Individual differences in self-assessed health: Gender, neuroticism and physical symptom reports

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Abstract

The current study utilized a path analytic strategy to examine the relationship between gender, neuroticism (N) and physical symptom reports. Trait self-focused attention and state negative affect (NA) were included as potential mediators. Results indicated that both gender and N have significant direct effects on symptom reports when considered in the same model. State NA partially mediated the relationship between N and symptom reports. Trait self-focused attention partially mediated the effects of N on symptom reports for women but not men. Findings are discussed with respect to the information processing aspects of individual differences in self-assessed health and directions for future research are suggested.

Introduction

It is widely accepted that there are large individual differences in retrospective physical symptom reports that reflect a host of factors beyond objective illness. Although it has been argued that recall of past health is unreliable and that physicians and researchers alike should focus on concurrent symptoms (e.g. Brown & Moskowitz, 1997), retrospective symptom reports remain the primary means by which individuals describe their health to physicians, which in turn influences diagnosis and subsequent medical treatment (Ellington and Wiebe, Leventhal et al., 1996). Moreover, subjective ratings of health are related to mortality beyond that predicted by objective physical indicators (Kaplan & Comacho, 1983). Thus, it seems pertinent to continue to explore factors related to individual differences in the recall of recent symptoms and illness.

In seeking to understand these factors, two individual difference variables, gender and neuroticism (N), have emerged as significant predictors of retrospective symptom reports. Interestingly, few studies have examined gender and N in the same model predicting physical symptom reporting. This is important because some studies have found that women are higher in N compared to men (Heaven and Shochet, 1995, Lynn and Martin, 1997, Martin and Kirkcaldy, 1998, Roberts and Gotlib, 1997) and there is evidence that gender role is related to N (Marusic & Bratko, 1998). Although the gender- and N-symptom reporting relationships have been investigated in largely independent empirical literatures, several of the proposed mediational pathways (e.g. self-focused attention, negative mood states) between these factors and symptom reports are similar. Given the conceptual overlap between these predominantly separate literatures, it seems important to investigate the relationships between gender, N and symptom reports. Indeed, in a recent review of gender differences in symptom reporting, Gijsbers Van Wijk and Kolk (1997) highlighted the need for empirical investigation of the manner in which gender and trait measures of negative affectivity covary in their relationship to self-reported symptoms.

Neuroticism is a personality factor involving the propensity to experience emotional distress and to report poor stress coping (Costa and McCrae, 1987, Costa and McCrae, 1992, Eysenck, 1967, Eysenck, 1981, Eysenck and Eysenck, 1985). There is substantial empirical evidence that individuals high in N (and in the highly related construct trait Negative Affectivity (Watson & Clark, 1984)), rate themselves to be in poorer health than individuals low in this dimension (Clark and Watson, 1988, Costa and McCrae, 1987, Watson and Pennebaker, 1989).

One proposed mechanism by which N is linked to symptom reporting is via heightened symptom perception (Watson & Pennebaker, 1989). It is thought that individuals high in N are more likely to be self-focused (and thus more likely to detect changes in physical status) than individuals low in this dimension. Thus, individuals high in N may have greater detection of physical symptoms. Indeed, N has been found to be significantly related to trait measures of self-focused attention, which in turn are related to symptom reports (Watson & Pennebaker, 1989). Although this seems to be a plausible mechanism by which N is related to physical symptom reports, the mediating role of trait self-focused attention in this relationship has not been tested in a single model.

Given that N, by definition, is related to more frequent and intense experience of negative emotional states, it has been suggested that state negative affect (NA) may mediate N effects on symptom reports. There is considerable evidence that negative mood states are related to more negatively-assessed health (Croyle and Uretsky, 1987, Salovey and Birnbaum, 1989). One mechanism by which state NA may impact retrospective symptom reports is via mood-congruent recall (Larsen, 1992). Specifically, negative mood states may serve to enhance recall of negative events (e.g. Blaney, 1986), which presumably include past physical illness.

Women consistently rate themselves to be in poorer health compared to men (Gijsbers van Wijk and Kolk, 1997, Pennebaker, 1982, Verbrugge, 1985). Furthermore, women make more physician visits (NCHS, 1994), take more sick days from work (NCHS, 1994) and use more prescription and non-prescription medication (Verbrugge, 1985). While each of these indices of physical morbidity may have their own unique predictors, it is typically assumed that womens' assessments of their health serve as a basis for many related health care decisions (e.g. when to go to the physician, when to take medication, etc.) (Waldron, 1997).

Because most national health statistics are based upon self-report data, the issue of whether women are actually sicker than men, or are merely more likely to report symptoms of illness compared to men remains unresolved. Because biological differences between men and women have not been demonstrated to fully account for gender differences in symptom reporting (e.g. Popay et al., 1993, Verbrugge, 1985), psychosocial factors are thought to play an important role.

