Research ArticleOriginal Research

Self-Rated Health and Long-Term Prognosis of Depression

Gilles Ambresin, Patty Chondros, Christopher Dowrick, Helen Herrman and Jane M. Gunn
The Annals of Family Medicine January 2014, 12 (1) 57-65; DOI: https://doi.org/10.1370/afm.1562

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Flowchart of the diamond study cohort.

    Note: Flowchart of participants who were active in the cohort at each year after they withdrew or died, and the number of active participants that returned the survey questionnaire.

  • Figure 2
    Figure 2

    Predicted risk of major depressive syndrome at 1, 2, 3, 4, and 5 years using multiple imputation, by self-rated health and major depressive syndrome categories at baseline (N = 789).

    MDS = major depressive syndrome; SRH = self-rated health.

    Note: Using 50 imputed data sets.

Tables

  • Table 1

    Participant Sociodemographic, Mental, and Somatic Characteristics by Self-Rated Health Status at Baseline (N = 789)

    CharacteristicSelf-Rated HealthAssociation With Self-Rated Health
    Poor/Fair
    (N = 322) No. (%)    		Good/Excellent
    (N = 467) No. (%)    		UnivariableaMultivariablea
    OR (95% CI)P ValueOR (95% CI)P Value
    Demographic
    Female199 (61.8)364 (77.9)0.46 (0.32–0.68)<.0010.61 (0.40–0.92).02
    Age, y
     18–3437 (11.5)103 (22.1)Ref<.001Ref.02
     35–54162 (50.3)237 (50.7)1.87 (1.14–3.08)2.11 (1.22–3.63)
     55–76123 (38.2)127 (27.2)2.63 (1.69–4.11)1.92 (1.15–3.20)
    Marital status
     Never married68 (21.3)116 (25.0)Ref.62
     Widowed, divorced, separated96 (30.1)132 (28.4)1.22 (0.82–1.82)
     Married155 (48.6)216 (46.6)1.18 (0.79–1.78)
    Born in Australia270 (84.1)381 (81.8)1.16 (0.81–1.67).42
    English as first language305 (94.7)449 (96.6)0.61 (0.29–1.30).20
    Depression-related items
    Major depressive syndrome (PHQ-9)130 (40.4)81 (17.3)3.21 (2.33–4.43)<.0012.54 (1.69–3.80)<.001
    First episode94 (31.9)127 (30.2)1.09(0.77–1.54).63
    Medication
    Currently taking depression medication160 (49.7)157 (33.6)1.95 (1.52–2.49)<.001
    Currently taking anxiety medication34 (10.6)43 (9.2)1.18 (0.79–1.77).42
    Currently taking sedative medication16 (5.0)14 (3.0)1.74 (0.75–4.06).20
    Currently taking antipsychotic medication25 (7.8)12 (2.6)3.16 (1.61–6.20).001
    Chronic illness items
    Long-term illness limits daily activity241 (76.8)164 (35.8)5.86 (4.40–7.79)<.0013.85 (2.78–5.34)<.001
    Morbidity 2 or more in last 12 mo151 (46.9)139 (29.8)2.07 (1.48–2.90)<.001
    Substance abuse
    Alcohol abuse and/or dependence44 (14.9)72 (16.8)0.88 (0.60–1.29).50
    Substance abuse and/or dependence32 (10.9)28 (6.5)1.71 (0.97–2.99).06
    SES-related items
    Highest level of education
     Completed year 12 or less194 (60.4)240 (51.5)Ref.11
     Certificate or diploma73 (22.7)117 (25.1)0.79 (0.52–1.20)
     Bachelor degree or higher54 (16.8)109 (23.4)0.64 (0.42–0.98)
    Benefit as main source of income165 (51.6)116 (25.2)3.15 (2.46–4.02)<.0011.70 (1.32–2.20)<.001
    Employment status
     Employed or student144 (45.0)331 (71.0)Ref<.001Ref.001
     Not employed83 (25.9)117 (25.1)1.62 (1.08–2.43)1.18 (0.79–1.77)
     Unable to work93 (29.1)18 (3.9)11.67 (7.12–19.13)2.24 (1.45–3.47)
    Manage on available income
     Easily, not too bad105 (32.7)232 (50.0)Ref<.001
     Difficult some of the time117 (36.5)175 (37.7)1.49 (1.08–2.06)
     Difficult all of the time99(30.8)57 (12.3)3.85 (2.67–5.55)
     General physician rural location113 (35.1)136 (29.1)1.33 (0.92–1.93).13

    • OR = odds ratio; ref = reference; SES = socioeconomic status.

