社会支持和社会参与对社区老年人身心健康影响的多重中介效应分析  

Multiple mediating effects of social participation and social support on the physical and mental health of the community-dwelling elderly

作　　者：杜勤怡 马瑄 王晓旭 任燕 崔晓红 冯玫 Du Qinyi;Ma Xuan;Wang Xiaoxu;Ren Yan;Cui Xiaohong;Feng Mei(School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of General Medicine,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Taiyuan 030032,China;Department of Psychiatry,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Taiyuan 030032,China;Third Hospital of Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西医科大学公共卫生学院,太原030001 [2]山西白求恩医院(山西医学科学院)全科医学科,太原030032 [3]山西白求恩医院(山西医学科学院)精神卫生科,太原030032 [4]山西医科大学第三临床医院,太原030032

出　　处：《中华全科医师杂志》2023年第8期818-825,共8页Chinese Journal of General Practitioners

摘　　要：目的:了解社区老年人日常生活活动能力(ADL)、焦虑和抑郁现状及影响因素,探究社会支持和社会参与在ADL、焦虑和抑郁间的中介效应。方法:本研究为横断面研究。采用简单随机抽样方法,于2022年7—10月选取太原市经济技术开发区社区卫生服务中心登记在册的637名60岁以上老年人群进行问卷调查。调查问卷包括一般资料调查表、日常生活活动能力量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、社会支持量表(SSRS)、社会参与量表。采用二分类logistic回归模型分析社区老年人失能、焦虑和抑郁的影响因素,采用结构方程模型验证社会参与和社会支持在社区老年人的ADL和心理健康状况之间的中介效应。结果:社区老年人的失能率为42.9%(258/602),年龄(OR=2.87~4.91)、最近3个月有急性病发作(OR=2.03)、经济状况欠佳(OR=2.39)、轻度和中度社会参与能力受损(OR=4.07、11.75)和低水平社会支持(OR=2.37)是社区老年人失能的危险因素(P<0.05)。焦虑症状发生率为22.7%(137/602),患有慢性病(OR=2.24)、经济状况欠佳(OR=2.27)、轻度和中度社会参与能力受损(OR=6.97、180.43)和低水平社会支持(OR=2.04)是社区老年人焦虑的危险因素(P<0.05)。抑郁症状发生率为19.4%(117/602),最近3个月有急性病发作(OR=1.90)、近3个月感到孤独(OR=2.17)、轻度社会参与能力受损(OR=4.17)及低水平社会支持(OR=3.90)是社区老年人抑郁的危险因素(P<0.05)。社区老年人ADL对心理健康有正向的直接影响为0.204(Bootstrap 95%CI:0.081~0.330),占总效应的34.58%;社会参与和社会支持在ADL和心理健康状况之间的中介效应分别为0.343(Bootstrap 95%CI:0.274~0.418)和0.042(Bootstrap 95%CI:0.015~0.075),分别占总效应的58.13%和7.12%。结论:社会支持和社会参与不但是社区老年人ADL、焦虑和抑郁的共同影响因素,并且在ADL和心理健康状况之间介导中介效应。促进社区老年人的社会�Objective To investigate the status and influencing factors of activities of daily living(ADL),anxiety and depression of the community-dwelling elderly,and to explore the mediating effect of social support and social participation on ADL,anxiety and depression.Methods A questionnaire survey was conducted from July to October 2022,among 637 residents over 60 years old registered in the Community Health Service Center of Taiyuan Economic and Technological Development Zone selected by simple random sampling method.The general information questionnaire,Activities of Daily Living(ADL)scale,Anxiety Self-assessment Scale,Depression Self-assessment Scale,Social Support Scale,and Social Participation Scale were used in the survey.The dichotomous logistic regression model was used to analyze the influencing factors of disability,anxiety,and depression of the elderly.Structural equation modeling was used to verify the mediating effects of social participation and social support on the ADL and mental health status in the elderly.Results The disability rate of the elderly in the community was 42.9%(258/602).Age(OR=2.87-4.91),acute disease attack in the last three months(OR=2.03),poor economic status(OR=2.39),impaired social participation ability(OR=4.07,11.75)and low level of social support(OR=2.37)were risk factors for disability of the elderly in the community.The incidence of anxiety symptoms was 22.7%(137/602).The risk factors of anxiety were having more than one chronic disease(OR=2.24),poor economic status(OR=2.27),mild and intermediate impairment of social participation ability(OR=6.97,180.43)and low level of social support(OR=2.04).The incidence of depressive symptoms was 19.4%(117/602).The risk factors of depression were acute disease attack in the past three months(OR=1.90),loneliness in the past three months(OR=2.17),impaired social participation(OR=4.17)and low level of social support(OR=3.90).The direct effect of ADL on mental health was 0.204(Bootstrap 95%CI:0.081-0.330),accounting for 34.58%of the total effect.

关 键 词：老年人 社会参与 社会支持 身心健康 多重中介效应 

分 类 号：R195.4[医药卫生—卫生统计学] R592[医药卫生—卫生事业管理]