International Journal of Public Health

, Volume 58, Issue 4, pp 555–564 | Cite as

Differentiating positive and negative self-rated health: results from a cross-sectional study in Estonia

  • Rainer Reile
  • Mall Leinsalu
Original Article



To examine possible differences in the correlates of positive and negative self-rated health (SRH).


Data for 2,127 men and 2,385 women in the 25–74 age group came from the Estonian Health Interview Survey 2006. Multinomial logistic regression analysis was used to study the association of socio-demographic, physical and psychological health and well-being characteristics with positive (good or very good) and negative (bad or very bad) SRH as compared to fair SRH.


Negative SRH was related to male gender, the presence of chronic illnesses, limitations in daily activities and physical functioning, emotional distress, an external locus of control, and to low satisfaction with life and physical fitness. These indicators (except satisfaction with life) were also related to positive SRH, presenting a mirrored pattern of association. Additionally, positive SRH was related to younger age, an Estonian ethnic identity, and to higher education and income.


Although SRH forms a ill/healthy continuum when physical and psychological health characteristics are considered, the broader spectrum of predictors indicates that positive SRH and negative SRH are two distinct and alternative concepts.


Self-rated health Continuity Determinants Estonia 



ML’s contribution was supported by the Swedish Foundation for Baltic and East European Studies (grant number A052-10) . The authors would like to thank Andrew Stickley and Anneli Uusküla for their valuable comments on the earlier version of the manuscript. Authors have neither conflicts of interest nor financial interest to disclose.


