沈阳市居民健康状况及其影响因素分析
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摘要
前言
随着医学模式的转变以及对病因研究的不断深入，人们发现对健康的评定不能仅限于躯体健康水平。目前很多研究都证明了心理、社会因素与健康有着极为密切的关系，如Baum A和Posluszny DM的研究就表明，应激和其他情绪反应能影响机体维持健康、抵御或克服疾病的能力。应激和情绪由神经、内分泌和免疫系统来调节，并对其他系统和主要的健康相关行为施加有力的影响，而且可能与癌症、HIV、心血管疾病以及其他疾病的发生和发展有重要联系。现在普遍的观点认为社会支持能通过为应激事件的有害作用提供一个“缓冲系统”而减少患精神疾病的危险性。而本实验就是要从生理、心理和社会三方面对个体的健康进行评价，并分析可能存在的影响健康的因素，这些结果可为市卫生部门制定卫生保健政策和疾病防治措施提供有价值的参考资料。
对象与方法
1、对象
选取沈阳市年满18岁以上的成年人。首先将沈阳市内五区的居民小区按高、中、低档分为三个层次，每个层次随机抽取3个社区，每个社区再随机抽取50户，共计5703例。
2、方法
2．1评定工具：本实验采用许军等编制的《自测健康评定量表(SRHMS)》进行自我健康评定。
2．2调查方法：本次研究首先由专业人员对调查员进行集中培训，再由调查员进行入户调查。培训要求调查员向被调查者说明量表的填写方法，让被调查者按过去四周的实际情况，根据自己
对条目的理解，独立地进行自我评定。
2.3统计方法:所有数据输人计算机，使用SPSS10.0软件包
进行统计分析。
结果
1、男女两组在生理健康、心理健康、社会健康三个子量表分及
总分上都存在非常显著的差异(P<0.01)。且各项分数男性均
高于女性。相邻年龄组除40一49和50一59两年龄组间心理、社
会健康子量表分和总分无显著差异外(P>0.05)，其他相邻年龄
组间各项均存在非常显著的差异(P<0.01)。其中各项最高分
均出现在18一29岁年龄组，最低分均出现在70岁以上的年龄组。
2、数据经肠gistic回归分析后显示:对于健康有影响的因素包
括:文化程度、有无职业、婚姻状况、政治面貌、生活经历、饮酒习
惯、有无疾病、职务分层、年龄、工作时间、音乐时间、人均收人、做
家务时间。
讨论
一、健康状况分析
1、健康状况的性别差异
从本实验的调查结果来看，男女之间在各子量表分及总分上
均存在着非常显著的差异，男性在各子量表分和总分上均高于女
性，这种两性差别相关障碍可能来自于给男女两性以不同的角色
期望并给女性以更大压力的社会化过程，比如女性在择业过程中
遇到的差别对待，与男性相比较难以得到升迁机会，以及女性在工
作的同时还要兼顾家庭等。美国1987年和澳大利亚1992年的调
查表明女性常见病和症状的患有率高于男性。这种男女之间健康
水平的差异也可能与社会支持有关，男性倾向于比女性有更广阔
的社会支持网络，但与男性相比女性拥有更亲密的更强有力的支
持，而且，在我国男性一般担当着一家之主的角色，与女性相比拥
有较高的地位及收人，而后两者在我们的研究中均表明是健康的
保护因素，因此，与女性相比他们容易拥有较高的健康水平。
2、健康状况的年龄差异
各子量表分和总分在相邻各年龄组之间，除40一49岁与50
一59岁两个年龄组之间的心理健康子量表分、社会健康子量表
分、总体健康得分无显著差异外，其他均有非常显著的差异。在
18一29岁年龄组各子量表分和总体健康得分均明显高于其他年
龄组，随着年龄的增长，各项分数均逐渐下降，但在40一49岁年龄
组却出现心理健康子量表分低于50一59岁年龄组的情况，而社会
健康子量表分和健康总分只稍稍高于后者，无统计学意义，考虑可
能与这组人生活负担较重，也有可能与这组人多处于更年期，情绪
较易波动、不稳定有关;而18一29岁年龄组可能由于生活负担较
轻，经历的生活事件较少，对未来仍充满憧憬，生活态度较积极，因
此，各项评分均较高。随着年龄的增长，生理机能逐渐衰退，表现
为生理健康子量表分数的逐渐下降;衰老后所面临的一个主要变
化是退休，退休和其他一些相应的改变是不能随意选择的。对多
数人而言，职业生涯的结束是对他们身份的打击，感觉迷失了生活
的目标和方向，对自我价值的评价也有所下降。而衰老也会带来
社会关系上的很多变化，包括与同事、家庭成员和配偶关系的变
化，生活圈子渐渐变小，社会网络支持系统也就随之发生了变化。
Heidrich SM等研究的多因素回归分析显示老龄与较低水平的生
活目标、个人成长、以及积极人际关系有关，低水平的健康状况，不
论年纪大小，均与更高的抑郁和焦虑水平、更低的积极的人际关系
和自主性有关。而且老年人在轻度偏执、抑郁、疑病上都有轻微的
上升趋势。偏执没有达到典型的临床比率，但抑郁能达到严重的
程度，包括严重抑郁的发生。这些因素都可能是导致评分下降的
原因。
二、社会健康子量表、心理健康子量表及总体健康量表分的
bgisti。回归分析结果:
1、文化程度、人均
Introduction
With the change of medicine model, people find that it can not be limited in physical health on health rating. Many of the current research indicated that psychosocial factors were significantly associated with health. For example, Baum A and Posluszny DM' study addressed that, Stress and other emotional responses were components of complex interactions of genetic, physiological, behavioral, and environmental factors that affected the body's ability to remain or become healthy or to resist or overcome disease. Regulated by nervous, endocrine , and immune systems, and exerting powerful