【作者】 王春萍；

【导师】 王束玫；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2013， 硕士

【摘要】 研究背景孝文化,即子女奉养父母,是中华民族的优良传统,它反映了中国人特有的代际情感模式。这种以孝文化为传统的赡养方式,两千多年来一直由家庭直接承担,早已在国人的思维中根深蒂固。“养儿防老”、“家有一老如有一宝”、“父母在,不远游”、“百善孝为先”等都是孝道伦理的集中体现,长期积淀形成了中国“家庭养老”的传统模式。家庭养老是由家庭成员,主要靠子女承担养老责任,提供包括经济供养、生活照料、医疗保健和精神慰藉等方面的养老资源。老年阶段作为人生的最终阶段,是一个要求有针对性照料与护理的阶段。老年人的心理与情感需求也会随着年龄的衰老而变得复杂与多变。中国目前人口的年龄结构中,80岁以上的高龄人口已成为增长速度最快的一个群体。老龄人口高龄化趋势意味着家庭和社会照料在赡养老人的人、财、物方面的支出将不断增加,人力资源配置也将会有更高的需求。同时计划生育政策和老年人口高龄化趋势也可能会导致家庭结构由“4-2-1”延伸为"8-4-2-1”。子女处于三代或四代中间,不仅承担了照顾老人的责任,而且还需照顾子女、孙子女及应付日常工作生活中的种种问题,负担沉重,长此以往,子女极易出现心理健康问题。目前国内研究主要集中在脑卒中老人、痴呆症老人及其他失能老人子女照顾者的照顾负担上,而对普通家庭养老过程中子女照顾者可能出现的心理问题却鲜有涉及。在国外,家庭养老负担对子女照顾者心理健康的影响已得到了广泛的研究。众多研究表明照顾者在照顾过程中会产生抑郁、焦虑等负面情绪,因此对子女照顾者这一人群的心理健康状况进行调查研究具有重要的意义。研究目的1.了解济南市部分社区养老人群的自评抑郁量表(SDS)得分情况及抑郁症状的严重程度。2.分析不同养老家庭中子女照顾者自评抑郁状况的主要影响因素,为有效干预措施的实施,提高社区养老人群的精神健康水平提供理论依据。研究对象和方法选取济南市青年西路社区,棋盘街社区、佛山苑社区和二七社区四个社区,年龄40岁及以上、家中有老人居住在济南市区的常住人口作为调查对象,采用抑郁自评量表(SDS)、子女照顾者一般情况调查表和老人一般情况调查表进行问卷调查。调查采取两种方式进行,一是调查员在社区工作人员引导下入户进行调查；二是在居委会指定的地点设立调查点,统一问卷调查。应用Epidata3.1软件建立数据库,导入SPSS20.0进行数据整理和分析。应用t检验、H秩和检验、方差分析、广义线性回归分析、回归树等方法分析子女照顾者自评抑郁状况的相关影响因素,P<0.05时有统计学意义。研究结果1.养老人群与非养老人群SDS得分的比较调查对象SDS得分随着自感养老负担的增加而升高,在调整了调查对象的年龄、婚姻状况、文化程度和患病数量后,自感养老负担重的调查对象SDS得分明显高于非养老人群,差异具有统计学意义(P<0.001)。2.调查对象自评抑郁症状严重程度的差异情况770例调查对象中,191人出现轻到重度抑郁症状,抑郁症状比例为24.8%。调查对象的自评抑郁症状情况主要集中在轻度,其中出现轻度、中度、重度自评抑郁症状的比例分别为17.3%、6.5%、1.0%。3.一个养老家庭的影响因素分析5个变量最终保留在广义线性模型中。调整其他变量后,调查对象的年龄为50-54岁,55-59岁,60-64岁时的SDS得分与小于50岁时相比,分别低2.68分,3.10分,4.11分；没有工作压力的SDS得分比工作压力一般的,工作压力较大的和工作压力得大的分别低3.19分,2.18分,3.71分；不患病的比患一种疾病的和患两种以上疾病的SDS得分分别低1.32分和1.97分；家中老人自理能力强的调查对象比家中老人自理能力一般和较差的调查对象SDS得分低1.52和3.20分；家中老人思维能力轻度减退,明显减退和混乱的调查对象比家中老人思维能力正常的SDS得分分别高1.59分,2.91分和6.33分。家中老人思维能力差+调查对象工作压力大和老人自理能力差+调查对象工作压力大两组人群更易于出现自评抑郁症状阳性情况。4.一个养老家庭中父母组的影响因素分析5个变量最终保留在模型中。调整其他变量后,,调查对象的年龄为50-54岁,55-59岁,60-64岁时比年龄小于50岁的调查对象SDS得分分别低2.90分,4.29分,5.26分和2.63分；工作压力一般和很大的调查对象SDS得分比无工作压力的高2.49分和5.12分；患一种疾病的调查对象SDS得分比不患病的高2.77分；家中老人自理能力水平较差的比家中老人自理能力强的调查对象SDS得分高3.07分；家中老人思维能力轻度减退和混乱的调查对象SDS得分比家中老人思维正常的高1.68分和6.49分。老人自理能力差+调查对象工作压力大和调查对象年龄小于50岁+调查对象患病两组人群可能更易于出现自评抑郁症状阳性情况。5.一个养老家庭中配偶父母组的影响因素分析3个变量最终保留在模型中。调整其他变量后,家中老人文化水平高的调查对象SDS得分比家中老人文化水平低的高4.88分；家中老人自理能力一般和较差的调查对象SDS得分比家中老人自理能力强的高2.67分和4.63分；家中老人思维能力轻度减退,明显减退和混乱的调查对象SDS得分比家中老人思维能力正常的分别高3.48分,4.36分和6.01分。家中老人思维能力差+老人文化水平高+老人自理能力差的人群可能易于出现自评抑郁症状阳性状况。6.两个养老家庭的影响因素分析当调查对象家里两个养老家庭中各有一位老人的时候和两个养老家庭中老人均健在的时候其SDS得分比家中有三个老人的时候高,差异具有统计学意义(P=0.043)。当两个养老家庭中各有一位不能完全自理的老人和家里有四位不能完全自理的老人时调查对象的SDS得分明显增高,且与其他组别之间差异异具有统计学意义(P=0.029)。结论与建议1.随着自感养老负担的加重,子女的SDS得分随之增高。调查对象中自评抑郁症状情况以轻度和中度为主,出现重度自评抑郁症状的较少。2.在照顾父母的过程中,调查对象年龄越小、患病、工作压力越大和父母自理能力较差、父母思维能力混乱都易使照顾者产生抑郁倾向;在照顾配偶的父母过程中,调查对象家中老人的文化水平越高、老人的自理能力和思维能力越差越容易使照顾者产生抑郁倾向。3.子女照顾者的年龄、工作压力、患病数量、老人的文化水平、老人的自理能力和老人的思维能力是影响子女心理健康的主要因素。我们应对主要影响因素进行针对性的干预,并寻求最佳的养老方式,既使老人积极老龄化,同时又能减轻子女照顾者的心理负担,从而提高社区养老人群的精神健康水平更多还原

【Abstract】 BackgroundCulture of filial piety, that the children take care of their own parents, is a unique culture of the Chinese nation, which reflects the Chinese people’s own intergenerational emotional patterns. The traditional way of support characterized by culture of filial piety, which has been directly undertaken by the family unit for two thousand years, is firmly entrenched in the thinking among the people."Bring their children for old age","Elders are treasures","Don’t stray far from home you’re your parents are there","Filial piety is the most important of all virtues" and so on. Filial Piety is reflected in people’s daily life, and embodies the family network of senior-citizen support over the years. Family pension is a way that family members assume pension obligations especially their children and provide pension resources, including the basic economic support, life care, health care and spiritual solace.The old age is the final stage of a general life, which requires special needs and the targeted care. Psychological and emotional needs of the elderly will become more complex and varied with age aging. Over the age of80has become one of the fastest growing groups in Chinese population age structure. The trend of the population aging means that human, financial and material expenditures to the elderly will continue to increase in family and social resources and that the allocation of human resources will also have higher requirements. The result of the family planning policy and the elderly population aging may directly lead the "4-2-1"family structure to the "8-4-2-1" structure. The