Elder abuse and mental health: the modifying effect of social support
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摘要:
目的 探讨农村地区老年人虐待和心理健康的关系及社会支持在两者关系中的调节效应。 方法 采用多阶段分层随机抽样的方法在湖南省长沙、株洲和湘潭农村地区抽取1 418名60岁及以上老年人作为调查对象，建立Logistic回归分析模型对变量间的关系进行检验。 结果 在控制了人口基本特征变量后，虐待经历、精神虐待、照料忽视、虐待长期性与多重性每提高一个单位，心理健康水平分别下降21.4%（OR=2.14，95% CI：1.49~2.83，P=0.001）、34.2%（OR=3.42，95% CI：1.53~4.26，P < 0.001）、17.8%（OR=1.78，95% CI：1.36~2.41，P=0.001）、25.4%（OR=2.54，95% CI：1.68~2.93，P < 0.001）和13.7%（OR=1.37，95% CI：1.15~2.37，P=0.001）。当加入社会支持变量后，虐待对心理健康的负面影响系数下降了，但男性老年人中差异无统计学意义，主观支持比客观支持的调节效应更大。 结论 虐待是老年人心理健康问题的危险因素，高水平社会支持可以减少虐待对女性老年人心理健康的负面影响。 Abstract:Objective To explore the relationship between elder abuse and mental health, and the modifying effect of social support between them in rural area. Methods A multi-stage stratified random sampling method was used to select 1 418 elderly people aged 60 years and above from rural areas of Changsha, Zhuzhou and Xiangtan in Hunan Province. Logistic regression model was established to test the relationship among the variables. Results After controlling the basic characteristic variables, when the abuse experience, mental abuse, care neglected, chronicity and multiplicity of abuse increased by one unit, the level of mental health decreased by 21.4%(OR=2.14, 95% CI: 1.49-2.83, P=0.001)、34.2%(OR=3.42, 95% CI: 1.53-4.26, P < 0.001)、17.8%(OR=1.78, 95% CI: 1.36-2.41, P=0.001)、25.4%(OR=2.54, 95% CI: 1.68-2.93, P < 0.001) and 13.7%(OR=1.37, 95% CI: 1.15-2.37, P=0.001), respectively. After social support variables were added, the negative impact coefficient of abuse on mental health decreased. However, it had no statistical significance among the male elderly. Subjective support had greater moderating effect than objective support. Conclusions Abuse is a risk factor for mental health among the elderly. High level of social support can reduce the negative impact of abuse on the mental health among female elderly. -
Key words:
- Elder abuse /
- Mental health /
- Social support /
- Modifying effect
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表 1 老年人受虐待和心理健康的状况[n(%)]
Table 1. abuse and mental health of the elderly [n(%)]
变量 全部样本
(n=1 418)男性
(n=598)女性