    • Note: Discrepancies in totals are due to missing responses.

    • ↵a N = 761. Odds ratio, 95% confidence intervals, and P values calculated using marginal logistic regression using generalized estimating equations with robust standard errors to allow for correlated responses within practices and individuals.

  • Table 2

    Risks, Risk Differences, and Risk Ratios of Major Depressive Syndrome at 1, 2, 3, 4, and 5 Years for Poor to Fair Compared With Good to Excellent Self-Rated Health: Complete Case Analysis

    AnalysisPoor/Fair SRHGood/Excellent SRHUnadjustedAdjusteda
    Nn%Nn%Risk Differenceb (95% CI)Risk Ratiob (95% CI)Risk Ratiob (95% CI)
    1 year2308637.43505515.721.3 (15.4–27.1)2.36 (1.78–3.13)1.81 (1.37–2.39)
    2 years1916333.03033210.622.1 (14.0–30.2)3.11 (2.07–4.68)2.29 (1.53–3.42)
    3 years1876333.72943110.522.7 (14.5–31.0)3.20 (2.20–4.66)2.33 (1.49–3.62)
    4 years1695029.62773813.715.4 (7.0–23.9)2.13 (1.46–3.10)1.50 (1.03–2.18)
    5 years1634829.5261259.619.7 (13.1–26.3)3.06 (2.13–4.41)2.34 (1.57–3.49)

    • PHQ-9 = 9-item Physicians’ Health Questionnaire; SRH = self-rated health.

    • ↵a Adjusted for PHQ-9 major depressive syndrome at baseline.

    • ↵b Calculated with generalized linear models using generalized estimating equations with robust standard errors to allow for correlated responses within practices and individuals.

  • Table 3

    Risks, Risk Differences, and Risk Ratios of Major Depressive Syndrome at 1, 2, 3, 4, and 5 Years for Poor to Fair Compared With Good to Excellent Self-Rated Health: Multiple Imputation Analysis

    AnalysisPoor/Fair SRH (N = 322) %Good/Excellent SRH (N = 467) %UnadjustedAdjusteda
    Risk Differenceb (95% CI)Risk Ratiob (95% CI)Risk Ratiob (95% CI)
    1 year39.018.520.2 (13.6–26.8)2.10 (1.60–2.76)1.67 (1.28–2.19)
    2 years35.114.720.1 (13.2–27.1)2.38 (1.77–3.20)1.88 (1.40–2.53)
    3 years35.515.919.3 (12.3–26.3)2.22 (1.70–2.89)1.81 (1.36–2.40)
    4 years33.619.413.9 (6.5–21.3)1.73 (1.30–2.28)1.37 (1.03–1.84)
    5 years34.215.818.0 (11.1–24.8)2.15 (1.59–2.90)1.79 (1.32–2.42)

    • PHQ- = 9-item Patient Health Questionnaire; SRH = self-rated health.

    • Note: Using 50 imputed data sets.

    • ↵a Adjusted for PHQ-9 major depressive syndrome at baseline.

    • ↵b Calculated with generalized linear models using generalized estimating equations with robust standard errors to allow for correlated responses within practices and individuals.

Additional Files

  • Supplemental Table

    Supplemental Table. Unadjusted and Adjusted Risk Ratios of Major Depressive Syndrome at 1, 2, 3, 4, and 5 Years for Poor/Fair Self-Rated Health Compared With Good/Excellent Self-Rated Health

    Files in this Data Supplement:

  • The Article in Brief

    Self-Rated Health and Long-Term Prognosis of Depression

    Gilles Ambresin , and colleagues

    Background Self-rated health has been used as a reliable, quick way to assess and monitor population health. This study examines whether self-rated health (SRH) predicts long-term depression outcomes in primary care using the following question: "In general, would you say your health is excellent, very good, good, fair or poor?"

    What This Study Found Self-rated health appears to be a strong and consistent predictor of the risk of future depression in patients with recent experience of depressive symptoms. Patients who rated their health as poor to fair had a two-fold greater risk of major depression up to five years later compared with those who rated their health as good to excellent. The association between self-rated health and future depressive status remained strong even after adjusting for age, sex, multimorbidity, and baseline depression status or severity.

    Implications

    • Few tools exist to help physicians identify those at increased risk of persistent or recurring depression. SRH provides enough information to indicate long-term increased risk of poor depression outcome for primary care patients with recent experience of depressive symptoms.
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