adult-child caregivers, who are in three generations or four generations, not only bear the responsibility to take care of their parents, their children, grandchildren, even their spouses but also have to deal with kinds of problems from their jobs and daily life. Their burden is so heavy and their mental health easily breaks down over time.Domestic studies about adult-child caregiver burden mainly focused on those caregivers who took care of the parents that had stroke, dementia, Disability and so on. There are few studies that on the psychological problems of caregivers of ordinary family pension. But psychological problems caused by the family pension on child caregivers have been widely taken into account. They found that caregivers will obtain negative emotions and psychological problems in the process of caregiving.Objectives1.Investigate the self-rating depression status among adult-child caregivers and its severity in part of Jinan Communities.2.Analyze the main predictors that may affect the self-rating depression status of adult-child caregivers and provide theoretical support for exerting effective interventions and improving the level of adult-child caregivers’ mental health in the communities.MethodsThis was a cross-sectional descriptive study. The participants were recruited from three communities by convenience sampling in this study. The participants must meet the inclusion criteria: resident population of Jinan; were aged40years or above; cared for their parents who lived in Jinan over one year; were free from any mental illness. Participants were evaluated using three assessment tools: the Self-Rating Depression Scale (SDS), general questionnaire survey of child caregivers and general questionnaire survey of the elderly. Database was built by Epidata3.1software for data entry. Data arrangement and data analyses were carried out using the SPSS (version22.0) statistical software. Statistical description was used to describe the socio-demographic characteristics of the adult-child caregivers and the elderly. T-test or one-way analysis of variance test was used to compare the differences in mean depression scores between subgroups in terms of socio-demographic characteristics of the sample. Non-parameter test was used if the depression scores didn’t meet the homogeneity of variance between subgroups. Pearson’s correlation was conducted between continuous variables. The generalized linear regression analysis was conducted to determine the predictors that may affect the depression scores. The significant level of statistical tests was set at P<0.05.Results1. Comparison of the self-rating depression scores between subgroupsSamples’ self-rating depression score was significantly higher with the increase of perceived burden of supporting the elderly and after adjusting for age, marital status, educational level of cases and the numbers of diseases, participants who had heavy perceived burden of supporting the elderly got higher scores than the ordinal people and the difference was statistically significant (P<0.001).2. Self-rating depression states of the samples770samples surveyed were evaluated by the self-rating depression scale. Samples were positive for depression was24.8%in all participants. There were191samples experienced mild to severe depressive symptoms, accounting for24.8%of all770cases surveyed. The degree of samples’self-rating depressive symptoms was mainly in mild. The proportion of mild, moderate, severe self-rating depression symptoms were17.3%,6.5%and1.0%, respectively in the group.3. Statistical analysis of participants who supported one old-age familyThere were five variables ultimately retained in the model at the level of a=0.05. In the case of other independent variables remained unchanged, the caregivers in the group of less than50-year-old got2.68,3.10,4.11self-rating depression scores higher than that in the group of50-54-year-old,55-59-year-old,60-64-year-old; the caregivers in the group of general job stress, higher job stress, heavy job stress got about3.19,2.18,3.71self-rating depression scores higher than that in the group of no job stress. Who suffered one disease and more than two diseases got1.32and1.97scores higher than those who were healthy. Caregivers whose family had old man with general and poor self-care ability got1.53and3.20scores higher than those whose family had old man with good