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      Poor or fair self-rated health is associated with depressive symptoms and impaired perceived physical health: A cross-sectional study in a primary care population at risk for type 2 diabetes and cardiovascular disease

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          Abstract

          Background: Psychosocial factors such as depressive symptoms should be considered when assessing cardiovascular (CV) risk. Depressive symptoms are suggested to be associated with poor perception of one’s health, i.e. self-rated health (SRH). Thus, assessing SRH could be a practical tool in CV risk prediction. However, SRH may also emphasize physical, mental or social aspects.

          Objectives: To assess the relationship of SRH and depressive symptoms, classic CV risk factors and perceived physical health among persons at risk for type 2 diabetes (T2D) and cardiovascular disease (CVD).

          Methods: In this cross-sectional study in a primary care population, 2555 persons (mean age 58 ± 7, 56% women) at risk for T2D or CVD were evaluated. Generalized linear statistical models were used to evaluate the association of depressive symptoms (Beck’s Depression Inventory score ≥10), CV risk factors, and perception of SRH and physical health (assessed by Short Form Health Survey).

          Results: Poor or fair health was reported by 40% of the participants. They had more unhealthy lifestyle habits and CV risk factors than subjects rating their health as at least good. Among those with poor or fair SRH, the prevalence of depressive symptoms was 36% and associated with perception of physical health.

          Conclusion: Poor SRH is associated with depressive symptoms and impaired perceived physical health. Assessing SRH might be useful for detecting possible depressive symptoms in patients in CV risk management and diabetes care.

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          Most cited references7

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          The RAND-36 measure of health-related quality of life.

          The RAND-36 is perhaps the most widely used health-related quality of life (HRQoL) survey instrument in the world today. It is comprised of 36 items that assess eight health concepts: physical functioning, role limitations caused by physical health problems, role limitations caused by emotional problems, social functioning, emotional well-being, energy/fatigue, pain, and general health perceptions. Physical and mental health summary scores are also derived from the eight RAND-36 scales. This paper provides example applications of the RAND-36 cross-sectionally and longitudinally, provides information on what a clinically important difference is for the RAND-36 scales, and provides guidance for summarizing the RAND-36 in a single number. The paper also discusses the availability of the RAND-36 in multiple languages and summarizes changes that are incorporated in the latest version of the survey.
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            Health status and risk for depression among the elderly: a meta-analysis of published literature.

            the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively. the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20-1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94-2.97). despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.
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              Relationship of Self-Rated Health with Fatal and Non-Fatal Outcomes in Cardiovascular Disease: A Systematic Review and Meta-Analysis

              Background People who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists. Objectives To estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease. Methods A comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales. Results ‘Poor’ relative to ‘excellent’ self-rated health (defined by most extreme categories in each study, most often’ poor’ or ‘very poor’ and ‘excellent’ or ‘good’) was associated over a follow-up of 2.3–23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). ‘Poor’ relative to ‘excellent’ self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I2 = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%). Conclusions Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.
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                Author and article information

                Journal
                Eur J Gen Pract
                Eur J Gen Pract
                IGEN
                igen20
                The European Journal of General Practice
                Taylor & Francis
                1381-4788
                1751-1402
                2019
                8 July 2019
                : 25
                : 3
                : 143-148
                Affiliations
                [a ]Department of General Practice, University of Turku and Turku University Hospital , Turku, Finland;
                [b ]Salo Health Center , Salo, Finland;
                [c ]Department of Psychiatry, University of Turku and Turku University Hospital , Turku, Finland;
                [d ]Department of Psychiatry, Hospital District of Satakunta , Pori, Finland;
                [e ]Folkhälsan Research Center , Helsinki, Finland;
                [f ]Unit of Primary Health Care, Kuopio University Hospital , Kuopio, Finland;
                [g ]Central Satakunta Health Federation of Municipalities , Harjavalta, Finland
                Author notes
                CONTACT Ansa Talvikki Rantanen atsipp@ 123456utu.fi ICT-City, General Practice, University of Turku and Turku University Hospital , Joukahaisenkatu 3-5A, 20520 Turku, Finland
                Article
                1635114
                10.1080/13814788.2019.1635114
                6713142
                31280603
                2a9361fe-e855-4ee2-897b-637d5f31fa68
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 November 2018
                : 16 June 2019
                : 17 June 2019
                Page count
                Figures: 2, Tables: 1, Pages: 7, Words: 2963
                Funding
                Funded by: Central Satakunta Health Federation of Municipalities
                Funded by: Foundation of Research and Education of Turku University Hospital
                This study was supported by the Central Satakunta Health Federation of Municipalities and the Foundation of Research and Education of Turku University Hospital.
                Categories
                Research Letter

                Medicine
                heart and circulation,anxiety/depression/somatization/surmenage/sleep,general practice/family medicine,general,cross-sectional designs

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