Subjective Health Status

Self-rated health status is an important measure of subjective well-being. Although it tends to correlate with more objective measures of health, it is based on personal perception and judgment. These may be influenced by health problems in the past, the level of health of other persons in the subject's social sphere, and the subject's aspirations for the future. Thus, certain persons may underestimate the severity of their illnesses and postpone seeking treatment.

There have been only a few studies examining this issue in aging schizophrenic populations. One study by Krach (1993) used the Older Americans Resources Survey to obtain information from 20 older schizophrenic patients, with a mean age of 61 years, on physical health. Ratings of excellent/ good and fair/poor physical health were reported by 60% and 40% of the sample, respectively. Mental health ratings were similar, with 70% and 30% reporting excellent/good and fair/poor mental health, respectively. Based on the level of physical disorders and reports of impairment in activities of daily living (ADL) (e.g., 35% had moderate or severe ADL impairment),

Krach concluded that these patients overrated their physical health status and underreported medical symptoms, although the author provided no objective measures of physical health. Indeed, in contradistinction to Krach's conclusions, the authors of the PORT study (Dixon et al. 1999) maintained that "persons with schizophrenia have the capacity for reasonable appraisal of their medical conditions that can be a useful tool to promote positive health behaviors" (p. 502). This conclusion was based on the finding of a significant association between the number of medical conditions and self-rated health. In the PORT survey, lower educational level and number of comorbid medical disorders were the only variables associated with poorer self-rated physical health. Other variables, such as gender, race, age, comorbid alcohol or drug disorder, geographic location, or patient setting, were not associated with self-health ratings, although there was a trend for older subjects to perceive their health as better.

The study of older schizophrenic persons in New York City cited previously found that despite equal or lower prevalence rates of physical disorders among schizophrenic persons compared with older community persons, self-reported health differed between the two aging samples (C. I. Cohen, unpublished data). When the entire schizophrenic sample was examined, the percentage reporting excellent/good health was 38%, compared with 54% of community persons. In a multivariate analysis, only activity limitations and depression were significant predictors of negative self-health ratings among older schizophrenic persons. Compared with the general older community sample, older schizophrenic persons had higher scores on the scales for depression (7.5 vs. 5.5) and activity limitations (6.0 vs. 5.0), although it is worth noting that scores on the activity scale can be affected by limitations due to mental as well as physical causes. Thus, the results of the multivariate analysis indicate that self-health ratings may primarily reflect psychological rather than physical factors. Moreover, it suggests that older schizophrenic persons do not overestimate their physical well-being versus their age peers in the community, and, if anything, they may underrate their own physical well-being.

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