The self-rated health of women in midlife: A cross-sectional and longitudinal study of a New Zealand sample

This paper is concerned with the role that current determinants and persisting factors play in shaping the health status of women in midlife. We examined associations with current self-rated health and explored causal pathways using health status, well-being, lifestyle, and psychosocial data from 739 New Zealand women, all mothers of the participants in the Dunedin Multidisciplinary Health and Development Study. Survey data collected in 1994, and longitudinal determinants from as early as 1975-76 were included. Cross-sectionally, poor health was associated with depression, chronic conditions, acute symptoms, role limitations due to chronic illness, unemployment, and being overweight. In addition, physical inactivity distinguished 'good' from 'very good' health - as did use of hormone replacement therapy and a history of hysterectomy. Independently, employment status had the strongest association with present self-rated health and the findings also highlighted the importance of support satisfaction. In contrast, the longitudinal data showed a linear pattern between poor health and early neuroticism and no post high school education. Furthermore, current depression was exacerbated by prior depression. Past physical symptoms and prior poor lifestyle behaviours were independently associated with current 'good' rather than 'very good' health. Overwhelmingly, however, a prior history of chronic depression was the most predictive factor for those with current reduced health. The findings highlight the complexity of health determinants and the need for future research on the mechanisms through which determinants may persist and compromise health. Implications are discussed in terms of health promotion efforts, particularly for mental health, and how the findings extend our understanding of determinants of health in policy informed ways.