title: Effect of Health Comparisons on Functional Health and Depressive Symptoms - Results of a Population-Based Longitudinal Study of Older Adults in Germany.
abstract: OBJECTIVE
  To investigate the effect of health comparisons on functional health and depressive symptoms in a longitudinal approach. Gender differences were examined.
  
  
  METHODS
  The German Ageing Survey (DEAS) is a nationwide, representative longitudinal study of community dwelling individuals living in Germany aged 40 and older. The surveys in 2008 and 2011 were used, with n = 3,983 respondents taking part in both waves. Health comparisons were quantified by the question "How would you rate your health compared with other people your age" (Much better; somewhat better; the same; somewhat worse, much worse). Functional health was assessed by the subscale "physical functioning" of the 36-Item Short Form Health Survey (SF-36) and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).
  
  
  RESULTS
  Adjusting for sociodemographic factors, self-assessed health, social network, self-efficacy and optimism, and morbidity, fixed effects regressions revealed that functional health decreased significantly and considerably with negative health comparisons in the total sample (transitions from 'the same' to 'much worse': β = -11.8), predominantly in men. The effects of negative health comparisons (transitions from 'the same' to 'much worse': β = 4.8) on depressive symptoms were comparable (in terms of significance) to the effects on functional health, with stronger effects in women. Positive comparisons did not affect functional health and depressive symptoms.
  
  
  CONCLUSIONS
  Our findings underline the relevance of negative health comparisons on functional health (men) and depressive symptoms (women). Comparison effects are asymmetric and mostly upwards.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Hajek
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D015577:Geriatric Assessment; D005858:Germany; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D011795:Surveys and Questionnaires