Examination of Self-Rated Health, Psychological Well-Being and Cardiovascular Health Risks – 10-Year Follow-Up of the Budakalász Epidemiological Study in Hungary

Authors

DOI:

https://doi.org/10.5708/EJMH.21.2026.0051

Keywords:

psychological well-being, cardiovascular disease, self-rated health, medical status, health behavior

Abstract

Introduction: Self-rated health (SRH) predicts morbidity and mortality; however, its long-term trajectories and associations with psychological wellbeing (PWB), health behaviors, and cardiovascular risk remain understudied in Central and Eastern Europe.

Aim: To describe 10-year changes in cardiovascular risk, health behaviors, PWB, and SRH, and to examine how SRH relates to PWB, health behaviors, and cardiovascular risk in a non-clinical Hungarian adult sample.

Methods: Adults from Budakalász who participated in a cardiovascular screening in 2012 were invited to follow up in 2023. The analysis included 170 participants aged 45–65 years without major cardiovascular events. SRH was assessed with a single global item. Anthropometric and laboratory measures, FINDRISK and Framingham risk scores, health behaviors, and a fouritem PWB score derived from the Short Form (36) Health Survey (SF-36)were included. Non-parametric tests, independent sample t-tests, and Spearman correlations were applied.

Results: Over the 10-year period, SRH showed a modest overall decline, with approximately one-quarter of participants reporting deteriorated SRH, more than half remaining stable, and a minority improving. SRH trajectories were not consistently associated with changes in PWB, cardiovascular risk, or health behaviors. Cross-sectionally, SRH was moderately correlated with PWB but only weakly related to health behaviors. Anthropometric data and cardiovascular risk scores increased, whereas fasting glucose, HbA1c%, and fruit and vegetable consumption improved, and physical activity shifted toward lower intensity.

Conclusions: SRH was closely aligned with PWB over 10 years but largely decoupled from objective cardiovascular risk and health behaviors, supporting SRH as a psychologically grounded subjective health construct relevant for cardiovascular prevention.

References

Albus, C., Waller, C., Fritzsche, K., Gunold, H., Haass, M., Hamann, B., Kindermann, I., Köllner, V., Leithäuser, B., Marx, N., Meesmann, M., Michal, M., Ronel, J., Scherer, M., Schrader, V., Schwaab, B., Weber, C. S., & Herrmann-Lingen, C. (2019). Significance of psychosocial factors in cardiology: Update 2018. Clinical Research in Cardiology, 108, 1175–1196.
https://doi.org/10.1007/s00392-019-01488-w

Arora, M., ElSayed, A., Beger, B., Naidoo, P., Shilton, T., Jain, N., Armstrong-Walenczak, K., Mwangi, J., Wang, Y., Eiselé, J.-L., Pinto, F. J., & Champagne, B. M. (2022). The impact of alcohol consumption on cardiovascular health: Myths and measures. Global Heart, 17, Article 45.
https://doi.org/10.5334/gh.1132

Bagyura, Z., Kiss, L., Édes, E., Lux, Á., Polgár, L., Soós, P., Szenczi, O., Szelid, Z., Vadas, R., Józan, P., Bagdy, G., & Merkely, B. (2014). Cardiovascular screening programme in the Central Hungarian region: The Budakalász Study. Orvosi Hetilap, 155(34), 1344–1352.
https://doi.org/10.1556/oh.2014.29969

Benyamini, Y., Idler, E. L., Leventhal, H., & Leventhal, E. A. (2000). Positive affect and function as influences on self-assessments of health: Expanding our view beyond illness and disability. Journal of Gerontology: Series B, 55(2), 107–116.
https://doi.org/10.1093/geronb/55.2.P107

Boehm J. K. (2021). Positive psychological well-being and cardiovascular disease: Exploring mechanistic and developmental pathways. Social and Personality Psychology Compass, 15(6), Article e12599.
https://doi.org/10.1111/spc3.12599

Czimbalmos, Á., Nagy, Z., Varga, Z., & Husztik, P. (1999). Páciens megelégedettségi vizsgálat SF-36 kérdőívvel, a magyarországi normálértékek meghatározása [Patient satisfaction survey using the SF-36 questionnaire and determination of normal values in Hungary].
Népegészségügy, 80(1), 4–19.