influence on other bodily systems and key health - relevant behaviors, stress and emotion appeared to have important implications for the initiation or progression of cancer, HIV, cardiovascular disease, and other illnesses. Several authors have suggested that social support reduces the risk of psychiatric disorder by providing a " buffer" against the adverse effects of stressful events. Others have proposed, in contrast, that
social support was beneficial irrespective of life stress. Our study just rated health from biological, psychological and social point, and analyzed the possible factor that could influence health. The results of the study can provide the government health department some valuable information in making the health promoting decision and making practices for disease prevention and treatment.
Subjects and methods
1. Sample
We selected Shenyang citizens who were 18 years or older as our subjects. First we compartmentalized administrative level as best, middle, worst according the community's condition; then, randomly selected three communities from every administrative level; last, we randomly selected 50 families from every community. That summed to 5703 cases.
2. Methods
2. 1 Measuring Instruments; We selected the Self - reted Health Measurement Scale made by Xu Jun as our health rating scale.
2. 2 Methods.- First the professional worker of psychological measurement trained the investigators, then, the investigators did the investigation. At the beginning of the investigation, the investigators should tell the informants of the rules for completing the scale, then let the informants complete the scale all by themselves according their own understanding of the scale and their real situation of the past 4 weeks.
2. 3 Statistical analysis:
All the data were input into computer and analyzed the data with SPSS 10.0 for windows.
Results
1. There were significant differences between male and female in all three subscales scores and the whole scale score(P <0.01), and male got higher scores than female in every subscales and the whole scale. There were significant differences between connected age
group, expect the social subscale score, the psychological subscale score and the whole scale score of the 40 - 49 age group and the 50 -59 age group which had no significant differences between them. All the highest scores were found in the 18-29 age group, and all the lowest scores were found in the more than 70 age group.
2. The regressive analysis indicated that, the factors that could influence health status were educational level, occupation, marital status, political status, life events, alcohol use, physical disease, age, work time, music time, income, house - work time.
