Self-assessed health and mortality: could psychosocial factors explain the association?

The single-item question of self-assessed health has consistently been reported to be associated with mortality, even after controlling for a wide range of health measurements and known risk factors for mortality. It has been suggested that this association is due to psychosocial factors which are both related to self-assessed health and to mortality. We tested this hypothesis.

The study was carried out in a subsample (n = 5667) of the GLOBE-population, a prospective cohort study conducted in the southeastern part of the Netherlands. Data on self-assessed health, sociodemographic variables, various aspects of health status, behavioural risk factors, and a number of psychosocial factors (social support, psychosocial stressors, personality traits, and coping styles) were collected by postal survey and structured interview in 1991, and mortality data were collected between 1991 and 1998. Cox proportional hazards analyses were used to calculate the association between self-assessed health and mortality, before and after controlling for the psychosocial variables.

After controlling for sociodemographic variables, various aspects of health status, and behavioural risk factors, self-assessed health is still strongly associated with mortality in our dataset (Relative Risk [RR] of dying for 'poor' versus 'very good' self-assessed health = 3.98; 95% CI: 1.65-9.61). After controlling for the same set of confounders, many of the psychosocial variables are statistically significantly associated with a 'less-than-good' self-assessed health, particularly instrumental social support, long-lasting difficulties, neuroticism, and locus of control. However, only 'disclosure of emotions'-coping style has a statistically significant relationship with mortality. Adding the psychosocial variables to a model already containing self-assessed health does not attenuate the association between self-assessed health and mortality.

We did not find indications that the association between self-assessed health and mortality is due to the psychosocial factors included in this analysis. It seems likely that the unexplained mortality effects of self-assessed health are due to the fact that self-assessed health is a very inclusive measure of health reflecting health aspects relevant to survival which are not covered by other health indicators.