health on survival. Covariates used in Cox proportional hazard models included sociodemographic factors, chronic medical conditions, activities of daily living, use of health services, health risk behaviors, cognitive function, affective mood, and negative life events. Adjusted risk of mortality associated with poor (compared to excellent) self-ratings of health was significantly elevated among urban men only. Confounders of the association between survival and overall health assessment varied widely by subgroup. Pooled estimates from heterogeneous populations may mask significant subgroup differences both in the pattern of variables that mediate crude risk and also in the magnitude of residual risk of global self-ratings of health.

Assessing reliability of a measure of self-rated health

The test-retest reliability of self-rated health is analysed and compared with the reliability of health questions phrased more as well as less precisely. Differences in reliability between men and women and between age groups are also assessed. The study is based on 204 and 409 re-interviews from the 1991 Swedish Level of Living Survey and the 1989 Survey of Living Conditions respectively. The results show that the reliability of self-rated health is as good as or even better than that of most of the more specific questions. Only an indicator of high blood pressure showed significantly higher reliability. The reliability of self-rated health is good in all subgroups studied, and is even excellent among older men. It is concluded that the good overall reliability of self-rated health found in this study is in line with previous results concerning the validity of people's assessments of their general health as well as results concerning the basis upon which they make these judgements.

Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark

STUDY OBJECTIVE

To analyse the association between self rated health and the incidence of fatal and non-fatal coronary heart disease (CHD) in a Danish cohort followed up over 16 years.

DESIGN

This was a prospective epidemiological follow up study.

SETTING

A cohort from the County of Copenhagen, Denmark.

PARTICIPANTS

The study included 1052 men and women born in 1936. During the 16 years' follow up 50 cases of CHD were registered in either the Danish register of deaths or the register of hospital admissions.

MAIN RESULTS

Univariate analysis showed the following relative risks of CHD in the four self rated health groups: 'extremely good': 1.0, 'good': 4.0, 'poor': 5.8, 'miserable': 12.1 (p = 0.02). After control for the conventional CHD risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively.

CONCLUSIONS

Self rated health was an independent predictor of CHD in the present cohort. If confirmed, the association between self rated health and CHD may lead to new insight into psychosocial processes leading to this disease.

Examining points of reference of self-rated health among Swedish oldest old

The aim of the study is to assess the relative importance of comparisons with people of the same age and comparisons with the respondent's own health 1 year before the survey as two likely points of reference for ratings of health status among the elderly. Data was derived from the Swedish Panel Study of Living Conditions of the Oldest Old (n=438) comprising those aged 77-98. On the basis of multiple regression analyses we first map the relationships between three measures of self-rated health (SRH) on the one hand and measures of ill-health and physical functioning on the other. In our main analyses it is shown that both men and women use other persons of the same age as an important point of reference when rating their own health. Our results also tend to suggest that men, in contrast to women, also refer to recent changes in their own health when giving a general health rating.

Symptoms of psychological distress predict 7-year mortality

As part of the Health and Lifestyle Survey (HALS), 6096 adults from a representative sample of community residents completed a standardized questionnaire which elicited psychiatric symptoms--the General Health Questionnaire (GHQ-30) of Goldberg (1972). Their survival status at 7 years was determined, and 474 had died. Respondents whose GHQ score was above the conventional threshold (4/5), used when screening for psychiatric disorder, were 60% more likely to die over the 7-year interval than respondents whose GHQ score was below threshold (risk ratio 1.64 for men and 1.58 for women). The differences were statistically significant for both sexes when the effects of age, physical disorder, social class and smoking behaviour were taken into account. Personality traits (neuroticism, extraversion) were not related to mortality, neither was self-reported difficulty in sleeping. However, a low subjective rating of one's general health was associated with increased mortality. We explored a range of cut-points and found reliable effects for both sexes at all cut-points from 3/4 to 6/7. Possible differences related to natural versus unnatural causes of death were explored and found not to explain the results. The findings from this general population study confirm that is is not only psychiatric disorders, but also psychiatric symptoms, which are associated with subsequent mortality, and thereby reinforce the importance of appropriate intervention to alleviate these symptoms.

Psychopathology and mortality in the general population

Community studies of the relationship between mortality and mental disorders remain equivocal with mixed and unclear results. Longitudinal prospective data from the Epidemiologic Catchment Area Program are examined for the relationship between psychopathology and mortality. Analyses were performed with mortality at 1-year follow-up as the dependent variable using logistic regression. Specifically, the odds of dying from psychiatric disorders were considered while statistically adjusting for sociodemographic characteristics and treatment in primary or specialty medical care sectors. Significant predictors of dying were being male, older, and from low income households. Subjects with drug abuse or dependence were 12.4 times (CI = 2.9, 53.0) as likely to die as those without drug abuse/dependence. The odds of dying for those with major depressive disorder were over 2.6 times (CI = 1.1, 6.0) those without major depression. Separate analyses for all five communities and for only those over the age of 55 years showed similar results.

Mental health status as a predictor of morbidity and mortality: a 15-year follow-up of members of a health maintenance organization

OBJECTIVES

This study sought to relate preexisting depression, worries, affect balance, and mental health symptoms to subsequent risk of morbidity and mortality.