Dawber, T. R., Meadors, G. F., & Moore Jr., F. E. (1951). Epidemiological approaches to heart disease: The Framingham Study. American Journal of Public Health, 41(3), 279–286.
https://doi.org/10.2105/AJPH.41.3.279

Dennison, R. A., Feldman, A. L., Usher-Smith, J. A., & Griffin, S. J. (2018). The association between psychosocial factors and change in lifestyle behaviour following lifestyle advice and information about cardiovascular disease risk. BMC Public Health, 18, Article 731.
https://doi.org/10.1186/s12889-018-5655-7

Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion, 12(2), 191–220.
https://doi.org/10.1080/026999398379718

Guindon, S., & Cappeliez, P. (2010). Contributions of psychological well-being and social support to an integrative model of subjective health in later adulthood. Ageing International, 35, 38–60.
https://doi.org/10.1007/s12126-009-9050-7

Jancsó, Z., Csenteri, O., Szőllősi, G. J., Vajer, P., & Andréka, P. (2022). Cardiovascular risk management: The success of target level achievement in high- and very high-risk patients in Hungary. BMC Primary Care, 23, Article 305.
https://doi.org/10.1186/s12875-022-01922-5

Keyes, C. L. M. (2005) Chronic physical conditions and aging: Is mental health a potential protective factor? Ageing International 30, 88–104.
https://doi.org/10.1007/BF02681008

Kim, E. S., Park, N., & Peterson, C. (2011). Dispositional optimism protects older adults from stroke: The Health and Retirement Study. Stroke, 42(10), 2855–2859.
https://doi.org/10.1161/STROKEAHA.111.613448

KSH [Hungarian Central Statistical Office]. (2010). European Health Interview Survey (EHIS), 2009. Statistical Reflection, 14(4). https://www.ksh.hu/docs/eng/xftp/stattukor/eelef09.pdf

Kubzansky, L. D., Huffman, J. C., Boehm, J. K., Hernandez, R., Kim, E. S., Koga, H. K., Feig, E. H., Lloyd-Jones, D. M., Seligman, M. E. P., & Labarthe, D. R. (2018). Positive psychological well-being and cardiovascular disease: JACC health promotion series. Journal of the American College of Cardiology, 72(12), 1382–1396.
https://doi.org/10.1016/j.jacc.2018.07.042

Kwak, S., Lee, Y., Baek, S., & Shin, J. (2022). Effects of subjective health perception on health behavior and cardiovascular disease risk factors in patients with prediabetes and diabetes. International Journal of Environmental Research and Public Health, 19(13), Article 7900.
https://doi.org/10.3390/ijerph19137900

Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., DiMaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S. Jr., Nnacheta, L. C., …, & Zwischenberger, B. A. (2021). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 145(3), e18–e114.
https://doi.org/10.1161/CIR.0000000000001038

Manderbacka, K., Lundberg, O., & Martikainen, P. (1999). Do risk factors and health behaviours contribute to self-ratings of health? Social Science & Medicine, 48(12), 1713–1720.
https://doi.org/10.1016/S0277-9536(99)00068-4

McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., … ESC Scientific Document Group. (2021). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42(36), 3599–3726.
https://doi.org/10.1093/eurheartj/ehab368

Ocsovszky, Z., Martos, T., Otohal, J., Berényi, B., Merkely, B., Csabai, M., & Bagyura, Z. (2023). A cardiovascularis rizikóbecslés és az egészségmagatartás kapcsolata pszichoszociális tényezők tükrében [Relationship between cardiovascular risk assessment and health behavior in the light of psychosocial factors]. Orvosi Hetilap, 164(4), 119–131.
https://doi.org/10.1556/650.2023.32685

OECD & European Observatory on Health Systems and Policies. (2023). State of health in the EU: Magyarország Egészségügyi országprofil 2023 [Hungarian healthcare country profile 2023]. European Commission.
https://health.ec.europa.eu/document/download/e5c2e963-4ddc-421b-8291-32f845460f17_en?filename=2023_chp_hu_hungarian.pdf&prefLang=hu

Ostir, G. V., Markides, K. S., Peek, M. K., & Goodwin, J. S. (2001). The association between emotional well-being and the incidence of stroke in older adults. Psychosomatic Medicine, 63(2), 210–215.
https://doi.org/10.1097/00006842-200103000-00003

