By Amy Norton

NEW YORK (Reuters Health) - When it comes to defining good health, low-income teenagers may put more stock in mental well-being than wealthier teens do, a new study suggests.

The study, of 1,157 U.S. children ages 12 to 15, was partially aimed at confirming a phenomenon seen in earlier research -- that teenagers' views of their own general health are often out of sync with their parents' views.

And, in fact, teenagers in the study often rated their health differently than their parents did, the researchers report in the journal Pediatrics.

But the study also found that families' views differed according to income. Among higher-income families, children's and parents' health ratings depended on physical health factors -- such as how often the child had been sick in the past month, or the number of missed school days in the past year.

For low-income families, physical health mattered, but so did mental health. In general, teenagers who had seen a mental health professional in the past year gave better ratings to their overall health than other low-income teens did.

Mental health indicators did not have a clear influence on higher-income teenagers' health ratings, even though they reported about as many days of "sub-par mental health" as low-income kids did.

In general, teenagers seem to consider a host of factors when describing their health, according to Dr. Sara B. Johnson, the lead researcher on the study and an assistant professor at the Johns Hopkins School of Public Health in Baltimore.

"For adolescents, their own health ratings take into account family, school and social relationships -- all of which may influence their physical or mental health," Johnson told Reuters Health.

So despite the fact that teenagers are, as a group, very healthy physically, relatively few see their health as "excellent." In this study, less than one-quarter rated their health that highly.

It's not clear why low-income teenagers, in particular, were influenced by their access to mental health care. But past studies have shown that poorer children are more likely to have "unmet mental health needs," Johnson explained. "So we think this suggests that when adolescents get help in addressing their problems, they feel better about their health in general," she said.

Low-income parents in the study also gave a good amount of weight to mental well-being -- but they tended to rate their child's health as poorer if he or she had seen a mental health professional.

The reason for this difference is unknown. It might be because of a lack of communication between parents and their kids, or because parents are not seeing "outward" signs of improvements in their children's mental health, Johnson speculated.

"One take-home message from this study," she said, "is that parents should not necessarily assume that because their adolescent is seeking mental health care, that this is a sign of poor health -- adolescents don't see it this way."

SOURCE: Pediatrics, February 2008.