浏阳市农村社区老年人抑郁症状发生率及其影响因素研究
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摘要
目的:了解湖南省浏阳市农村社区60岁及以上老年人中抑郁症状的发生率及分布特征,探讨促使抑郁症状发生的危险因素,为制定社区老年抑郁症状及抑郁症的防治及干预措施提供科学的依据。
方法:采用多级分层整群随机抽样的方法,首先根据上一年人均年收入将浏阳市36个乡镇分为经济状况好、中、差三层,从每层中各选择1个乡镇为研究现场,再从每个乡镇的所有行政村中各随机抽取6个行政村,每个村随机抽取2个村民小组,以36个村民小组的所有符合条件的老年人为理论样本,对符合条件的老年人进行一般情况、自评状况(包括自评经济状况、自评健康状况、自评在家庭中的地位)、老年抑郁量表(Geriatric Depression Scale,GDS)、社会支持评定量表(Social Support Rating Scale,SSRS)、日常生活能力(Activities of Daily Living,ADL)和老年人生活事件量表(Life EventsScale for the Elderly,LESE)等内容的调查。
结果:36个村民小组共有475名60岁及以上老年人,其中符合调查条件的有446人,实际访谈到413人,应答率92.6%,有效样本412人,资料有效率99.7%。
412名老年人过去一周内30条抑郁症状的发生率从11.7%到89.1%不等(标化发生率为10.8%-85.1%),标化发生率最高的五条症状依次为“记忆力比以前差”(85.1%)、“开始一件新的工作很困难”(73.6%)、“头脑像往常一样清晰”(67.0%)、“觉得大多数人比自己强得多”(62.4%)、“希望呆在家里而不愿去做些新鲜事”(54.2%)。
发生抑郁症状的总数范围为0-30条,中位数为12.0±12.0条。按GDS抑郁水平的划分标准,47.5%的老年人无抑郁(0-10分),35.2%可能有轻度抑郁(11-20分),17.3%可能有中重度抑郁(21-30分)。
单因素Ordinal回归分析显示女性、高龄、农村户口、婚姻状况不稳定、靠他人负担生活、自评经济状况差、自评健康状况差、在家庭中的地位低、获得的社会支持少、日常生活能力有障碍、承受的负性生活事件刺激量大是促使抑郁症状发生的危险因素。
将上述因素同时纳入多因素Ordinal回归模型,结果显示对抑郁水平的影响有统计学意义的因素为女性(OR=2.565,95%CI:1.598-4.121)、自评经济状况差(OR=2.138,95%CI:1.465-3.117)、自评健康状况差(OR=1.972,95%CI:1.480-2.627)、在家庭中的地位低(OR=1.682,95%CI:1.165-2.425)、获得的社会支持少(OR=2.835,95%CI:1.826-4.402)、日常生活能力有障碍(OR=2.983,95%CI:1.605-5.546)、承受的负性生活事件刺激量大(OR=3.277,95%CI:2.042-5.259)。
路径分析结果显示社会支持是日常生活能力、负性生活事件与抑郁症状之间相互作用的中介变量。
结论:浏阳市农村社区老年人中抑郁症状发生率较高,分布特征各异;抑郁症状的发生受多种因素影响。农村社区老年人的心理健康问题应引起足够的重视,应加强对农村社区老年人的心理健康指导,对抑郁症状多的老年人及时进行干预和抑郁症诊断。
Objective: To assess the depressive symptoms of rural community-dwelling elderly in Liuyang County, Hunan Province, and find out associated factors. The results would provide scientific basis for the primaiy and secondary prevention of late-life depressive disorder.
Methods: We selected the subjects through a multistage stratified cluster sampling procedure. First, all the thirty-six towns of Liuyang County were stratified into three levels according to economic status and one were selected as survey fields from each economic level. And then we randomly selected six villages from each town, so there were eighteen villages. At last, tow groups were chosen randomly from each village. So, all the 60 years old and older, namely bora before May 31,1947, from the thirty-six groups made up our sample in the abstract. Socio-demographic characteristics, Geriatric Depression Scale (GDS), Social Support Rating Scale (SSRS), Activities of Daily Living (ADL) and Life Events Scale for the Elderly (LESE) were administered.
The elderly in this study included those local residents and those who had been living in the locality more than six months continuously. Those who met one of the criteria as follows were not included: first, living in institutions such as hospital and nursing homes during the survey time; second, those local residents who left for more than six months; third, and those local residents who left for no more than six months but would not come back in the survey period. Those who had impaired cognitive, disturbance conscious and serious illness were excluded.
