In the conscientious moments of feeling worse, you might want to nurture your health over a quick fix

BY Katsuya Oi AND MelissA hardy

Perceptions of personal health are inherently subjective, varying in depth and scope of consideration from person to person. Expressing one's health status can be a challenge for many of us, yet our reports have proved to be a remarkably good indicator or population health. What insights do these straightforward scales like self-rated health (SRH) provide for our well-being as a population and as individuals?

In SRH, individuals are asked to rate their health as "excellent," "very good," "good," "fair," or "poor." Analyzing data from a nationally representative sample of US residents aged above 50, we find that, for most people, the rating tends to fall between "very good" and "good," with a notable minority at the extremes (either "excellent" or "poor"). Scholars have long acknowledged the importance of this scale when comparing one's rating with that of others. Those who rate their health as "excellent" tend to have better health outcomes, including aspects like mortality and heart health, compared to those who rate their health as "poor." However, a less explored aspect is how closely individuals adjust their self-ratings in response to changes in their health.

While it's widely accepted that variations in ratings among individuals reflect genuine differences in their actual health, an important clinical question has been the extent to which doctors should be concerned when a patient rates their health as "good" during one visit and then as "fair" during the next. Tracking changes in both ratings and specific health indicators for individuals can offer a clearer understanding of this situation and add to what we know about comparative ratings across individuals.

Personality is a common indicator of individual differences in behavior. The "Big-Five" personality factors, brought into the spotlight by the controversial psychologist Jordan Peterson, are also known by the acronym OCEAN (openness, conscientiousness, extraversion, agreeableness, and neuroticism). To better understand why people change their health ratings, the study examined how people with different personalities adjusted their health ratings over time as they experience specific physical changes. For example, individuals who are highly conscientious are often recognized for their forward-thinking and organized nature, and they also are likely to experience better health outcomes, consistent with Peterson’s prediction. But in the few studies that look at how these Big-Five factors shape subjective perceptions of health, disagreements persist. Do people who are more conscientious downgrade their health ratings more sharply when they experience new health challenges, while less conscientious people are less negative in their self-rating?

This study brought clarification on several notable fronts. First, changes in self-rated health and actual health conditions are closely associated, regardless of an individual's Big-Five personality traits. Whether evaluating health based on pain levels, daily challenges in performing typical activities (ADLs), or pre-existing health conditions, the connection remained consistent. If an individual experiences an increase in pain intensity from "moderate" to "severe," they are more likely to lower their self-rating by nearly one point. Second, those with a higher degree of conscientiousness are more inclined to lower their self-rated health when facing additional challenges in daily activities. These individuals appear to prioritize new information or recent experiences when updating their health ratings. In other words, their ratings seem based, at least in part, in specific symptoms or capabilities. Even for those less inclined toward conscientiousness, there's still a connection between changes in their self-rated health and the challenges they encounter in their daily activities – it's just not as pronounced.

These findings challenge some earlier notions of how to interpret the health ratings people provide. Rather than discounting self-assessments or assuming that a change in self-rated health simply signifies having a ‘bad day,’ this study suggests that SRH is a valid indicator of health status and change in health status, but that personality differences are also involved in this process. Perhaps more conscientious people are keener observers of how their bodies are changing or are more aware of small and gradual changes that may indicate a significant developing health issue. While future research may test and expand on these ideas, the main takeaway of the current study is this: if someone's self-rated health declines, especially if they are known to be conscientious, it could be an indication of some emerging condition, a possibility that doctors should seriously consider and a warning doctors will hear by listening closely to their patients.

Article details

Are Changes in Somatic Health Reflected Differently in Updated Self-Ratings by Big-Five Personality Traits?
Katsuya Oi, PhD & Melissa Hardy, PhD
First Published: June 5, 2023
DOI: 10.1177/08982643231180934
Journal of Aging and Health

About the Authors

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Katsuya Oi, PhD is an Assistant Professor of Sociology at Northern Arizona University. Katsuya finds joy in conducting longitudinal analyses to unearth the roles of social factors in personality and agency-related psychometrics. He also channels his passion for understanding the intricacies of human development into his sociological teaching. Rather than working in solitude, he gravitates towards the ambiance of his cherished local café, Steep, where he engages in occasional thought-provoking discussions with the staff and passersby alike. His research focus now pivots towards serving the needs of the local community more effectively, centering on the screening and monitoring of evolving social determinants of health.

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Melissa Hardy, PhD is a Distinguished Professor of Sociology and Demography at Penn State. Hardy’s research focuses on the intersection of age stratification, the life course, health, and social inequality. Within this broad area of concentration, her goal is to examine how social structure (expressed through policy, social institutions, and social categories) organizes individual behaviors, attitudes, and experiences at older ages. Research on retirement, income and assets, and chronic health conditions are combined with subjective assessments (reflecting, in part, subgroup perspectives) in much of this work. A related area of research investigates cohort differences and cohort change as constituted by and reflected in patterns of life course transitions, demographic trends, and patterns of social inequality. Using large longitudinal data sets of national populations or specific cohorts, she employs a range of quantitative techniques. She frequently teaches courses on quantitative techniques, the sociological perspective, sociology and demography of the life course, and age and aging.