The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults

OBJECTIVE: To confirm the association between depression and self-rated general health, independent of demographics, functional disability, physical illness burden, and health services utilization. DESIGN: Logistic regression analyses of data obtained in a cross-sectional epidemiological survey. SETTING:The mid-Monongahela Valley, a rural, nonfarm, low SES community. PARTICIPANTS: Random sample of 880 subjects aged 65 and older. MEASUREMENTS: The dependent variable was self-rated overall health, categorized as excellent, good, fair, or poor. The independent variables were demographics (age, gender, education), number of depressive symptoms, number of impaired instrumental activities of daily living (IADLs), measures of physical illness burden (individual medical conditions, number of affected organ systems or disease processes, and number of prescription medications), and measures of health services utilization (number of visits to physicians, and acute hospitalization). RESULTS: Univariate analyses indicated that poorer self-rated health was associated with lesser education, higher numbers of depressive symptoms, impaired IADLs, prescription medications, physician visits, hospitalizations, and affected organ systems, and with the presence of several specific conditions. However, multiple logistic regression analyses revealed that only the following variables were associated independently with poorer self-rated health: age less than 75 years, education less than high school graduation, greater numbers of depressive symptoms, impaired IADLs, prescription medications, and physician visits. CONCLUSIONS: Even when controlling for physical illness and functional disability, subjective rating of overall health remains strongly and independently associated with depressive symptoms.