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Article Excerpt
Self-rated health (SRH) is widely recognized as a significant measure of the overall global health of an individual and has been researched for over 40 years. One of the more consistent findings in SRH research is its predictive ability of mortality and survival (Benyamini & Idler, 1999; Idler & Benyamini, 1997). Even after taking into consideration objective measures of health status and health condition, SRH still emerges as an additional independent predictor, thereby highlighting the significance of the subjective view of one's health. Much of the research on SRH has focused predominantly on older adults and in identifying the numerous predictors of SRH. However, there is a lack of studies that include special groups and different ages, and this has been identified as a limitation in the literature and the represents the next stage of research in this field (Idler & Benyamini, 1997).
One group not adequately studied in regards to SRH is people of all ages with an early to mid-life physical disability onset such as cerebral palsy (CP), polio, or spinal cord injury (SCI). We cannot assume that the existence of a long term physical disability automatically leads to a lower SRH rating. Despite functional limitations resulting from a disability, people with physical impairments may vary widely in how they view their health, with many even reporting good to excellent health. Data from the Health and Retirement study (Finnegan, Marion, & Cox, 2005) documented that 34% of people with chronic conditions reported their SRH as either very good or excellent. Also, the issues of health and wellness for people with a disability have become a significant focus in the national health agenda (U.S. Department of Health and Human Services, 2000) and thus knowledge about how people with a disability perceive their health is also relevant (Putnam, Geenen, & Powers, 2003).
For older adults without a disability, studies on SRH have found that functional impairment and frailty were often associated with lower SRH (Han, Small, & Haley, 2001; Idler & Benyamini, 1997; Idler, Hudson, & Leventhal, 1999). However, the impact of physical impairment and any resulting functional impairment on SRH may operate differently for people with a permanent disability. Disability is often a consequence of permanent physical impairment and people with such impairments learn to adapt over time. Functional impairment that results from a disability becomes a permanent part of the experience of people with a disability and is not considered evidence of poor health. These individuals may separate their physical condition from their general health status and not consider their impairment when forming their subjective health perceptions. They may form a health perception that takes other variables into consideration, such as the debilitating consequences of severe pain or fatigue, or psychosocial factors like emotional mood and the ability to socialize and participate in the community.
Only a few studies on SRH have specifically identified or included people with disabilities. Hoeymans, Feskens, Kromhout, and Van den Bos (1999) looked at the association between poor SRH and seven different chronic conditions such as stroke, diabetes, and musculoskeletal conditions in elderly men in Amsterdam. Stroke had the largest impact on poor SRH followed by respiratory symptoms, heart disease, musculoskeletal complaints, and diabetes. Finnegan et al. (2005) looked at profiles of SRH for midlife adults ages 50 to 60 years with chronic illnesses. Data were taken from the Health and Retirement Study, and disability was defined as having one or more chronic health conditions such as arthritis, hypertension, heart disease, or diabetes. Some of the variables associated with different levels of SRH were work limitations, depressed mood, smoking, being overweight, lack of vigorous activity, and having other co-morbid health problems.
The impact of psychological variables, especially depression, on SRH was examined by Han and colleagues (Han, 2002; Han et al., 2001). For a sample of people without disabilities, Han (2002) found that a high degree of depression at baseline was predictive of decline in SRH two years later; and for a sample of older adults with stroke, Han et al. (2001) found that depression explained the SRH variance by an additional 21% after accounting for functional status and number of physical illnesses.
Only one study has compared SRH predictors between people with or without a disability, that of Cott, Gignac, and Badley (1999). Cott et al. (1999) reported results from a national health survey of Canadians 20 years and older. Disability was defined as having a long-term chronic condition such as arthritis, back disorders, heart disease or respiratory disorders. Cott et al. (1999) found that people with disabilities generated a stronger predictive model for SRH than people without disabilities. For persons with disabilities, strong predictor variables for SRH were pain severity, presence of a short-term health condition within the last two weeks, having a lower education, and being unemployed. In contrast, the predictive model for those without a disability was age and the presence of a short-term health condition within the last two weeks.
The purpose of our study was twofold: (a) to investigate what factors are associated with SRH for people with disabilities and (b) to compare the predictor patterns for SRH between people with and without disabilities. According to Finnegan et al. (2005) knowledge of factors associated with SRH among people with a disability can be beneficial, especially if any are amendable to change that can be used to improve SRH. Finnegan et al. (2005) found that midlife adults with chronic conditions who reported positive baseline SRH actually reduced their odds of lower SRH levels in the future by 15% over an 8-year span. In contrast, people with average and poor SRH at baseline increased their odds of poorer future SRH levels by 2% and 4% respectively for each year. This study included adults of all ages, not just older adults, because people with disabilities are likely to experience new health problems at an...
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