Psychological Well-Being and Social Support
Psychological Well-Being and Social Support
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This study examined the contributions of psychological well-being and social support to an integrative model of subjective health among older adults. Structural equation modeling was used to test the proposed model of subjective health which included age, education, physical health problems, functional status, psychological well- being and social support. Partial support for the model was found. Psychological well- being had both a direct effect on subjective health and an indirect effect mediated by physical health problems. Social support had an indirect association with subjective health via its effect on psychological well-being. Functional status had only a weak effect on subjective health. Longitudinal data at a six-year interval revealed the same direct and/ or indirect effects of these variables on subjective health. This study sheds light on how psychological and social resources are linked with subjective health in later adulthood.
Keywords Subjective health . Older adults . Psychologicalwell-being . Social support
Older age is associatedwith an increase in chronic health problems and physical disability, yet the majority of older adults evaluate their health in positive terms (e.g. Statistical Report on the Health of Canadians 1999; Canadian Study of Health and Aging Working Group 2001). Subjective health is of particular interest in gerontological research, as it appears to predict important variables including functional decline (Grand et al. 1988; Idler and Kasl 1995; Kaplan et al. 1993; Mor et al. 1994) and even mortality after other
Ageing Int (2010) 35:38–60 DOI 10.1007/s12126-009-9050-7
The Canadian Study of Health and Aging (CSHA) was funded by the Seniors’ Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (Project No. 6606-3954-MC[S]). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, the NHRDP (Project No. 6603-1417-302 [R]), Bayer Incorporated, and the British Columbia Health Research Foundation (BCHRF Projects No. 38 [93-2] & No. 34 [96-1]). The CSHA was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. The authors wish to express their appreciation to all staff across Canada involved in the CSHA.
S. Guindon : P. Cappeliez (*) School of Psychology, University of Ottawa, Ottawa, ON, Canada e-mail: Philippe.Cappeliez@uottawa.ca
covariant factors including objective indicators of health are taken into account (for reviews, see Benyamini and Idler 1999; Idler and Benyamini 1997). These observations suggest that subjective health encompasses elements that are not necessarily captured by objective measures of health and underlines the relevance of gaining a better understanding of subjective health. In keeping with this objective, it appears important to identify the principal determinants of subjective health, and in particular, those variables which may affect subjective health positively in later adulthood.
Consistent with traditional biological and Western views of health, models of subjective health have generally focused on physical health and functional status (e.g. Johnson and Wolinsky 1993; Liang 1986). Subjective health in later adulthood is indeed linked to physical health indicators such as number of reported health problems (Pinquart 2001), medications used (Benyamini et al. 2000), as well as functional disability (Bookwala et al. 2003; Lee and Shinkai 2003; Pinquart 2001).
Sociodemographic factors have also been included in many studies of the determinants of subjective health. Review of the literature reveals that the relationship between gender and the subjective health of older adults is still unclear (Gonzalez et al. 2002; Henchoz et al. 2008; Saevareid et al. 2007; Prus and Gee 2003). In particular, several studies have found that the predictors of subjective health may vary according to gender (Heikkinen et al. 1997; Leinonen et al. 1999; Prager et al. 1999; Prus and Gee 2003; Rodin and McAvay 1992; Schulz et al. 1994). The effect of age on subjective health also varies from one study to the next. Results of two meta-analyses that included cross-sectional (Roberts 1999) and longitudinal (Pinquart 2001) studies, reveal a slight decrease in subjective health with increasing age, especially among adults 80 years and older. However, these results are interpreted as the effect of increasing health problems and functional limitations with age (Pinquart 2001), which suggests that age probably does not exert a direct effect on subjective health, but rather an indirect one through physical health and functional status. This hypothesis has received some empirical support (Orfila et al. 2000). In addition, studies have shown rather consistently that higher education is associated with better subjective health (e.g. Grundy and Sloggett 2003; Murrell and Meeks 2002; Prus and Gee 2003; Von dem Knesebeck et al. 2003; Zimmer and Amornsirisomboon 2001).
As Mossey (1995) pointed out, psychological variables can also influence subjective health. She proposed a model of subjective health that includes mental health as predictor of subjective health, alongside physical health, functional status, and sociodemographic variables. This model proposes that sociodemographic variables have a direct effect on subjective health, as well as indirect effects through the three other variables. The model further posits that physical health exerts direct and indirect effects through mental health and functional status, which in turn both have direct effects on subjective health. Finally, in addition to its direct effect on subjective health, mental health is hypothesized to have indirect effects via physical health and functional status. Regrettably research simultaneously testing the predictions of Mossey’s model is still lacking.