(n=820)t/χ2值 P值 虐待经历 是 467(32.9) 190(40.7) 277(59.3) 18.67 0.003 否 951(67.1) 408(42.9) 543(57.1) 虐待的形式 身体虐待 是 102(7.2) 43(41.7) 59(58.3) 14.35 0.364 否 1 316(92.8) 555(42.2) 761(57.8) 精神虐待 是 332(23.4) 118(35.5) 214(64.5) 21.92 0.012 否 1 086(76.6) 480(44.2) 606(55.8) 经济虐待 是 139(9.8) 83(59.6) 56(40.4) 12.63 0.684 否 1 279(80.2) 515(40.3) 764(59.7) 照料忽视 是 230(16.2) 93(40.6) 137(59.4) 17.81 0.002 否 1 188(83.8) 505(38.8) 683(61.2) 虐待长期性 没有 971(68.5) 406(41.8) 565(58.2) 24.93 0.005 低度长期性 267(18.8) 111(41.6) 156(58.4) 高度长期性 180(12.7) 81(45.0) 99(55.0) 虐待长期性(x) 15.2 14.8 15.4 7.96 0.014 虐待多重性(次) 无 951(67.1) 408(42.9) 543(57.1) 19.54 0.021 1 37(2.6) 14(37.8) 23(62.2) 2 98(6.9) 40(40.5) 58(59.5) 3~4 332(23.4) 136(40.9) 196(59.1) 心理健康 有问题 540(38.1) 209(38.7) 331(62.3) 13.82 0.001 没有问题 878(61.9) 389(44.3) 489(55.7) 抑郁(x±s) 2.74±0.45 2.52±0.14 2.96±0.13 6.51 0.002 焦虑(x±s) 2.65±0.36 2.58±0.35 2.72±0.27 13.84 0.016 精神病性(x±s) 2.42±0.63 2.31±0.47 2.53±0.46 8.65 0.003 心理健康(x±s) 2.6±0.41 2.45±0.18 2.74±0.86 11.43 0.001 
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表 2 老年人虐待和心理健康的交叉分析[n(%)]
Table 2. Cross analysis of elder abuse and mental health [n(%)]
变量 全部样本(n=1 418) 男性(n=598) 女性(n=820) 有虐待
467(32.9)无虐待
951(67.1)χ2值 有虐待
190(40.7)无虐待
408(42.9)χ2值 有虐待
277(59.3)无虐待
543(57.1)χ2值 抑郁 有 115(24.6) 146(15.4) 10.45b 41(21.3) 67(16.4) 29.47c 81(29.4) 72(13.2) 25.83b 无 352(75.4) 805(84.6) 149(78.7) 341(83.6) 196(70.6) 471(86.8) 焦虑 有 101(21.7) 151(15.9) 14.91c 33(17.3) 58(14.2) 18.93b 71(25.8) 85(15.6) 16.52b 无 366(78.3) 800(84.1) 157(72.7) 350(75.8) 206(74.2) 458(84.4) 精神病性 有 90(19.3) 131(13.8) 13.74b 29(15.4) 40(9.8) 11.38b 68(24.6) 66(12.1) 13.18b 无 377(80.7) 820(86.2) 161(74.6) 368(90.2) 209(75.4) 477(77.9) 心理健康 有 99(21.2) 160(16.8) 23.95c 33(17.3) 47(11.6) 27.13c 91(32.8) 67(12.4) 30.62c 无 368(78.8) 791(83.2) 157(82.7) 361(88.4) 186(67.2) 476 (87.6) 注：aP < 0.05，bP < 0.01，cP < 0.001。
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表 3 老年人虐待和心理健康的Logistic回归模型
Table 3. Logistic regression model of elder abuse and mental health
变量 全部样本 女性 男性 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 性别 男 1.00 女 1.62(1.35~2.42) 0.034 年收入(元) < 5000 1.00 1.00 1.00 5000~ 0.81(0.63~0.92) 0.015 0.67(0.53~0.85) 0.014 0.78(0.73~2.29) 0.212 ≥10000 0.56(0.31~0.67) 0.025 0.54(0.35~0.62) 0.011 0.58(0.46~0.92) 0.016 受教育程度 不识字 1.00 1.00 1.00 小学 0.64(0.49~0.88) 0.004 0.72(0.58~0.95) 0.036 0.77(0.59~0.91) 0.023 初中及以上 0.58(0.43~0.82) 0.001 0.63(0.51~0.92) 0.019 0.68(0.53~0.94) 0.004 自评健康 好 1.00 1.00 1.00 一般 1.63(1.46~2.82) 0.018 1.85(1.41~2.72) 0.015 1.84(1.42~2.77) 0.032 差 2.21(1.53~3.15) 