邻里心理健康对老年人心理健康的影响。
The impact of neighborhood mental health on the mental health of older adults.
机构信息
School of Public Management and Law, Anhui University of Technology, Ma'anshan, China.
College of Public Administration and law, Hunan Agricultural University, Changsha, China.
出版信息
BMC Public Health. 2023 Jul 14;23(1):1352. doi: 10.1186/s12889-023-16263-w.
BACKGROUND
In this article, we use cross-sectional data obtained from the 2018 China Health and Aging Tracking Survey (CHARLS) to examine the impact of neighborhood mental health at the community level on the mental health of older adults aged 60 years and older.
METHODS
NMH is the average mental health of older adults in the same community, excluding the older adults themselves. The explained variable mental health in this paper was measured using the simple CES-D depression scale. The mediating variables were social connectedness, social participation and social inclusion, and the instrumental variables were physical exercise and amusement. regression analysis was conducted using OLS regression models, two-stage least squares (IV-2SLS) instrumental variables to address the two-way causality of NMH and MH, and KHB decomposition was used to investigate the effect mechanism.
RESULTS
Baseline regressions showed that the neighborhood mental health effect positively influenced the mental health of older adults (Coef. = 0.356, 95% CI 0.315,0.397). The neighborhood mental health effect estimated by IV-2SLS (Coef. = 0.251, 95% CI 0.096,0.405) was higher than the OLS regression, indicating endogeneity. The mediated effects of KHB showed total (Coef. = 0.356, 95% CI 0.314,0.398), direct (Coef. = 0.281, 95% CI 0.232,0.330), and indirect effects (Coef. = 0.075, 95% CI 0.049,0.101). While the total effect was 1.266 times higher than the direct effect, 21.03% of the total effect came from mediating variables.
CONCLUSIONS
First, the neighborhood mental health effect has a positive impact on the mental health of older adults, but there are heterogeneous differences based on gender, age, and place of residence. Second, the results of the IV-2SLS estimation showed that the effect of the neighborhood mental health effect was underestimated if endogenous problems were not controlled for. Third, the effect of neighborhood mental health on older adults' mental health was tested to be stable. Moreover, social connectedness, social participation, and social interaction are important mediating mechanisms for the effect of neighborhood mental health on older adults' mental health. This study provides new perspectives and ideas for an in-depth understanding of the mental health of older adults in the context of social transformation in China.
背景
本文使用 2018 年中国健康与养老追踪调查（CHARLS）的横断面数据，考察了社区层面的邻里心理健康对 60 岁及以上老年人心理健康的影响。
方法
NMH 是同一社区内老年人的平均心理健康水平，不包括老年人自身。本文中使用简单的 CES-D 抑郁量表来衡量解释变量心理健康。中介变量为社会联系、社会参与和社会包容，工具变量为体育锻炼和娱乐。使用 OLS 回归模型、两阶段最小二乘法（IV-2SLS）工具变量来解决 NMH 和 MH 的双向因果关系，并使用 KHB 分解来探讨影响机制。
结果
基线回归显示，邻里心理健康效应正向影响老年人的心理健康（Coef. = 0.356，95% CI 0.315，0.397）。IV-2SLS 估计的邻里心理健康效应（Coef. = 0.251，95% CI 0.096，0.405）高于 OLS 回归，表明存在内生性。KHB 的中介效应显示总效应（Coef. = 0.356，95% CI 0.314，0.398）、直接效应（Coef. = 0.281，95% CI 0.232，0.330）和间接效应（Coef. = 0.075，95% CI 0.049，0.101）。虽然总效应是直接效应的 1.266 倍，但总效应的 21.03%来自中介变量。
结论
第一，邻里心理健康效应对老年人的心理健康有正向影响，但存在基于性别、年龄和居住地的异质性差异。第二，IV-2SLS 估计结果表明，如果不控制内生性问题，邻里心理健康效应的估计会被低估。第三，邻里心理健康对老年人心理健康的影响是稳定的。此外，社会联系、社会参与和社会互动是邻里心理健康对老年人心理健康影响的重要中介机制。本研究为深入了解中国社会转型背景下老年人的心理健康提供了新的视角和思路。
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