The criticism of tautological reasoning could be leveled against this approach to the determinants of subjective health, as physical and mental health indicators can be expected to share much variance with subjective health. However, closer examination of these constructs and their measurements reveals that they are distinct. Specifically, while more objective indicators of physical health (e.g. health problems checklist or
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medical antecedents) and functional status (e.g. ability to accomplish various activities of daily living or level of mobility) may indeed influence self-assessment of health, clearly the perception of one’s health transcends this information and indeed is influenced by a variety of personal factors such as mood, self-perception/concept, expectations, and comparisons with others, to name a few. Regarding psychological well-being, typical indicators such as life satisfaction, happiness, self-esteem and perception of control, are much broader and multi-facetted concepts than subjective evaluation of health. At the empirical level also, items referring to perception of physical health in typical measures of psychological well-being constitute only a very small fraction of the dimensions assessed by such measures.
It is important to note that research on the psychological determinants of subjective health has largely adopted a pathogenic perspective by conceptualizing mental health in terms of level of psychological distress and thus focusing on factors that undermine subjective health. Yet it has been reported that positive indicators of psychological well-being such as life satisfaction (Lee and Shinkai 2003), perception of control (Chipperfield et al. 2004), and self-esteem (Cairney 2000; Starr et al. 2003), are also associated with subjective health. In fact, emerging evidence suggests that positive psychological functioning may represent an important long-term predictor of subjective health (Benyamini et al. 2000). However, how these psychological factors precisely relate to subjective health remains an open question.
While psychological well-being could directly influence self-evaluations of health, a growing body of research suggests that objective indicators of physical health can also be positively affected by various dimensions of psychological well-being, including positive affect (Fredrickson and Levenson 1998; Ostir et al. 2001a; Ostir et al. 2004; Ostir et al. 2001b; Xu 2006), perception of control (Chipperfield et al. 2004), and healthy global psychological well-being (Keyes 2005). Notably, experimental research has demonstrated that the induction of positive emotions restored cardiovascular physiological activation induced by negative emotions or stress, which suggests that mood can exert a direct effect on the risk of illness (Fredrickson and Levenson 1998). Thus, it appears likely that psychological well-being could indirectly affect subjective health through its effect on objective physical health.
Although findings have been inconsistent, there is also research pointing to the relevance of social support. Overall, positive integration within diverse social networks appears to be related to better subjective health (Wu and Rudkin 2000; Zunzunegui et al. 2004), with emotional support seemingly the most beneficial for subjective health (Zunzunegui et al. 2001). The positive effects of social support on subjective health may well be mediated by psychological variables (Landau and Litwin 2001; Okamoto and Tanaka 2004).
Despite the above-mentioned evidence, research on subjective health from a salutogenic perspective, focusing on factors that promote health such as positive psychological functioning and social support (Ryff and Singer 1998; Seligman and Csikszentmihalyi 2000), has been lacking. Yet, considering the role of these variables could help elucidate how older adults can maintain a favorable subjective health despite an objective decline of physical health. Therefore, the main objective of the present study was to examine how psychological well-being and social support relate to subjective health among older adults. These relationships were tested using the framework of an integrative model of subjective health that stems
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from Mossey’s model of subjective health (Mossey 1995). The proposed model incorporates positive indicators of psychological well-being and social support as predictors of subjective health.
On the basis of the literature reviewed above, and as Fig. 1 illustrates, the main hypothesis was that psychological well-being, operationalized as general mental health status, life satisfaction and positive psychological functioning, would have a favorable direct effect on subjective health, as well as an indirect effect through mediation by physical health problems and functional status. Given the less consistent relationship between social support and subjective health, it was hypothesized that the effect of social support would be a favorable but indirect one, mediated by psychological well-being. The proposed model further posits the following subsidiary hypotheses : 1) age would have an indirect unfavorable effect on subjective health, mediated by physical health problems and functional status; 2) education would have direct and indirect favorable effects on subjective health, the latter mediated by physical health problems, functional status and psychological well-being; 3) physical health problems would have direct and indirect unfavorable effects on subjective
Physical Health Problems
