Ellen L. Idler

Community Studies Reporting Association between Self-Rated Health and Mortality Additional Studies, 1995 to 1998

The following table amends and updates the summary table of mortality studies published in 1997 (Idler and Benyamini 1997). To locate additional studies, we searched Medline using the terms self-rated health, self-rating/s of health, self-assessment/s of health, self-assessed health, self-evaluated health, perception/s of health, perceived health, self-evaluation/s of health, subjective assessment/s of health, subjective health, selfreported health, and self-reports of health and crossed these terms with mortality, survival, and deaths. Additional studies not reporting these terms in their abstracts were identified through careful monitoring of the literature. Articles identified with this process were eliminated if they were not in English, if the study population was not a representative community sample, or if the estimate of the effect of self-rated health on mortality was not adjusted for a set of health status covariates. With these restrictions, we identified 19 additional studies for the period 1995 to 1998. The studies in Table 1 are presented chronologically. They report secondary analyses of large data sets, use increasingly sophisticated statistical methods, and adjust for comprehensive sets of health status covariates. The association of poor self-ratings of health with higher risk of mortality is consistent; in just 2 of the 19 studies there were no effects of self-rated health for either men or women. In most of its content, the table presented here is like the 1997 table. The data sources are international, 15 of the 19 have elderly samples, and the health status covariates almost always include activities of daily living

Measuring multiple dimensions of religion and spirituality for health research: Conceptual background and findings from the 1998 general social survey

Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure religiousness and spirituality, intended explicitly for studies of health. It is multidimensional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional religiousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey (N = 1,445). Nine dimensions have indices with moderate-to-good internal consistency, and there are three single-item domains. Analysis by age and sex shows that elderly respondents report higher levels of religiousness in virtually every domain of the measure.

Religion, Disability, Depression, and the Timing of Death'

Despite its importance in Durkheims work, the subject of religions influence on health and well-being is rarely addressed in contemporary sociological research. This study of elderly persons in New Haven, Connecticut, examines the prospective relationship between religious involvement and several aspects of health status. Results show significant protective effects of public religious in volvement against disability among men and women and of private religious involvement against depression among recently disabled men over a three-year period. Religious group membership also protected Christians and Jews against mortality in the month before their respective religious holidays during a six-year period. The article concludes that religious involvement exerts a strong positive effect on the health of the elderly; that this effect varies by religious group and by sex; that the health behaviors, social contacts, and optimistic attitudes of religious group members may explain part but not all of this association; and that several aspects of religious experience, such as participation in ritual and religions provision of meaning play a role.

The Meanings of Self-Ratings of Health A Qualitative and Quantitative Approach

Self-ratings of health are central measures of health status that predict outcomes such as mortality and declines in functional ability. Qualitative and quantitative data are used to test the hypothesis that definitions of health that are narrowly biomedical are associated with underestimates of self-ratings relative to respondents’medical histories, while definitions that are broad and inclusive are related to relatively better self-ratings. A sample of 159 elderly African Americans rates their health and reports “what went through your mind.” Analysis of variance shows that respondents who overestimate their health are more likely to report ratings based on social activities and relationships, or psychological, emotional, or spiritual characteristics, rather than biomedical criteria. The authors conclude that inclusive definitions of health facilitate more positive self-ratings of health, given a fixed health status; methodologically, they conclude that this is a promising method for exploring self-ratings of health.

Psychosocial Factors in Outcomes of Heart Surgery: The Impact of Religious Involvement and Depressive Symptoms

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness.

In Sickness but Not in Health: Self-ratings, Identity, and Mortality∗

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.

Aging, health, and behavior

Foreword - Matilda White Riley Introduction - Marcia G Ory, Ronald P Abeles and Paula Darby Lipman An Overview of Research on Aging, Health, and Behavior PART ONE: SELF, INFORMAL, AND FORMAL HEALTH CARE BEHAVIORS Health-Related Behavior - Kathryn Dean Concepts and Methods Informal and Formal Health Care Systems Serving Older Persons - Gordon H Defriese and Alison Woomert The Behavior System of Dependency in the Elderly - Margret M Baltes and Hans-Werner Wahl Interactions with the Social Environment PART TWO: BIO-PSYCHOSOCIAL MECHANISMS LINKING HEALTH AND BEHAVIOR Vigilant Coping and Health Behavior - Howard Leventhal, Elaine A Leventhal and Pamela Schaefer Coping with Chronic Illness and Disability - H Asuman Kiyak and Soo Borson Sense of Control, Aging, and Health - Judith Rodin and Christine Timko Aging, Stress, and Illness - Thomas M Vogt Psychobiological Linkages PART THREE: SOCIAL AND BEHAVIORAL INTERVENTIONS Disease Prevention and Health Promotion with Older Adults - William Rakowski Intervening in Social Systems to Promote Health - Lennart Levi PART FOUR: IMPLICATIONS FOR PUBLIC POLICY Social Characteristics, Social Structure, and Health in the Aging Population - Carroll L Estes and Thomas G Rundall Forecasting Health and Functioning in Aging Societies - Kenneth G Manton and Richard Suzman Implications for Health Care and Staffing Needs

Quality of Life Following Cardiac Surgery: Impact of the Severity and Course of Depressive Symptoms

Objectives: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. Methods: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. Results: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. Conclusions: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery. BDI = Beck Depression Inventory; CABG = coronary artery bypass graft surgery; MI = myocardial infarction; MOS = Medical Outcomes Study; QOL = quality of life; SF-36 = MOS 36-item short form health survey.

Editorial: Religion, Spirituality, and Medicine: A Rebuttal to Skeptics

A recent article by Sloan et al. in the Lancet has presented the skeptical side in the scientific debate on the religion-health relationship [1]. The interest in this topic and its relevance to medicine is underscored by the fact over 60 of 126 medical schools in the United States have initiated courses on religion/spirituality, and more are planning to do so. While we agree with Sloan et al. that the

Understanding Recent Changes in Suicide Rates among the Middle-Aged: Period or Cohort Effects?:

Objective. We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005. Methods. We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques. Results. Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40–49 years, and since 1999 for females aged 40–59 years and males aged 50–59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree. Conclusions. The timing of the post-1999 increase coincides with the complete replacement of the U.S. populations middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.