METHODS

A random sample of members of a health maintenance organization were interviewed at home in a 1970/71 survey. Baseline psychological measures from that survey were then related to 15-year mortality and first incidence of cancer, heart disease, hypertension, stroke, functional gastrointestinal disease, and hyperimmune diseases.

RESULTS

Baseline depression and the Langner Mental Health Index predicted incidence of functional gastrointestinal and hyperimmune diseases. The relationship of the Langner index to hyperimmune diseases was particularly strong; mortality, cancer, heart disease, hypertension, and stroke incidence were not related to that index. Except for affect balance, which was worst in the elderly, indications of psychological dysfunction were strongest in the young.

CONCLUSIONS

Psychological indices detected increased risk for functional gastrointestinal and hyperimmune diseases but were not related to mortality risk. Further research is needed to disaggregate relationships of the specific conditions that were included in the hyperimmune group. Functional gastrointestinal disease might be preventable with early attention to depressed persons and to those scoring high on the Langner index.

Nutrition and health risks in the elderly: the nutrition screening initiative

OBJECTIVES

The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons.

METHODS

A 14-item checklist of characteristics associated with nutritional status was administered to a random sample of Medicare beneficiaries, aged 70 years and older, in New England. Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores.

RESULTS

A revised checklist containing 10 yes/no items was adopted. Scores of 6 or more points defined persons at high nutritional risk. Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist. Among those in the high-risk group, 56% perceived their health to be "fair" or "poor" and 38% had dietary intakes below 75% of the recommended dietary allowances for three or more nutrients.

CONCLUSIONS

The Nutrition Screening Initiative Checklist is a brief, easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems.

The effect of psychosocial stress and risk factors for ischaemic heart disease on the plasma fibrinogen concentration

OBJECTIVES

To assess the effect on the fibrinogen concentration of sleep disturbance and mental stress, taking into account the effect of 21 other variables related to the risk of cardiovascular disease.

DESIGN

A cross-sectional study on men threatened by redundancy, and controls.

SETTING

A health screening programme in Malmö, Sweden.

SUBJECTS

Four hundred and eighty five workers in a shipbuilding yard, scheduled for closure, and 190 age-matched men. The subjects were randomly selected from a larger group of shipyard workers and controls invited to a health screening programme. Mean age was 51.6 years (range 38-62 years).

MAIN OUTCOME MEASURES

Plasma fibrinogen concentration, serum cortisol concentration, body composition, blood pressure, heart rate, blood lipids, platelet number and size, white blood cell count, haemoglobin concentration, vital capacity, liver enzymes, blood glucose concentration fasting and after an oral glucose tolerance test. Questionnaire designed to evaluate muscle tension, sleep disturbance, anxiety, depression, job stress, alcohol and smoking habits and perceived health.

RESULTS

In stepwise regression analysis fibrinogen concentration was found to be correlated to white blood cell count, muscle tension, heart rate, body mass index, age and serum cholesterol concentration in non-smokers, which together explained 14.9% of the variation in fibrinogen concentration. In smokers, platelet count, heart rate, serum triglyceride concentration, age and fasting glucose explained 22.5% of the variation in fibrinogen concentration. The fibrinogen concentration was inversely correlated to the psychological variables, but unrelated to the serum cortisol concentration or to factors connected with the job situation, and it was decreased in moderate alcohol consumers.

CONCLUSIONS

Our interpretation of the findings is that an increase in the plasma fibrinogen concentration reflects the presence of a low-grade inflammatory process, and poor physical fitness.

Selection to postmenopausal therapy by women's characteristics

Many surveys have shown that women using postmenopausal hormone therapy have a lower incidence of cardiovascular diseases and lower overall mortality. The purpose of this study was to compare past and non-users with current users of hormone therapy in regard to characteristics known to, or assumed to, predict poor subsequent health (indicators). The main data source was a survey in 1989 of a random sample (n = 2000, 86% response rate) of 45-64 year-old Finnish women. Among women with their uterus, after adjusting for age and urbanism, of the 21 indicators studied, 10 suggested a poorer and none a better health prognosis for the non-users than for current users. Many differences were greater among older women, suggesting a cohort effect or long-term users being an especially selected group. Among hysterectomized women, differences between users and non-users were similar or smaller than among women with uteri. The past users were more similar to non-users than current users. Our study suggests that women with a better health prognosis are selected or select themselves for hormone therapy, and that may impede interpretation of observational studies on hormone therapy and health.