As with N, it has been suggested that womens' higher symptom reports may be related to greater sensitivity to bodily changes compared to men (e.g. Gijsbers van Wijk and Kolk, 1997, Leventhal et al., 1994). This suggestion places self-focused attention as a mediator of the gender–symptom report relationship; women may have greater self-focused attention which, in turn, contributes to increased symptom reports. Although this full mediational model has not been tested, data relevant to the hypothesis are inconsistent. For example, findings from the few studies which have examined gender differences in trait measures of self-focused attention are equivocal (Fenigstein et al., 1975, Hansell and Mechanic, 1985, Miller et al., 1981, Shields, 1989). On the other hand, Ingram, Cruet, Johnson and Wisnicki (1988) found women may be more responsive to experimental manipulations of attentional focus compared to men. That is, women may be more prone to become self-focused in some contexts. Given the equivocal nature of the previous literature, the current study examined trait self-focused attention as a potential mediator of the gender–symptom reporting relationship.

An alternative and, we believe, more likely pattern of relationships among these variables is that gender may moderate the effects of self-focused attention on symptom reports. This is based on preliminary evidence that state self-focused attention is related to concurrent symptom reports for women, but not men, during experimental symptom induction (Williams, Wiebe & Rozanas, 1995). Thus, the present study also examined whether gender moderates the attentional focus–symptom reporting relationship.

Negative mood states represent another factor that may play a role in gender differences in symptom reports. There is evidence that emotional well-being is more highly related to self-assessed health for girls compared to boys in adolescent samples (Alexander, 1989, Mechanic and Hansell, 1987). Although this suggests that state NA may be more highly related to symptom reports for women than for men, this has not been systematically studied. Among adults, women have higher rates of clinical depression (e.g. Nolen-Hoeksema, 1990), but there is little evidence that men and women are consistently different in state mood measures (Shields, 1991) or in subjective well-being (Myers & Diener, 1995). However, it has been suggested that women may be more prone to mood congruent recall bias, perhaps because of chronically greater awareness of their own mood state compared to men (Rothkopf & Blaney, 1991). Thus, the current literature suggests that gender may moderate the relationship between state mood and symptom reporting. As with self-focused attention, the current study tested competing mediation (i.e. state mood mediates the gender–symptom reporting relationship) and moderation (gender moderates the relationship between state mood and symptom reports) hypotheses.

An issue which frequently arises in discussions of gender differences in self-assessed health is whether or not it is gender role, rather than biological sex, that is most predictive of symptom reporting. Although some studies have found evidence that gender role is predictive of health reports (Annandale and Hunt, 1990, Klonoff and Landrine, 1992), others that have examined gender role and sex in the same model, have not found gender role to be a significant predictor beyond that accounted for by biological sex (Gijsbers van Wijk & Kolk, 1996). No previous studies have examined gender, gender role and symptoms in the context of N. Therefore, a measure of gender role was included in the current study.

The purpose of the current study was to examine the relationship between N, gender, and retrospective symptom reports in a path model testing both the direct effects of these individual difference factors on symptom reports, as well as potential mediating pathways (self-focused attention and state NA). Finally, the interactive effects between gender and N on mediational pathways in the symptom reporting model will be examined.

Section snippets

Participants

Participants were 63 male and 77 female undergraduate students enrolled in introductory psychology courses. The average age of participants was 21 years. They received extra credit for their participation in the study.

Measures

In group testing sessions, participants completed the following measures:

  • Neuroticism: Participants completed the Neuroticism scale of the NEO-PI-R (Costa & McCrae, 1992). The N scale contains 48 items answered on a 5-point Likert scale. The scale has well-established validity and

Descriptive analyses

Mean values for all study variables by gender and results of one-way ANOVAs to examine gender differences are reported in Table 1. Consistent with previous studies, significant gender differences were found on symptom reports and the three gender role variables.

Correlational analyses

Zero-order correlations between gender, gender role, N, the proposed mediator variables and symptom reports are reported in Table 2. As expected, N was positively related to symptom reports. Higher N was also related to greater PSC,

Discussion

There is considerable empirical evidence that gender and N are each significantly related to self-reported symptomatology. What has been previously undetermined is the manner in which these two individual difference factors are inter-related in predicting symptom reports and potential mediational pathways. Results of the current study suggest that, when considered together in the same model, both gender and N uniquely predict retrospective symptom reports.

Consistent with recent findings by

Acknowledgements

The first author was supported during this research by University of Utah Research Committee and Marriner S. Eccles Research fellowships, a National Research Service Award, Grant No. 5T32-MH-19109 and an American Psychological Association Dissertation Award. The research is based on portions of a doctoral dissertation by the first author under the supervision of the second author. We acknowledge the insightful input of committee members James Alexander, Robert Croyle, Timothy Smith and Bert

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