Schnittker, Jason
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Publication When Mental Health Becomes Health: Age and the Shifting Meaning of Self-evaluations of General Health(2005-09-01) Schnittker, JasonSelf-evaluations of general health are among the most widely-used measures of health status in research on the need for and outcomes of medical care. Yet, researchers know little about the psychological processes behind them. This study looks at whether such evaluations, often referred to as self-rated health, shift in what they measure as individuals age. Although several perspectives point to age-related shifts, few researchers have explicitly tested these perspectives against each other. The study tests several competing hypotheses using a large, nationally representative, and longitudinal data set. The results suggest two countervailing trends. First, the correspondence between functional limitations and self-rated health declines, especially after the age of 50. Similarly, the correspondence between a variety of chronic conditions and self-rated health, while strong, declines precipitously. Both of these findings are consistent with the idea that individuals evaluate their health through a process of social comparison and, in so doing, are able to maintain an elevated sense of general health even as they age. Yet, the results also suggest that the correspondence between depressive symptoms and self-rated health increases steadily throughout the life course. Indeed, after the age of 74, the correspondence between self-rated health and some common symptoms of depression becomes stronger than the correspondence between self-rated health and several chronic, and often fatal, somatic conditions. The implications of this crossover for both theory and policy are discussed. Among other things, the crossover has important implications for the detection and treatment of depressive symptoms in later life.Publication Natural Symptoms? The Intersection of Social, Biological, and Genetic Determinants of Depression in Later Life(2014-06-17) Schnittker, JasonPurpose. This study explores the social, biological, and genetic determinants of depression in later life. It adds complexity to the idea that later life depression is a natural outgrowth of vascular impairment, antagonistic pleiotropy, or compromised neuroanatomical structures. Approach. The study uses the NAS-NRC Twin Registry of World War II Veterans. The use of twins allows for the exploration of gene-environment interplay. A recent survey instrument associated with the registry contains numerous indicators of health, as well as an established measure of geriatric depression. Findings. The results show that education has a strong negative relationship with depression among those in their 70s and early 80s. Although this relationship is partly explained by lower rates of cardiovascular disease and diabetes among the well-educated, the relationship between education and many common physical illnesses is quite small. Most people of this age experience at least one chronic illness. The relationship between education and depression is explained, instead, by reduced impairments in activities of daily living. These impairments are not an inevitable outgrowth of declining health. The well-educated are better able to moderate the impact of poor health on daily functioning. Moreover, the well educated are able to avoid the otherwise strong genetic risks for depression in later life. Gene × environment models show a high heritability for later life depression on average, but also reveal that this heritability declines with increasing education. Among those with a four-year college degree, the heritability of depression is very small. Value. These patterns are interpreted in light of models for understanding compensatory gene × environment interactions. These models emphasize the importance of especially enriched environments for overcoming genetic risk.