0.004 2.56(1.58~3.57) 0.002 2.48(1.53~2.89) 0.003 生活照料 不需要 1.00 1.00 1.00 需要 1.48(1.13~1.85) 0.003 2.32(1.51, 2.34) 0.001 2.14(1.53, 2.35) 0.002 虐待经历 否 1.00 1.00 1.00 是 2.14(1.49~2.83) 0.001 2.26(1.36~2.84) 0.001 2.03(1.49~2.68) 0.003 虐待形式 身体虐待 否 1.00 1.00 1.00 是 1.84(1.51~2.42) 0.028 1.91(1.84~2.45) 0.003 1.81(1.63~2.37) 0.026 精神虐待 否 1.00 1.00 1.00 是 3.42(1.53~4.26) < 0.001 3.53(1.46~4.38) < 0.001 3.35(1.87~4.03) 0.002 照料忽视 否 1.00 1.00 1.00 是 1.78(1.36~2.41) 0.001 1.64(1.32~2.38) < 0.001 1.46(1.06~2.32) 0.004 虐待长期性 低/没有 1.00 1.00 1.00 高 2.54(1.68~2.93) < 0.001 2.42(1.51~2.87) < 0.001 2.64(1.53~2.81) 0.001 虐待多重性(种) 1 1.00 1.00 1.00 2 1.37(1.15~2.37) 0.001 1.45(1.32~2.53) 0.002 1.38(1.15~2.66) 0.006 3~4 2.04(1.49~2.36) < 0.001 3.35(1.83~3.71) < 0.001 2.03(1.58~2.48) 0.001
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表 4 社会支持在老年人虐待与心理健康关系中的调节效应
Table 4. The modifying effect of social support in the relationship between elder abuse and mental health
虐待变量 全部样本 男性 女性 交互前 交互后 交互前 交互后 交互前 交互后 PE±SE P值 PE±SE P值 PE±SE P值 PE±SE P值 PE±SE P值 PE±SE P值 虐待经历 1.51±0.36 0.012 0.65±0.15 0.591 1.81±0.22 0.002 0.51±0.18 0.591 0.93±0.51 0.001 0.32±0.24 0.001 身体虐待 1.07±0.28 0.025 0.43±0.22 0.415 0.94±0.36 0.032 0.47±0.26 0.612 1.12±0.43 0.022 0.56±0.31 0.004 精神虐待 1.73±0.45 0.001 0.74±0.35 0.053 1.47±0.21 0.001 0.36±0.18 0.014 1.34±0.35 0.001 0.49±0.28 0.015 经济虐待 1.66±0.54 0.258 0.92±0.28 0.541 1.79±0.45 0.258 0.53±0.26 0.723 0.83±0.42 0.002 0.34±0.21 0.021 照料忽视 1.45±0.34 0.003 0.53±0.15 0.246 1.58±0.27 0.013 0.36±0.12 0.263 1.63±0.35 0.001 0.58±0.27 0.003 虐待长期性 1.63±0.44 0.001 0.51±0.14 0.004 1.88±0.12 0.002 0.24±0.09 0.384 1.47±0.14 0.003 0.35±0.11 0.001 虐待多重性 1.75±0.68 0.001 0.83±0.25 0.011 1.32±0.16 0.001 0.12±0.06 0.571 1.52±0.24 0.001 0.66±0.19 0.004 注：PE：Parameter Estimate参数估计；SE：Standard Error标准误；交互项：虐待变量、社会支持。
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表 5 社会支持类型在老年人虐待和心理健康关系的调节效应
Table 5. The modifying effect of social support type in the relationship between elder abuse and mental health
社会支持变量 全体样本 男性 女性 PE±SE P值 PE±SE P值 PE±SE P值 总体支持 -0.38±0.12 0.432 -0.36±0.18 0.593 -0.63±0.21 0.501 客观支持 0.41±0.16 0.003 -0.47±0.23 0.371 0.55±0.23 0.002 主观支持 -0.25±0.06 0.673 0.37±0.24 0.733 0.34±0.16 0.223 支持利用度 -0.32±0.13 0.025 -0.53±0.15 0.469 0.47±0.39 0.041 注：PE：Parameter Estimate参数估计；SE：Standard Error标准误。
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