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      Factors associated with self-rated health status in university students: a cross-sectional study in three European countries

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          Abstract

          Background

          Self-rated health status (SRHS) is a reliable and valid measure for assessing the subjective and objective health of individuals. Previous studies have either focused predominantly on the elderly or investigated only a narrow range of factors potentially associated with SRHS. In examining student populations, these past studies were limited to single countries. The objectives of this study were to assess which candidate variables were independently associated with SRHS in university students, to compare these variables by country and by gender, and to investigate which of the variables was most important as a rating frame for SRHS.

          Methods

          The data is from the Cross-National Student Health Survey, conducted in 2005 in universities in Germany, Bulgaria, and Poland (n = 2103; mean age = 20.7 years). SRHS was assessed with a single question using a five-point scale ranging from "excellent" to "poor". The study also measured a wide range of variables including: physical and psychological health, studying, social contacts/social support, and socio-demographic status.

          Results

          Psychosomatic complaints (considered an aspect of physical health and, adjusted for psychological health) were the most important indicators in forming a rating frame for students' SRHS. There were few differences in the effects of variables associated with SRHS by gender (well-being: a measure of psychological health) and the variables associated with SRHS by country (well-being and self-efficacy). The remaining variables showed homogenous effects for both genders and for all three countries.

          Conclusion

          The results suggest that SRHS can be reasonably used to compare students' health across countries. SRHS is affected by different physical, psychological and psychosomatic aspects of health; however, its strongest association is with psychosomatic complaints.

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          Most cited references36

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          Self-rated health and mortality: a review of twenty-seven community studies.

          We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
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            Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

            To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted. The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development. Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.
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              What do global self-rated health items measure?

              One of the most frequently used health status measures consists of a single item that asks respondents to rate their overall health as excellent, good, fair, or poor. This study identified the conceptual domain that is assessed by this self-rated health measure. Findings from 158 in-depth interviews revealed that the same frame of reference is not used by all respondents in answering this question. Some study participants think about specific health problems when asked to rate their health, whereas others think in terms of either general physical functioning or health behaviors. The data further revealed that the specific referents that are used vary by age. In addition, more tentative findings suggest that the use of specific referents may also vary by education and race. Finally, the results suggest that certain referents may not be related to closed-ended health ratings in predictable ways.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2008
                18 June 2008
                : 8
                : 215
                Affiliations
                [1 ]Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
                [2 ]Department of Epidemiology & International Public Health, School of Public Health, University of Bielefeld, Bielefeld, Germany
                [3 ]Department of Prevention & Health Promotion, School of Public Health, University of Bielefeld, Bielefeld, Germany
                [4 ]Institute of Family Sciences, Catholic University of Lublin, Lublin, Poland
                [5 ]Department of Social, Work and Educational Psychology, Faculty of Philosophy, Sofia University "St. Kl. Ohridski", Sofia, Bulgaria
                [6 ]Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, UK
                Article
                1471-2458-8-215
                10.1186/1471-2458-8-215
                2438349
                18564422
                ceaa0e9f-05e2-4b0e-9ee6-c9ba8063815b
                Copyright © 2008 Mikolajczyk et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 January 2007
                : 18 June 2008
                Categories
                Research Article

                Public health
                Public health

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