Pogosova, N., Saner, H., Pedersen, S. S., Cupples, M. E., McGee, H., Höfer, S., Doyle, F., Schmid, J.‑P., & von Känel, R. (2015). Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. European Journal of Preventive Cardiology, 22(10), 1290–1306.
https://doi.org/10.1177/2047487314543075

Szabados, E., Sándor, B., & Pálfi, A. (2022). 2021. évi ESC-irányelvek a szív-és érrendszeri betegségek megelőzéséről a klinikai gyakorlatban [2021 ESC Pocket Guidelines on cardiovascular disease prevention in clinical practice]. Cardiologia Hungarica, 52, 60–72.

Timmis, A., Aboyans, V., Vardas, P., Townsend, N., Torbica, A., Kavousi, M., Boriani, G., Huculeci, R., Kazakiewicz, D., Scherr, D., Karagiannidis, E., Cvijic, M., Kapłon‑Cieślicka, A., Ignatiuk, B., Raatikainen, P., De Smedt, D., Wood, A., Dudek, D., Van Belle, E., Weidinger, F., & ESC National Cardiac Societies. (2024). European Society of Cardiology: The 2023 Atlas of cardiovascular disease statistics. European Heart Journal, 45(38), 4019–4062.
https://doi.org/10.1093/eurheartj/ehae466

Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.‑M., Capodanno, D., Cosyns, B., Crawford, C., Davos, C. H., Desormais, I., Di Angelantonio, E., Franco, O. H., Halvorsen, S., Hobbs, F. D. R., Hollander, M., … Williams, B. (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 42(34), 3227–3337.
https://doi.org/10.1093/eurheartj/ehab484

Ware Jr, J. E., & Sherbourne, C. D. (1992). The MOS 36-ltem short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.

Whitman, I. R., Pletcher, M. J., Vittinghoff, E., Imburgia, K. E., Maguire, C., Bettencourt, L., Sinha, T., Parsnick, T., Tison, G. H., Mulvanny, C. G., Olgin, J. E., & Marcus, G. M. (2015). Perceptions, information sources, and behavior regarding alcohol and heart health. The American Journal of Cardiology, 116(4), 642–646.
https://doi.org/10.1016/j.amjcard.2015.05.029

Whyne, E. Z., Woo, J., & Jeon-Slaughter, H. (2023). The effects of subjective wellbeing and self-rated health on lifetime risk of cardiovascular conditions in women. International Journal of Environmental Research and Public Health, 20(14), Article 6380.
https://doi.org/10.3390/ijerph20146380

World Health Organisation. (2006). Physical activity and health in Europe: Evidence for action.
https://iris.who.int/items/e6cdad6d-6cbc-489b-8972-d869941c8829

Wu, S., Wang, R., Zhao, Y., Ma, X., Wu, M., Yan, X. & He, J. (2013). The relationship between self-rated health and objective health status: A population-based study. BMC Public Health, 13, Article 320.
https://doi.org/10.1186/1471-2458-13-320

Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., & Lisheng, L., & INTERHEART Study Investigators (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. The Lancet, 364(9438), 937–952.
https://doi.org/10.1016/S0140-6736(04)17018-9

Yusuf, S., Joseph, P., Rangarajan, S., Islam, S., Mente, A., Hystad, P., Brauer, M., Kutty, V. R., Gupta, R., Wielgosz, A., AlHabib, K. F., Dans, A., Lopez-Jaramillo, P., Avezum, A., Lanas, F., Oguz, A., Kruger, I. M., Diaz, R., Yusoff, K., … Dagenais, G. (2020). Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study. The Lancet, 395(10226), 795–808.
https://doi.org/10.1016/S0140-6736(19)32008-2

Published 2026-02-26

How to Cite

Ehrenberger, B., Ocsovszky, Z., Assabiny, A., Otohal, J., Papp, M., Borenszki-Gutási, Éva, Bagyura, Z., & Csabai, M. (2026). Examination of Self-Rated Health, Psychological Well-Being and Cardiovascular Health Risks – 10-Year Follow-Up of the Budakalász Epidemiological Study in Hungary. European Journal of Mental Health, e0051, 1–13. https://doi.org/10.5708/EJMH.21.2026.0051