Discussion
1. Analysis of the health status
1. 1 Sex differences in health status
According to our study, there were significant differences in ever-y subscale score and the whole scale score between male and female, and male got higher scores in three subscales and the whole scale than female. This sex related differences maybe come from the different role expectation exerted on male and female, and the socialization progress which bringing female with heavier stress. For example, female encountered the sex differential treatment in finding job, and had more difficulties in getting promotion, and took care the family as well as work. Both the investigation of America in 1987 and the investiga
随着医学模式的转变以及对病因研究的不断深入，人们发现对健康的评定不能仅限于躯体健康水平。目前很多研究都证明了心理、社会因素与健康有着极为密切的关系，如Baum A和Posluszny DM的研究就表明，应激和其他情绪反应能影响机体维持健康、抵御或克服疾病的能力。应激和情绪由神经、内分泌和免疫系统来调节，并对其他系统和主要的健康相关行为施加有力的影响，而且可能与癌症、HIV、心血管疾病以及其他疾病的发生和发展有重要联系。现在普遍的观点认为社会支持能通过为应激事件的有害作用提供一个“缓冲系统”而减少患精神疾病的危险性。而本实验就是要从生理、心理和社会三方面对个体的健康进行评价，并分析可能存在的影响健康的因素，这些结果可为市卫生部门制定卫生保健政策和疾病防治措施提供有价值的参考资料。
对象与方法
1、对象
选取沈阳市年满18岁以上的成年人。首先将沈阳市内五区的居民小区按高、中、低档分为三个层次，每个层次随机抽取3个社区，每个社区再随机抽取50户，共计5703例。
2、方法
2．1评定工具：本实验采用许军等编制的《自测健康评定量表(SRHMS)》进行自我健康评定。
2．2调查方法：本次研究首先由专业人员对调查员进行集中培训，再由调查员进行入户调查。培训要求调查员向被调查者说明量表的填写方法，让被调查者按过去四周的实际情况，根据自己
对条目的理解，独立地进行自我评定。
2.3统计方法:所有数据输人计算机，使用SPSS10.0软件包
进行统计分析。
结果
1、男女两组在生理健康、心理健康、社会健康三个子量表分及
总分上都存在非常显著的差异(P<0.01)。且各项分数男性均
高于女性。相邻年龄组除40一49和50一59两年龄组间心理、社
会健康子量表分和总分无显著差异外(P>0.05)，其他相邻年龄
组间各项均存在非常显著的差异(P<0.01)。其中各项最高分
均出现在18一29岁年龄组，最低分均出现在70岁以上的年龄组。
2、数据经肠gistic回归分析后显示:对于健康有影响的因素包
括:文化程度、有无职业、婚姻状况、政治面貌、生活经历、饮酒习
惯、有无疾病、职务分层、年龄、工作时间、音乐时间、人均收人、做
家务时间。
讨论
一、健康状况分析
1、健康状况的性别差异
从本实验的调查结果来看，男女之间在各子量表分及总分上
均存在着非常显著的差异，男性在各子量表分和总分上均高于女
性，这种两性差别相关障碍可能来自于给男女两性以不同的角色
期望并给女性以更大压力的社会化过程，比如女性在择业过程中
遇到的差别对待，与男性相比较难以得到升迁机会，以及女性在工
作的同时还要兼顾家庭等。美国1987年和澳大利亚1992年的调
查表明女性常见病和症状的患有率高于男性。这种男女之间健康
水平的差异也可能与社会支持有关，男性倾向于比女性有更广阔
的社会支持网络，但与男性相比女性拥有更亲密的更强有力的支
持，而且，在我国男性一般担当着一家之主的角色，与女性相比拥
有较高的地位及收人，而后两者在我们的研究中均表明是健康的
保护因素，因此，与女性相比他们容易拥有较高的健康水平。
2、健康状况的年龄差异
各子量表分和总分在相邻各年龄组之间，除40一49岁与50
一59岁两个年龄组之间的心理健康子量表分、社会健康子量表
分、总体健康得分无显著差异外，其他均有非常显著的差异。在
18一29岁年龄组各子量表分和总体健康得分均明显高于其他年
龄组，随着年龄的增长，各项分数均逐渐下降，但在40一49岁年龄
组却出现心理健康子量表分低于50一59岁年龄组的情况，而社会
健康子量表分和健康总分只稍稍高于后者，无统计学意义，考虑可
能与这组人生活负担较重，也有可能与这组人多处于更年期，情绪
较易波动、不稳定有关;而18一29岁年龄组可能由于生活负担较
轻，经历的生活事件较少，对未来仍充满憧憬，生活态度较积极，因
此，各项评分均较高。随着年龄的增长，生理机能逐渐衰退，表现
为生理健康子量表分数的逐渐下降;衰老后所面临的一个主要变
化是退休，退休和其他一些相应的改变是不能随意选择的。对多
数人而言，职业生涯的结束是对他们身份的打击，感觉迷失了生活
的目标和方向，对自我价值的评价也有所下降。而衰老也会带来
社会关系上的很多变化，包括与同事、家庭成员和配偶关系的变
化，生活圈子渐渐变小，社会网络支持系统也就随之发生了变化。
Heidrich SM等研究的多因素回归分析显示老龄与较低水平的生
活目标、个人成长、以及积极人际关系有关，低水平的健康状况，不
论年纪大小，均与更高的抑郁和焦虑水平、更低的积极的人际关系
和自主性有关。而且老年人在轻度偏执、抑郁、疑病上都有轻微的
上升趋势。偏执没有达到典型的临床比率，但抑郁能达到严重的
程度，包括严重抑郁的发生。这些因素都可能是导致评分下降的
原因。
二、社会健康子量表、心理健康子量表及总体健康量表分的
bgisti。回归分析结果:
1、文化程度、人均
Introduction
With the change of medicine model, people find that it can not be limited in physical health on health rating. Many of the current research indicated that psychosocial factors were significantly associated with health. For example, Baum A and Posluszny DM' study addressed that, Stress and other emotional responses were components of complex interactions of genetic, physiological, behavioral, and environmental factors that affected the body's ability to remain or become healthy or to resist or overcome disease. Regulated by nervous, endocrine , and immune systems, and exerting powerful influence on other bodily systems and key health - relevant behaviors, stress and emotion appeared to have important implications for the initiation or progression of cancer, HIV, cardiovascular disease, and other illnesses. Several authors have suggested that social support reduces the risk of psychiatric disorder by providing a " buffer" against the adverse effects of stressful events. Others have proposed, in contrast, that
social support was beneficial irrespective of life stress. Our study just rated health from biological, psychological and social point, and analyzed the possible factor that could influence health. The results of the study can provide the government health department some valuable information in making the health promoting decision and making practices for disease prevention and treatment.
