title: Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study.
abstract: OBJECTIVE
  To measure within-person change in scores on the short form general health survey (SF-36) by age, sex, employment grade, and disease status.
  
  
  METHODS
  Longitudinal study with a mean of 36 months (range 23-59 months) follow up, with screening examination and questionnaire to detect physical and psychiatric morbidity.
  
  
  METHODS
  20 civil service departments originally located in London.
  
  
  METHODS
  5070 male and 2197 female office based civil servants aged 39-63 years.
  
  
  METHODS
  Change in the eight scales of the SF-36 (adjusted for baseline score and length of follow up) and effect sizes (adjusted change standard deviation of differences).
  
  
  RESULTS
  Within-person declines (worsening health) with age were greater than estimated by cross sectional data alone. General mental health showed greater declines among younger participants (P for linear trend < 0.001). Employment grade was inversely related to change; lower grades had greater deteriorations than higher grades (P < 0.001 for each scale in men; P < 0.05 for each scale in women except general health perceptions and role limitations due to physical problems). The greatest declines were seen among participants with disease at baseline, with the effects of physical and psychiatric morbidity being additive. Effect sizes ranged from 0.20 to 0.65 in participants with both physical and psychiatric morbidity.
  
  
  CONCLUSIONS
  Health functioning, as measured by the SF-36, changed in hypothesised directions with age, employment grade, and disease status. These changes occurred within a short follow up period, in an occupational, high functioning cohort which has not been the subject of intervention, suggesting that the SF-36 is sensitive to changes in health in general populations.
authors.affiliation: Department of Public Health, Kensington & Chelsea and Westminster Health Authority, London. h.hemingway@public-health.ucl.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
authors.forename: M
authors.initials: M
authors.lastname: Stafford
authors.forename: S
authors.initials: S
authors.lastname: Stansfeld
authors.forename: M
authors.initials: M
authors.lastname: Shipley
authors.forename: M
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D009784:Occupational Diseases / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*