http://www.iowaaces360.org/uploads/1/0/9/2/10925571/relationship_of_childhood_abuse_and..._1998.pdf

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study

We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.

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Self-rated health and mortality : a review of twenty-seven community studies

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.

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The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?

HEALTH-related quality of life (HRQL) is increasingly used as an outcome in clinical trials, effectiveness research, and research on quality of care. Factors that have facilitated this increased usage include the accumulating evidence that measures of HRQL are valid and "reliable,"1the publication of several large clinical trials showing that these outcome measures are responsive to important clinical changes,2-5and the successful development and testing of shorter instruments that are easier to understand and administer.6-13Because these measures describe or characterize what the patient has experienced as the result of medical care, they are useful and important supplements to traditional physiological or biological measures of health status. Given this improved ability to assess patients' health status, how can physicians and health care systems intervene to improve HRQL? Implicit in the use of measures of HRQL in clinical trials and in effectiveness research is the concept that clinical

Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes

Health inequalities among British civil servants: the Whitehall II study

Self-evaluations of health status have been shown to predict mortality, above and beyond the contribution to prediction made by indices based on the presence of health problems, physical disability, and biological or life-style risk factors. Several possible reasons for this association are discussed: (a) methodological shortcomings of previous studies render the association spurious; (b) other psychosocial influences on mortality are involved and explain the association; and (c) self-evaluations of health status have a direct and independent effect of their own. Four-year follow-up mortality data from the Yale Health and Aging Project (N = 2812) are used to explore these possibilities. The analysis controls for the contribution of numerous indicators of health problems, disability and risk factors, and also makes adjustments of standard errors for the complex sample design. The findings favor the third possibility, an independent effect, to the extent that the particular set of psychosocial factors examined did not explain the basic association, and to the extent that the control variables were an adequately comprehensive set.

Health perceptions and survival: do global evaluations of health status really predict mortality?

Self-ratings of health by individuals responding to surveys have shown themselves to be potent predictors of mortality in a growing number of studies; they appear to contribute significant additional independent information to health status indicators gathered through self-reported health histories or medical examinations. A key question raised by these studies is: What are the mediating processes involved in the association? Specifically, do poor self-ratings increase the risk of disability and morbidity, and are these outcomes intervening steps in the link to mortality? In this report we address the first question, of self-ratings predicting future levels of functional disability, our choice of an index of overall impact of morbidity. Data come from the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) site (N = 2,812). Results show that self-ratings of health in 1982, net of baseline functional ability, health and sociodemographic status, are associated with changes in functional ability over periods of one through six years. These findings extend our understanding of the meaning of excellent, good, fair, and poor ratings of health, and that they have implications not just for survival but for the loss or maintenance of functional ability in daily life.

Self-Ratings of Health: Do they also Predict change in Functional Ability?

The ability of self-rated health status to predict mortality was tested with data from the National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-Up Study (NHEFS), conducted from 1971-84. The sample consists of adult NHANES-I respondents ages 25-74 years (N = 6,440) for whom data from a comprehensive physical examination at the initial interview and survival status at follow-up are available. Self-rated health consists of the response to the single item, "Would you say your health in general is excellent, very good, good, fair, or poor?" Proportional hazards analyses indicated that, net of its association with medical diagnoses given in the physical examination, demographic factors, and health related behaviors, self-rated health at Time 1 is associated with mortality over the 12-year follow-up period among middle-aged males, but not among elderly males or females of any age.

Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study.

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

Ellen L. Idler

Papers

Self-rated health and mortality : a review of twenty-seven community studies

Health perceptions and survival: do global evaluations of health status really predict mortality?

Self-Ratings of Health: Do they also Predict change in Functional Ability?

Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study.

Community Studies Reporting Association Between Self-Rated Health and Mortality