Beyond Physical Limitations: Depressive Mood and Self-Rated Health Among Adults with Severe Disabilities

Background/Objectives: Self-rated health (SRH) is a widely used summary indicator of health and a predictor of subsequent morbidity and mortality. Among adults with severe disabilities, SRH may reflect not only chronic conditions and functional limitations but also psychological factors, particularly depressive mood. This study examined the incremental contribution of depressive mood beyond physical and functional factors to SRH among adults with severe disabilities. Methods: We analyzed data from a survey of adults with severe disabilities in Seoul, South Korea (N = 1519). SRH (higher scores indicating better health) was modeled using block-wise hierarchical linear regression with robust standard errors. Models sequentially adjusted for (1) sociodemographic factors (including living arrangement); (2) disability characteristics (disability type and multiple disability status); (3) physical and functional health factors (illness status, instrumental activities of daily living (IADL), and unmet medical need); and (4) depressive mood. Results: In the fully adjusted model (R² = 0.241), illness status (b = -0.330, p < 0.001), functional capacity (IADL; b = 0.116, p < 0.001), and depressive mood (b = -0.105, p < 0.001) were independently associated with SRH. Adding disability characteristics significantly improved model fit (ΔR² = 0.074; Wald block F(3, 1510) = 42.56, p < 0.001). Further adding illness status, IADL, and unmet medical need improved model fit (ΔR² = 0.051; Wald block F(3, 1507) = 30.85, p < 0.001), and depressive mood provided additional explanatory power (ΔR² = 0.011; Wald block F(1, 1506) = 16.86, p < 0.001). Living alone and unmet medical need were not significantly associated with SRH after adjustment. Conclusions: Depressive mood was independently associated with SRH among adults with severe disabilities, even after accounting for physical health and functional limitations. These findings suggest that attention to depressive mood may be relevant to disability-related assessment and service planning, alongside chronic disease management and functional support. The observed association reflects a short-term affective state rather than clinical depression and should be interpreted within the context of subjective health appraisal.