Older adults rate their mental health better than their general health.

Abstract

Background.Self-rated health (SRH) shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH) as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics.Design and methods.We analyzed data from the 2012 CAHPS Medicare Advantage Survey. SRH and SRMH ratings were crosstabulated to determine the distribution of responses across response categories. The expected joint probability distribution was computed and compared to the observed distribution. A constructed variable indicated whether SRMH was better, the same, or worse than SRH. We analyzed the distribution of this variable across various subgroups defined by sociodemographic and health-related factors.Results.A total of 114,905 Medicare Advantage beneficiaries responded to both the SRH and SRMH questions. Both in general and within all subgroups, SRMH was usually rated as better than SRH, and rarely as worse.Conclusions.Within a large group of Medicare recipients, the overwhelming trend was for recipients to rate their mental health as at least as good as their overall health, regardless of any sociodemographic and health-related factors. This finding of a shifted distribution encourages caution in the analytic use of selfrated mental health, particularly the use of both SRH and SRMH for adjustment. Additional research is needed to help clarify the complex relationship between these variables.Significance for public healthSelf-rated health (SRH) has become established as a general measure of health status, but less is known about self-rated mental health (SRMH). Recent epidemiological studies have included self-rated mental health (SRMH) without scrutinizing its properties and in particular its relationship with SRH. In a large dataset of Medicare recipients, we found that self-rated mental health was consistently rated better than self-rated health, across all patient groups. None of the sociodemographic or health factors we examined accounted for this discrepancy. Self-rated mental health seemed to be more resistant to the effects of medical illnesses and functional impairments than was self-rated health. This points to a likely difference in how people formulate and differentiate between their mental and general health, with mental health being seen as more separate from other health factors. These findings encourage caution in the use of SRMH in analytic models, especially if included simultaneously with SRH.