Parsing pathways from chronic illness to self-rated health in Egypt: the role of mental well-being

Chronic noncommunicable conditions are a major driver of poor health in low- and middle-income countries, yet the mental health pathways through which these illnesses shape perceived health remain underexamined. This study investigates whether recent mental well-being—measured using the World Health Organization Five-Item Well-Being Index (WHO-5)—mediates the association between chronic illness and self-rated health (SRH) among Egyptian adults aged 32–65. This study uses nationally representative data from the 2023 Egypt Labor Market Panel Survey ( n = 23,044) and estimates survey-weighted Ordinary Least Squares models predicting SRH (1 = very good/excellent to 5 = very bad). The key independent variable is chronic illness status. Mediation analysis is conducted using the Sobel–Goodman method with 1,000 bootstrap replicates. All models adjust for sociodemographic covariates including age, sex, education, marital status, and regional residence. Chronic illness is associated with significantly worse SRH ( β = 0.59, standard error [ SE ] = 0.02, P < 0.001). When mental well-being is added to the model, the chronic illness coefficient declines to 0.50 ( SE = 0.02, P < 0.001), and WHO-5 is independently associated with better SRH ( β = ‒0.22, SE = 0.01, P < 0.001). The indirect effect via WHO-5 is 0.08 ( SE = 0.01, P < 0.001), indicating that 14.2% of the total association is mediated through recent psychological well-being. Although most of the self-rated health disadvantage linked to chronic illness flows through somatic and functional channels, mental well-being accounts for a meaningful share. Incorporating WHO-5 screening and stepped referral into chronic care could improve subjective health outcomes in Egypt. Mental health integration should be viewed as a critical component of equitable noncommunicable disease strategies.