Subjects and methods
1. Sample
We selected Shenyang citizens who were 18 years or older as our subjects. First we compartmentalized administrative level as best, middle, worst according the community's condition; then, randomly selected three communities from every administrative level; last, we randomly selected 50 families from every community. That summed to 5703 cases.
2. Methods
2. 1 Measuring Instruments; We selected the Self - reted Health Measurement Scale made by Xu Jun as our health rating scale.
2. 2 Methods.- First the professional worker of psychological measurement trained the investigators, then, the investigators did the investigation. At the beginning of the investigation, the investigators should tell the informants of the rules for completing the scale, then let the informants complete the scale all by themselves according their own understanding of the scale and their real situation of the past 4 weeks.
2. 3 Statistical analysis:
All the data were input into computer and analyzed the data with SPSS 10.0 for windows.
Results
1. There were significant differences between male and female in all three subscales scores and the whole scale score(P <0.01), and male got higher scores than female in every subscales and the whole scale. There were significant differences between connected age
group, expect the social subscale score, the psychological subscale score and the whole scale score of the 40 - 49 age group and the 50 -59 age group which had no significant differences between them. All the highest scores were found in the 18-29 age group, and all the lowest scores were found in the more than 70 age group.
2. The regressive analysis indicated that, the factors that could influence health status were educational level, occupation, marital status, political status, life events, alcohol use, physical disease, age, work time, music time, income, house - work time.
Discussion
1. Analysis of the health status
1. 1 Sex differences in health status
According to our study, there were significant differences in ever-y subscale score and the whole scale score between male and female, and male got higher scores in three subscales and the whole scale than female. This sex related differences maybe come from the different role expectation exerted on male and female, and the socialization progress which bringing female with heavier stress. For example, female encountered the sex differential treatment in finding job, and had more difficulties in getting promotion, and took care the family as well as work. Both the investigation of America in 1987 and the investiga
引文
1. Cohen S, Herbert TB. Health psychology: psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu Rev Psychol, 1996; 47:113-42.
2. Baum A, Posluszny DM. Health psychology: mapping biobehavioral contributions to health and illness. Annu Rev Psychol, 1999 ;50:137-63.
3. Sehneiderman N, Antoni MH, Saab PG, et al. Health psychology: psychosocial and biobehavioral aspects of chronic disease management. Annu Rev Psyehol, 2001; 52:555-80.
4. Parry G, Shapiro DA. Social support and life events in working class women. Stress buffering or independent effects? Arch Gen Psychiatry, 1986 Apr;43(4):315-23.
5．许军，自测健康评定量表(SRHMS)，《心理卫生评定量表手册》，1999，35-45。
6．许军，贾旭，洪军等，自测健康评定量表对康复科患者的健康评价。中国疾病控制杂志，2000，4(2)：124-126．
7．王启源，许军，黄靖康等，住院精神分裂症患者自测健康的对照研究。《中国行为医学科学》，2001；10(2)：113-114。
8. Donald M, Dower J. Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults. Aust N Z J Public Health 2002 Dec; 26(6):555-62.
9. Hann D, Baker F, Denniston M, et al. The influence of social support on depressive symptoms in cancer patients: age and gender differences. J Psychosom Res, 2002 May; 52(5): 279-83.