  1. Aittomäki A, Martikainen P, Laaksonen M, Lahelma E, Rahkonen O (2010) The associations of household wealth and income with self-rated health—a study on economic advantage in middle-aged Finnish men and women. Soc Sci Med 71:1018–1026PubMedCrossRefGoogle Scholar
  2. Aluoja A, Shlik J, Vasar V, Luuk K, Leinsalu M (1999) Development and psychometric properties of the emotional state questionnaire, a self-report questionnaire for depression and anxiety. Nord J Psychiatry 53:443–449CrossRefGoogle Scholar
  3. Apouey B, Clark AE (2009) Winning big but feeling no better? The effect of lottery prizes on physical and mental health. PSE working paper 09. Paris School of Economics, ParisGoogle Scholar
  4. Babones SJ (2009) The consistency of self-rated health in comparative perspective. Public Health 123:199–201PubMedCrossRefGoogle Scholar
  5. Barger SD (2006) Do psychological characteristics explain socioeconomic stratification of self-rated health? J Health Psychol 11:21–35PubMedCrossRefGoogle Scholar
  6. Benyamini Y, Leventhal EA (1999) Self-assessment of health: what do people know that predicts their mortality? Res Aging 21:477–500CrossRefGoogle Scholar
  7. Breidablik HJ, Meland E, Lydersen S (2008) Self-rated health in adolescence: a multifactorial composite. Scand J Public Health 36:12–20PubMedCrossRefGoogle Scholar
  8. Denton M, Walters V (1999) Gender differences in structural and behavioral determinants of health: an analysis of the social production of health. Soc Sci Med 48:1221–1235PubMedCrossRefGoogle Scholar
  9. Dominick KL, Ahern FM, Gold CH, Heller DA (2002) Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 14(6):499–508PubMedGoogle Scholar
  10. Dowd JB, Zajacova A (2010) Does self-rated health mean the same thing across socioeconomic groups? Evidence from biomarker data. Ann Epidemiol 20:743–749PubMedCrossRefGoogle Scholar
  11. Eriksson I, Unden AL, Elofsson S (2001) Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 30:326–333PubMedCrossRefGoogle Scholar
  12. Jylhä M (2009) What is a self-rated health and why does it predict mortality? Towards an unified conceptual model. Soc Sci Med 69:307–316PubMedCrossRefGoogle Scholar
  13. Jylhä M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E (1998) Is self-rated health comparable across cultures and genders? J Gerontol B Psychol Sci Soc Sci 58:144–152CrossRefGoogle Scholar
  14. Kaikkonen R, Rahkonen O, Lallukka T, Lahelma E (2009) Physical and psychosocial working conditions as explanations for occupational class inequalities in self-rated health. Eur J Public Health 19:458–463PubMedCrossRefGoogle Scholar
  15. Kaplan G, Baron-Epel O (2003) What lies behind the subjective evaluation of health status? Soc Sci Med 56:1669–1676PubMedCrossRefGoogle Scholar
  16. Kasmel A, Helasoja V, Lipand A, Prättäla R, Klumbiene J, Pudule I (2004) Association between health behaviour and self-rated health in Estonia, Finland, Latvia and Lithuania. Eur J Public Health 14:32–36PubMedCrossRefGoogle Scholar
  17. Katz P, Morris A, Gregorich S, Yazdany J, Eisner M, Yelin E, Blanc P (2009) Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions. J Clin Epidemiol 62(2):158–166PubMedCrossRefGoogle Scholar
  18. Krause NM, Jay GM (1994) What do global self-rated health items measure. Med Care 32:930–942PubMedCrossRefGoogle Scholar
  19. Leinsalu M (2002) Social variation in self-rated health in Estonia: a cross-sectional study. Soc Sci Med 55:847–861PubMedCrossRefGoogle Scholar
  20. Mackenbach JP, Van den Bos J, Joung IMA, Van de Mheen H, Stronks K (1994) The determinants of excellent health: different from the determinants of ill-health? Int J Epidemiol 23:1273–1281PubMedCrossRefGoogle Scholar
  21. Manderbacka K, Lahelma E, Martikainen P (1998) Examining continuity of self-rated health. Int J Epidemiol 27:208–213PubMedCrossRefGoogle Scholar
  22. Manderbacka K, Lundberg O, Martikainen P (1999) Do risk factors and health behaviours contribute to self-ratings of health? Soc Sci Med 481:1713–1720CrossRefGoogle Scholar
  23. Manderbacka K, Kareholt I, Martikainen P, Lundberg O (2003) The effect of point of reference on the association between self-rated health and mortality. Soc Sci Med 56:1447–1452PubMedCrossRefGoogle Scholar
  24. Martinez-Sanchez E, Regidor E (2002) Self-rated health by education level in persons with and without health problems. J Health Psychol 7:459–468PubMedCrossRefGoogle Scholar
  25. Mitchell JM, Adkins RH (2009) Differences in predictors of self-rated health among people with and without a disability. J Rehabil 75:35–42Google Scholar
  26. Oja L, Matsi A, Leinsalu M (2008) Estonian Health Interview Survey 2006: methodological report. Tervise Arengu Instituut, Tallinn. Accessed 15 August 2012
  27. Perlman F, Bobak M, Steptoe A, Rose R, Marmot M (2003) Do health control beliefs predict behaviour in Russians? Prev Med 37:73–81PubMedCrossRefGoogle Scholar
  28. Pikhart H (2002) Social and psychosocial determinants of self-rated health in central and eastern Europe. Kluwer Academic Publishers, BostonCrossRefGoogle Scholar
  29. Pulvers KM, Kaur H, Nollen N, Greiner A, Befort CA, Hall S, Born W, Fitzgibbon ML, Ahluawalia JS (2008) Comparison of body perceptions between obese primary care patients and physicians: implications for practice. Patient Educ Couns 73:73–81PubMedCrossRefGoogle Scholar
  30. Rotter J (1966) Generalized expectancies for internal versus external control of reinforcements. Psychol Monogr Gen Appl 80(1):1–28Google Scholar
  31. Schnittker J (2005) When mental health becomes health: age and shifting meaning of self-evaluations of general health. Milbank Q 83:397–423PubMedCrossRefGoogle Scholar
  32. Shaw I (2002) How lay are lay beliefs? Health 6:287–299Google Scholar
  33. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33PubMedGoogle Scholar
  34. Shooshtari S, Menee V, Tate R (2007) Comparing predictors of positive and negative self-rated health between younger (24–54) and older (55+) Canadian adults. A longitudinal study of well-being. Res Aging 29:512–554CrossRefGoogle Scholar
  35. Smith A, Shelley JM, Dennerstein L (1994) Self-rated health: biological continuum or social discontinuity? Soc Sci Med 39:77–83PubMedCrossRefGoogle Scholar
  36. Tekkel M, Veideman T, Rahu M (2010) Changes over fourteen years in adult obesity in Estonia: socioeconomic status and use of outpatient health care services. Centr Eur J Publ Health 18:186–191Google Scholar
  37. Turrell G (2000) Income non-reporting: implications for health inequalities research. J Epidemiol Community Health 54:207–214PubMedCrossRefGoogle Scholar
  38. Unden AL, Elofsson S (2001) Health from the patient’s view: how does it relate to the physician’s judgement? Fam Pract 18:174–180PubMedCrossRefGoogle Scholar
  39. Vågerö D, Kislitsyna O, Ferlander S, Migranova L, Carlson P, Rimachevskaya N (2008) Moscow health survey 2004–social surveying under difficult circumstances. Int J Public Health 53:171–179PubMedCrossRefGoogle Scholar
  40. Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13:105–110PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  1. 1.Department of Public HealthUniversity of TartuTartuEstonia
  2. 2.Stockholm Centre on Health of Societies in Transition, Södertörn UniversityStockholmSweden
  3. 3.Department of Epidemiology and BiostatisticsThe National Institute for Health DevelopmentTallinnEstonia

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