Work-health relationships in middle-aged and elderly residents of a Jerusalem community

Work-health relationships were examined cross-sectionally in 1886 men and women aged greater than or equal to 50 years in Jerusalem in 1985-1987, in the third round of a multipurpose longitudinal community health study. The main occupational variables were employment status, reasons for not working, and satisfaction with work. Sex and age were controlled in all comparisons. Workers were clearly healthier than nonworkers with respect to general, physical and emotional health, and people who had given up work were less healthy than those still working, whether they had stopped for health reasons, only because of their age, or only for extrinsic reasons (retrenchment or dismissal). Workers who expressed satisfaction with their work were healthier than others, the odds ratio in favour of good general health being 2.4 at 50-64 and 2.5 at greater than or equal to 65 years of age. The associations between job satisfaction and health remained apparent when education and origin were controlled. Multivariate analyses suggested that the associations were not spurious ones attributable to proneness to report both dissatisfaction and ill-health. Job dissatisfaction was not significantly associated with angina pectoris, possible myocardial infarction, or hypertension. Taken at their face value, the findings support the impact of job satisfaction or its determinants on the health of middle-aged and elderly men and women. The associations will be re-appraised in the longitudinal analysis of the study data.

The Tromsø Study: predictors of self-evaluated health--has society adopted the expanded health concept?

The determinants of self-evaluated general health status were examined in a comprehensive population study of 9408 men aged 20-61 and 9152 women aged 20-56. Reduced self-evaluated health was in both sexes closely related to symptoms and diseases connected to the musculo-skeletal system and psycho-social problems and less to age and some of the major chronic diseases. Physical activity at leisure time and workload were positively associated with self-evaluated health. Our findings indicate that an important dimension reflected by self-evaluation of health is the individual's perception of own physical performance and suffice in general. There is a striking gap between the conditions which reduce the population's subjective perceived health and our ability to offer these conditions effective treatment through the health care system. This suggests differences in health concept between the medical society and the population. The association between our applied measure and coronary risk profile, based on serum cholesterol, blood pressure and cigarette smoking, was found to be almost non-existent. This supports previous findings of self-evaluation of health as an independent predictor of survival.

The prognosis of depression in old age

The 12-month outcome of 103 elderly depressed patients treated by psychiatrists in Perth, Western Australia, was good in 32-47% of cases, depending upon the stringency of the outcome criteria used. A higher than expected mortality was found, especially in men. No clear association was found between 12-month outcome and a variety of clinical variables at index admission, including chronic physical illness, severity of depression, and severe life events during follow-up. As the statistical power of this and other studies is small, it would be unwise at present to draw definite conclusions about the role of possible risk factors in the prognosis of depressed elderly. Vigorous treatment of the depressive illness and adequate after-care are important.

Factors of importance when evaluating quality of life in clinical trials

Quality of life (QoL) has during recent years become recognized as an important outcome in clinical trials. But it is not sufficient just to incorporate QoL measures in a trial. Several factors have important repercussions on the results of clinical trials using QoL as an outcome measure. Unless more attention is directed towards factors that may be important when evaluating QoL, the value of including these measurements in clinical trials will be minimized. Important issues pertain to trial design, duration of follow-up, the role of placebo effects, side effects, and confounding variables.

Psychological distress and mortality: evidence from the Alameda County Study

The relationship between psychological distress, in this case depression, and subsequent risk of mortality is examined using data from the Alameda County (California) Study, an 18-yr, three-wave prospective investigation of psychosocial risk factors and health. The results indicate no relationship between psychological morbidity and all-cause mortality or specific causes of death. While these results are discordant with those reported from a majority of studies of psychiatric patients, they are concordant with a majority of community-based studies of the general adult population. Possible methodologic explanations are discussed which might account for disparate results reported to date, in particular failure to control for the effects of co-morbidity of somatic disorders and socioeconomic status.

Self-perceived health among sports participants and non-sports participants

This paper examines and compares the self-perceived health (SPH) of a sample of sports participants (n = 1385) and a matched sample of non-participants (n = 292). Ratings of health were generally found to be favourable among both samples, but a non-parametric analysis of their distributions revealed that the SPH of sports participants was significantly (P less than 0.0001) better than that of the non-participants. SPH improved with age among both samples, but above the age of 34, the non-participants' perceived health ceased to be inferior to that of participants. Controlling for age and gender revealed no difference in SPH above 24 years among males and 34 years among females. SPH was related to a variety of additional health-related factors. Multiple regression analysis was used to identify the predictors of SPH for both samples, and highlighted marked differences between them in the type and number of contributory factors. It is suggested that participation in active sports may enhance health awareness, especially among the young, and that future studies of this kind among sports populations should take account of the levels of commitment (frequency, duration and intensity) to sport.

The general health questionnaire (GHQ) as a predictor of hospital care and mortality in the non-institutionalized elderly

The general health questionnaire (GHQ) and its relation to hospital care and risk of death were studied prospectively in the total elderly population living in a community in northern Finland. Of the eligible elderly, 982 or 85% took part in the study, returning the GHQ. A high score on the questionnaire was considered an indicator of minor psychiatric illness. It was found that the average number of hospital days, calculated per person-years, was twice as high in the high scorers than in the low scorers. When the effects of age and certain diseases were controlled for, the high scoring men and women had a significantly higher risk of being hospitalized for at least ten days over a five-year period than the 0-1 scorers. The risk ratio was 1.6 and 1.4 for men and women, respectively. The ten-year mortality was significantly higher in the high scoring men and women than in the low scorers, when the effects of age and certain diseases were controlled for. The risk ratios for both men and women were 1.4. The GHQ was found to predict hospital care, physician visits, home services and mortality in a representative group of rural elderly people.