10. Lara ME, Leader J, Klein DN. The association between social
support and course of depression: is it confounded with personality? J Abnorm Psychol, 1997 Aug; 106(3) :478-82．
11． Phillip L. Rice (Health Psychology) ,2000,84．
12． Phillip L. Rice (Health Psychology) ,2000,67．
13． Mathers C. Health Differentials Among Adult Australians Aged 25-64 Years. Australian Istitute of Health &Welfare: Health Monitoring Series NO. 1． Canberra; Australian Government Publishing Service, 1994: 19-261．
14． 金华、吴文源、张明园。中国正常人SCL-90评定结果的初步 分析。《中国神经精神疾病杂志》，1986,12(5) :260-263．
15． Heidrich SM. The relationship between physical health and psychological well-being in elderly women : a developmental perspective. Res Nurs Health ,1993 Apr; 16(2) :123-30．
16． Phillip L. Rice (Health Psychology) ,2000,366．
17． Broom D. Soc Sci Med, 1984;18(11) :909-917．
18． Sturm R, Gresenz CR. Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. BMJ 2002 Jan 5 ;324 (7328) :20-3 .
19． Phillip L. Rice (Health Psychology) ,2000,68．
20． Costello EJ. Married with children: predictors of mental and physical health in middle-aged women. Psychiatry ,1991 Aug; 54(3) :292-305．
21． Phillip L. Rice (Health Psychology) ,2000,85．
22． OHare T. Alcohol consumption and presenting problems in an out-patient mental health clinic. Addict Behav 1993 Jan-Feb;18 (1) :57-65．
2. Baum A, Posluszny DM. Health psychology: mapping biobehavioral contributions to health and illness. Annu Rev Psychol, 1999 ;50:137-63.
3. Sehneiderman N, Antoni MH, Saab PG, et al. Health psychology: psychosocial and biobehavioral aspects of chronic disease management. Annu Rev Psyehol, 2001; 52:555-80.
4. Parry G, Shapiro DA. Social support and life events in working class women. Stress buffering or independent effects? Arch Gen Psychiatry, 1986 Apr;43(4):315-23.
5．许军，自测健康评定量表(SRHMS)，《心理卫生评定量表手册》，1999，35-45。
6．许军，贾旭，洪军等，自测健康评定量表对康复科患者的健康评价。中国疾病控制杂志，2000，4(2)：124-126．
7．王启源，许军，黄靖康等，住院精神分裂症患者自测健康的对照研究。《中国行为医学科学》，2001；10(2)：113-114。
8. Donald M, Dower J. Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults. Aust N Z J Public Health 2002 Dec; 26(6):555-62.
9. Hann D, Baker F, Denniston M, et al. The influence of social support on depressive symptoms in cancer patients: age and gender differences. J Psychosom Res, 2002 May; 52(5): 279-83.
10. Lara ME, Leader J, Klein DN. The association between social
support and course of depression: is it confounded with personality? J Abnorm Psychol, 1997 Aug; 106(3) :478-82．
11． Phillip L. Rice (Health Psychology) ,2000,84．
12． Phillip L. Rice (Health Psychology) ,2000,67．
13． Mathers C. Health Differentials Among Adult Australians Aged 25-64 Years. Australian Istitute of Health &Welfare: Health Monitoring Series NO. 1． Canberra; Australian Government Publishing Service, 1994: 19-261．
14． 金华、吴文源、张明园。中国正常人SCL-90评定结果的初步 分析。《中国神经精神疾病杂志》，1986,12(5) :260-263．
15． Heidrich SM. The relationship between physical health and psychological well-being in elderly women : a developmental perspective. Res Nurs Health ,1993 Apr; 16(2) :123-30．
16． Phillip L. Rice (Health Psychology) ,2000,366．
17． Broom D. Soc Sci Med, 1984;18(11) :909-917．
18． Sturm R, Gresenz CR. Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. BMJ 2002 Jan 5 ;324 (7328) :20-3 .
19． Phillip L. Rice (Health Psychology) ,2000,68．
20． Costello EJ. Married with children: predictors of mental and physical health in middle-aged women. Psychiatry ,1991 Aug; 54(3) :292-305．
21． Phillip L. Rice (Health Psychology) ,2000,85．
22． OHare T. Alcohol consumption and presenting problems in an out-patient mental health clinic. Addict Behav 1993 Jan-Feb;18 (1) :57-65．