Results: There were 475 elderly people aged 60 years and older in the thirty-six groups, of which 446 were identified as our sample. 413 were investigated; the response rate was 92.6%. Except one person, all the 412 had completed information.
The prevalence of the 30 depressive symptoms assessed by GDS ranged from 11.7% to 89.1% (weighted prevalence: 10.8%-85.1%). The five most prevalent depressive symptoms were "problem with memory" (85.1%), "hard to start new projects" (73.6%), "mind as clear as used to be"(67.0%), "others are better off" (62.4%)and "prefer to stay home"(54.2%).
The scores of GDS ranged from 0 to 30 with a median of 12.0 (QR=12.0). Using the normative score ranges for the 30-item GDS of "normal" (0-10), "mild depression" (11-20), and "moderate to severe depression" (21-30), these results indicated that 35.2% of the total sample having mild depression while 17.3% having moderate to severe depression.
Increasing age, female, rural residents, marriage instability, depending on others for living, self-rated lower economic status, lower health status, lower status in the family, getting few social support, impaired activities of daily living and bearing more stress from negative life events were associated with higher risk of depression in univariate ordinal regression models. But some associations disappeared after all the risk factors were considered together in the multi-regression model. The remaining risk factors included female(OR=2.565, 95%CI: 1.598-4.121), self-rated lower economic status(OR=2.138, 95%CI: 1.465-3.117), self-rated lower health status(OR=1.972, 95%CI: 1.480-2.627), self-rated lower status in the family(OR=1.682, 95%CI: 1.165-2.425), getting few social support(OR=2.835, 95%CI: 1.826-4.402), impaired activities of daily living(OR=2.983, 95%CI: 1.605-5.546) and bearing more stress from negative life events(OR=3.277, 95%CI: 2.042-5.259).Path analysis identified that social support could play a role as an intervening variable in the relationships between activities of daily living and depressive symptoms, negative life events and depressive symptoms.
Conclusion: Prevalence of depressive symptoms in the Liuyang rural community-dwelling elderly was quite high, and prevalence in people with different socio-demographic characteristics was quite different. Depressive symptoms were affected by several factors as stated above. More attention should be paid on the issue of depression in rural community-dwelling elderly. Older people with more depressive symptoms should be transferred and diagnosed in time.
方法:采用多级分层整群随机抽样的方法,首先根据上一年人均年收入将浏阳市36个乡镇分为经济状况好、中、差三层,从每层中各选择1个乡镇为研究现场,再从每个乡镇的所有行政村中各随机抽取6个行政村,每个村随机抽取2个村民小组,以36个村民小组的所有符合条件的老年人为理论样本,对符合条件的老年人进行一般情况、自评状况(包括自评经济状况、自评健康状况、自评在家庭中的地位)、老年抑郁量表(Geriatric Depression Scale,GDS)、社会支持评定量表(Social Support Rating Scale,SSRS)、日常生活能力(Activities of Daily Living,ADL)和老年人生活事件量表(Life EventsScale for the Elderly,LESE)等内容的调查。
结果:36个村民小组共有475名60岁及以上老年人,其中符合调查条件的有446人,实际访谈到413人,应答率92.6%,有效样本412人,资料有效率99.7%。
412名老年人过去一周内30条抑郁症状的发生率从11.7%到89.1%不等(标化发生率为10.8%-85.1%),标化发生率最高的五条症状依次为“记忆力比以前差”(85.1%)、“开始一件新的工作很困难”(73.6%)、“头脑像往常一样清晰”(67.0%)、“觉得大多数人比自己强得多”(62.4%)、“希望呆在家里而不愿去做些新鲜事”(54.2%)。
发生抑郁症状的总数范围为0-30条,中位数为12.0±12.0条。按GDS抑郁水平的划分标准,47.5%的老年人无抑郁(0-10分),35.2%可能有轻度抑郁(11-20分),17.3%可能有中重度抑郁(21-30分)。
单因素Ordinal回归分析显示女性、高龄、农村户口、婚姻状况不稳定、靠他人负担生活、自评经济状况差、自评健康状况差、在家庭中的地位低、获得的社会支持少、日常生活能力有障碍、承受的负性生活事件刺激量大是促使抑郁症状发生的危险因素。
将上述因素同时纳入多因素Ordinal回归模型,结果显示对抑郁水平的影响有统计学意义的因素为女性(OR=2.565,95%CI:1.598-4.121)、自评经济状况差(OR=2.138,95%CI:1.465-3.117)、自评健康状况差(OR=1.972,95%CI:1.480-2.627)、在家庭中的地位低(OR=1.682,95%CI:1.165-2.425)、获得的社会支持少(OR=2.835,95%CI:1.826-4.402)、日常生活能力有障碍(OR=2.983,95%CI:1.605-5.546)、承受的负性生活事件刺激量大(OR=3.277,95%CI:2.042-5.259)。
路径分析结果显示社会支持是日常生活能力、负性生活事件与抑郁症状之间相互作用的中介变量。
结论:浏阳市农村社区老年人中抑郁症状发生率较高,分布特征各异;抑郁症状的发生受多种因素影响。农村社区老年人的心理健康问题应引起足够的重视,应加强对农村社区老年人的心理健康指导,对抑郁症状多的老年人及时进行干预和抑郁症诊断。
Objective: To assess the depressive symptoms of rural community-dwelling elderly in Liuyang County, Hunan Province, and find out associated factors. The results would provide scientific basis for the primaiy and secondary prevention of late-life depressive disorder.
