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Self-Rated Health and Inflammation

A Test of Depression and Sleep Quality as Mediators

Uchino, Bert N., PhD; Landvatter, Joshua, BA; Cronan, Sierra, MA; Scott, Emily, MA; Papadakis, Michael, BS; Smith, Timothy W., PhD; Bosch, Jos A., PhD; Joel, Samantha, PhD

doi: 10.1097/PSY.0000000000000683

Objective Despite its simplicity, single-item measures of self-rated health have been associated with mortality independent of objective health conditions. However, little is known about the mechanisms potentially responsible for such associations. This study tested the association between self-rated heath and inflammatory markers as biological pathways, and whether sleep quality and/or depression statistically mediated such links.

Method Eighty-six heterosexual married couples completed a standard measure of self-rated health, the Center of Epidemiological Studies-Depression Scale, and the Pittsburgh Sleep Quality Index. Participants also had blood drawn for determination of plasma levels of interleukin 6 and high-sensitivity C-reactive protein. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

Results Results indicated that poor self-rated health was associated with higher CRP levels (B = .31, SE = .14, p = .028). Importantly, the Monte Carlo mediational analyses showed that these results were statistically mediated by sleep quality (aXb = 0.10, 95% confidence interval = 0.003 to 0.217) but not depressive symptoms (aXb = 0.03, 95% confidence interval = −0.03 to 0.10).

Conclusions These results highlight the biological and behavioral mechanisms potentially linking self-rated health to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.

From the Department of Psychology and Health Psychology Program (Uchino, Landvatter, Cronan, Scott, Papadakis, Smith), University of Utah, Salt Lake City; Department of Clinical Psychology (Bosch), University of Amsterdam, The Netherlands; and Department of Psychology (Joel), Western University, London, Ontario, Canada.

Address correspondence to Bert N. Uchino, PhD, Department of Psychology, University of Utah, 380 S. 1530 E. Room 502, Salt Lake City, UT 84112. E-mail:

Received for publication July 16, 2018; revision received January 16, 2019.

Copyright © 2019 by American Psychosomatic Society
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