代际支持和医疗支出对抑郁的影响：来自中国农村老年人的证据。
Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China.
机构信息
School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China.
Institute of Sociology, Shaanxi Academy of Social Sciences, Xi'an, China.
出版信息
Front Public Health. 2022 Jul 22;10:840864. doi: 10.3389/fpubh.2022.840864. eCollection 2022.
OBJECTIVE
Globally, depression has become a major health issue among older adults, who experience poor physical health and high medical expenditures. In Asian countries, older adults are greatly dependent on their children. This study assessed the impact of different types of intergenerational support and medical expenditures on depression among older adults in rural China.
METHOD
A three-phase balanced panel was constructed based on data from 1,838 rural older adults with comparable scores on the Center for Epidemiologic Studies Depression Scale (CES-D) from the China Family Panel Studies in 2012, 2016, and 2018. A fixed-effects model was used to analyze the impact of intergenerational support and medical expenditures on CES-D score and of intergenerational support on medical expenditures. The propensity score-matching model was used to test the regression results' robustness.
RESULTS
The findings were as follows. First, different types of intergenerational support had a heterogeneous impact on depression among rural older adults. Emotional support had a significantly negative impact on CES-D score, although too much care-based support had a positive impact on CES-D score. Low-level economic support had no significant effect on CES-D score. Second, medical expenditures impacted depression; among these, non-inpatient medical expenditure had a significant and positive impact on CES-D score. Third, CES-D scores among rural older adults were associated with chronic diseases and per capita family income. Fourth, care-based support was associated with reduced non-inpatient medical expenditures, and the sub-sample regression results indicated that the impact was significant for older adults with no chronic diseases and those younger than 75 years.
CONCLUSION
Intergenerational emotional support and non-inpatient medical expenditures directly affected rural older adults' CES-D scores. The mediating role of medical expenditures between intergenerational support and CES-D score was not significant. Measures should be taken to encourage intergenerational emotional support and reduce the pressure on children's economic and care-based support. Further, the medical insurance reimbursement policy, as formal support, should be improved to alleviate depression among rural older adults when children's support is limited.
目的
在全球范围内，抑郁症已成为老年人的一个主要健康问题，他们的身体健康状况不佳，医疗支出较高。在亚洲国家，老年人在很大程度上依赖子女。本研究评估了不同类型的代际支持和医疗支出对中国农村老年人抑郁的影响。
方法
根据中国家庭追踪调查 2012 年、2016 年和 2018 年具有可比的流行病学研究中心抑郁量表（CES-D）得分的 1838 名农村老年人的数据，构建了一个三阶段平衡面板。采用固定效应模型分析代际支持和医疗支出对 CES-D 得分的影响，以及代际支持对医疗支出的影响。采用倾向评分匹配模型检验回归结果的稳健性。
结果
研究结果如下。首先，不同类型的代际支持对农村老年人的抑郁有不同的影响。情感支持对 CES-D 得分有显著的负向影响，而过度的照顾支持对 CES-D 得分有正向影响。低水平的经济支持对 CES-D 得分没有显著影响。其次，医疗支出对抑郁有影响；其中，非住院医疗支出对 CES-D 得分有显著的正向影响。第三，农村老年人的 CES-D 得分与慢性病和人均家庭收入有关。第四，照顾支持与非住院医疗支出减少有关，子样本回归结果表明，对于没有慢性病和年龄在 75 岁以下的老年人，这种影响是显著的。
结论
代际情感支持和非住院医疗支出直接影响农村老年人的 CES-D 得分。代际支持与 CES-D 得分之间的医疗支出中介作用不显著。应采取措施鼓励代际情感支持，减轻子女经济和照顾支持的压力。此外，应完善医疗保险报销政策，作为正式支持，以缓解子女支持有限时农村老年人的抑郁。
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