Methods: We selected the subjects through a multistage stratified cluster sampling procedure. First, all the thirty-six towns of Liuyang County were stratified into three levels according to economic status and one were selected as survey fields from each economic level. And then we randomly selected six villages from each town, so there were eighteen villages. At last, tow groups were chosen randomly from each village. So, all the 60 years old and older, namely bora before May 31,1947, from the thirty-six groups made up our sample in the abstract. Socio-demographic characteristics, Geriatric Depression Scale (GDS), Social Support Rating Scale (SSRS), Activities of Daily Living (ADL) and Life Events Scale for the Elderly (LESE) were administered.
The elderly in this study included those local residents and those who had been living in the locality more than six months continuously. Those who met one of the criteria as follows were not included: first, living in institutions such as hospital and nursing homes during the survey time; second, those local residents who left for more than six months; third, and those local residents who left for no more than six months but would not come back in the survey period. Those who had impaired cognitive, disturbance conscious and serious illness were excluded.
Results: There were 475 elderly people aged 60 years and older in the thirty-six groups, of which 446 were identified as our sample. 413 were investigated; the response rate was 92.6%. Except one person, all the 412 had completed information.
The prevalence of the 30 depressive symptoms assessed by GDS ranged from 11.7% to 89.1% (weighted prevalence: 10.8%-85.1%). The five most prevalent depressive symptoms were "problem with memory" (85.1%), "hard to start new projects" (73.6%), "mind as clear as used to be"(67.0%), "others are better off" (62.4%)and "prefer to stay home"(54.2%).
The scores of GDS ranged from 0 to 30 with a median of 12.0 (QR=12.0). Using the normative score ranges for the 30-item GDS of "normal" (0-10), "mild depression" (11-20), and "moderate to severe depression" (21-30), these results indicated that 35.2% of the total sample having mild depression while 17.3% having moderate to severe depression.
Increasing age, female, rural residents, marriage instability, depending on others for living, self-rated lower economic status, lower health status, lower status in the family, getting few social support, impaired activities of daily living and bearing more stress from negative life events were associated with higher risk of depression in univariate ordinal regression models. But some associations disappeared after all the risk factors were considered together in the multi-regression model. The remaining risk factors included female(OR=2.565, 95%CI: 1.598-4.121), self-rated lower economic status(OR=2.138, 95%CI: 1.465-3.117), self-rated lower health status(OR=1.972, 95%CI: 1.480-2.627), self-rated lower status in the family(OR=1.682, 95%CI: 1.165-2.425), getting few social support(OR=2.835, 95%CI: 1.826-4.402), impaired activities of daily living(OR=2.983, 95%CI: 1.605-5.546) and bearing more stress from negative life events(OR=3.277, 95%CI: 2.042-5.259).Path analysis identified that social support could play a role as an intervening variable in the relationships between activities of daily living and depressive symptoms, negative life events and depressive symptoms.
Conclusion: Prevalence of depressive symptoms in the Liuyang rural community-dwelling elderly was quite high, and prevalence in people with different socio-demographic characteristics was quite different. Depressive symptoms were affected by several factors as stated above. More attention should be paid on the issue of depression in rural community-dwelling elderly. Older people with more depressive symptoms should be transferred and diagnosed in time.
引文
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