Academic journal article New Zealand Journal of Psychology

The Self-Rated Health of Women in Midlife: A Cross-Sectional and Longitudinal Study of a New Zealand Sample

Academic journal article New Zealand Journal of Psychology

The Self-Rated Health of Women in Midlife: A Cross-Sectional and Longitudinal Study of a New Zealand Sample

Article excerpt

This paper is concerned with the role that current determinants and persisting factors play in shaping the health status of women in midlife. We examined associations with current self-rated health and explored causal pathways using health status, well-being, lifestyle, and psychosocial data from 739 New Zealand women, all mothers of the participants in the Dunedin Multidisciplinary Health and Development Study. Survey data collected in 1994, and longitudinal determinants from as early as 1975-76 were included. Cross-sectionally, poor health was associated with depression, chronic conditions, acute symptoms, role limitations due to chronic illness, unemployment, and being overweight. In addition, physical inactivity distinguished 'good' from 'very good' health--as did use of hormone replacement therapy and a history of hysterectomy. Independently, employment status had the strongest association with present self-rated health and the findings also highlighted the importance of support satisfaction. In contrast, the longitudinal data showed a linear pattern between poor health and early neuroticism and no post high school education. Furthermore, current depression was exacerbated by prior depression. Past physical symptoms and prior poor lifestyle behaviours were independently associated with current 'good' rather than 'very good' health. Overwhelmingly, however, a prior history of chronic depression was the most predictive factor for those with current reduced health. The findings highlight the complexity of health determinants and the need for future research on the mechanisms through which determinants may persist and compromise health. Implications are discussed in terms of health promotion efforts, particularly for mental health, and how the findings extend our understanding of determinants of health in policy informed ways.

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It is well established that individual factors as well as aspects of the ones environment are key elements related to health status. Cross-sectional studies have identified a range of interacting associations with poor health, for example, low income, lack of education, health symptoms, degraded housing, reduced coping ability and lack of social support (e.g., Adams, Cartwright, Ostrove, 1998; Blakely, Lochner, & Kawachi, 2002; Ellaway & Macintyre, 1998; Manderbacka et al., 1999; Malmstrom, Sundquist, & Johansson, 1999; Ministry of Health, 1999a). In addition, longitudinal studies have identified the link between increased age, persisting poor lifestyle behaviours, prior unemployment, chronic health conditions and subsequent poor health (e.g., Cott, Gignac, & Badley, 1999; Blaxter, 1990; Goldberg, Gueguen, Schmaus, Nakache, & Goldberg 2001). It is these literatures and challenges that provide the context for the present study. We focus on the cross-sectional and the longitudinal contributions of individual and contextual factors to self-rated health status in a sample of New Zealand women in midlife.

The research interest in women's health has grown considerably, particularly with regard to influences on health at various stages throughout the life-course (e.g., Kuh, Hardy, Rodgers, & Wadsworth, 2002; Lee & Powers, 2002). Within this research area, midlife is a particular interesting stage of life to examine, as there can be many concurrent changes. Social networks and roles change as children leave home, retirement approaches, and with longer life expectancy for women, there may be the additional burden of caring for a parent or spouse (e.g., Benzeval, 1998; Lee & Porteous, 2002; Lee & Powers, 2002; Shadbolt, 1997). At the same time, midlife is the time at which women may reflect on career goals and achievement, which some studies have suggested affects well-being (e.g., Carr, 1997). In addition, the menopause occurs at midlife and hormonal changes have been associated with reduced health status (e.g., Brown, Mishra, & Dobson, 2002; McKinlay, 1996). …

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