Social inequalities, psychological well-being, and health: longitudinal evidence from a U.S. National study

Considerable research has linked lower socioeconomic status (SES) and non-majority racial-ethnic status with poorer health, but much research in this area has been cross-sectional and has not examined whether psychological well-being factors help mediate the influence of SES and race-ethnicity on physical health over time. The aims of this study were to examine the degree to which education, household income, and race-ethnicity were independently associated with changes in physical health (global health, functional limitations, and mortality) over five years and to examine whether psychological well-being factors (depressive symptoms, global happiness, self-esteem, and self-efficacy) helped account for these associations. Results from models estimated using data from 7,414 midlife and older adults (4,513 women, 2,883 men) aged 35–98 who participated in the U.S. National Survey of Families and Households 1987–1993 suggested that lower education helped predict a greater decline in global health and a greater increase in functional limitations over time for both men and women; lower income helped predict a greater decrease in global health for men and a greater increase in functional limitations over time for both men and women; being African-American (vs. non-Hispanic white) helped predict a greater increase in functional limitations for women; and lower income and being African-American each independently helped predict mortality over time for men. Psychological factors only very minimally accounted for social inequalities in health; however, a positive profile on each psychological factor (net of Time 1 health and numerous sociodemographic factors) helped predict more positive health over time.