self-care ability. Caregivers whose family had old man with general, poor and very poor thinking ability got1.59,2.91and6.33scores higher than those whose family had old man with normal and mild impaired thinking ability respectively. And two groups were apt to depression:who suffered heavy job stress+the elderly whose self-care ability was poor and who suffered heavy job stress+the elderly whose thinking ability was poor.4. Statistical analysis of participants who supported their own parentsThere were five variables ultimately retained in the model at the level of a=0.05. Under the condition of the other variables remained unchanged, the caregivers get the lower self-rating depression scores with age. The caregivers in the group of less than50-year-old got2.90,4.29.5.26self-rating depression scores higher than that in the group of50-54-year-old,55-59-year-old,60-64-year-old; the caregivers in the group of general job stress and heavy job stress got about2.49and5.12self-rating depression scores higher than that in the group of no job stress. Who suffered one disease got2.77scores higher than those who were healthy. Caregivers whose family had old man with poor self-care ability got3.07scores higher than those whose family had old man with good self-care ability. Caregivers whose family had old man with general and very poor thinking ability got1.68and6.49scores higher than those whose family had old man with normal and mild impaired thinking ability respectively. And two groups were apt to depression: who suffered heavy job stress+the elderly whose self-care ability was poor and who suffered diseases+those who were young.5.Statistical analysis of participants who supported their parents-in-lawThere were three variables ultimately retained in the model at the level of a=0.05. Caregivers in the group that the literacy level of the elderly was senior got4.88scores higher than that in the group that the literacy level of the elderly was low. Caregivers whose family had old man with general and poor self-care ability got2.67and4.63scores higher than those whose family had old man with normal self-care ability. Caregivers whose family had old man with general, poor and very poor thinking ability got3.48,4.36and6.01scores higher than those whose family had old man with normal thinking ability. And the people who supported the elderly that had poor thinking ability and poor self-care ability and had high educational level were apt to depression.6. Statistical analysis of participants who supported two old-age familiesThe participants got higher scores when their family had to support two old man in different families and four old man. and the difference had statistical significance(P=0.043). The participants also got higher scores when their family had two old men who had poor self-care ability in different families and four old men who couldn’t take care of themselves and the difference had significance(P=0.029).Conclusions1.Samples’ self-rating depression score was significantly higher with the increase of perceived burden of supporting the elderly. The degree of samples’ self-rating depressive symptoms is mainly in mild and moderate. There are few samples have severe self-rating depressive symptoms.2.The relationship between the caregivers and the elderly may result in different influences on children’s mental health in the process of taking care of the elderly. The cases will be apt to depression if they are younger, or ill, or have severe job stress, or the elderly have poor self-care ability, or the elderly have more confused thinking than the normal conditions in the group that caregivers support their own parents. In the group that caregivers support their parents-in-law, cases will be apt to depression if the elderly have higher educational level than the normal conditions, or the elderly have poor self-care ability and thinking ability.3. These findings indicate that these factors that samples’age, job stress, number of disease, the educational level of the elderly, the self-care ability of the elderly and the thinking ability of the elderly may affect caregivers’mental health mainly. We can implement some targeted interventions to these factors and seek the best elderly-supporting pattern which can propel the active aging and alleviate the mental burden of adult-child caregivers to improve the level of mental health in the communities.更多还原