Li Zhong, Fu You, Wang Chengzhong, Sun Hui, Hung Peiyin
School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China; Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Review and Investigation, Nanjing Medical University, Nanjing, Jiangsu, China.
J Affect Disord. 2023 Jun 15;331:405-412. doi: 10.1016/j.jad.2023.03.035. Epub 2023 Mar 20.
Community-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China.
Multiple cross-sectional data were derived from the 2005-2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities.
Of 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home.
Service availability might have been disrupted during the COVID-19 pandemic.
Despite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.
基于社区的心理咨询服务（CPCS）对于高龄老人至关重要，他们常常面临挑战，或不愿在医疗机构寻求护理。本研究旨在探讨中国全国范围内高龄老人中CPCS服务可及性随时间的变化趋势以及城乡服务可及性差异。
多截面数据来源于2005 - 2018年中国老年健康长寿纵向调查。每位高龄老人参与者或其近亲报告所在社区是否有CPCS服务。我们使用 Cochr an - Armitage检验来估计服务可及性趋势，并应用样本加权逻辑回归模型来检验城乡差异。
在38032名高龄老人中，CPCS服务可及性从2005年的6.7%降至2008/2009年的4.8%，随后持续上升至2017/2018年的13.6%。2017/2018年，农村高龄老人所在社区的服务可及性并未更高。居住在中部（6.7%）、西部（13.4%）和东北地区（8.1%）的高龄老人比东部地区（17.8%）的高龄老人报告当地有服务的可能性更低。有任何残疾或住在养老院的高龄老人报告的服务可及性高于无残疾或居家的老人。
在新冠疫情期间，服务可及性可能受到了干扰。
尽管服务可及性有所增加，但截至2017/2018年，中国只有13.6%的高龄老人报告有CPCS服务可及。这引发了对心理健康护理获取不均衡和连续性的担忧，尤其是对于居住在中部、西部以及居家的老人。需要政策努力来激励服务扩展并消除服务可及性方面的差异。
