Kuang Jiawen, Zhang Wei, Zhang Haoran, Lin Nan, Fang Jialie, Song Rui, Xin Zhaohua, Wang Jingyi
School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China.
Lingqiao Community Health Center, Pudong New Area, Shanghai, People's Republic of China.
Psychol Res Behav Manag. 2024 Jul 18;17:2701-2716. doi: 10.2147/PRBM.S464848. eCollection 2024.
Psychosocial factors have been found to profoundly impact mental health of older adults, but the main focus in the current literature has been on one particular aspect of these factors. This study aimed to identify latent classes of older adults based on four psychosocial factors (loneliness, social isolation, perceived social support, and social capital) and the transition of classes over 6 months. We also sought to assess the predictive role of changes in these classes in relation to depression, anxiety, and stress at 18-month follow-up.
We analyzed longitudinal data from 581 community-dwelling older adults in Shanghai, China. The data were collected at baseline (T0), 6-month follow-up (T1) and 18-month follow-up (T2) between March 2021 and April 2023. Using latent class analysis, we identified three underlying classes (Social Connectors, Subjective Social Isolates, and Social Isolates) of the sample. We also established five transition categories from T0 to T1 (Social Connectors T0-T1, Subjective Social Isolates T0-T1, Social Isolates T0-T1, Good Transition, and Bad Transition) using latent transition analysis. Logistic regression was employed to examine the temporal relationships between these transition categories and subsequent symptoms of depression, anxiety and stress, adjusting for age, sex, education, marital status, family income level, sleep quality, health status and outcome variables at T0.
Multivariable associations revealed that compared to older adults with persistent good social environment (Social Connectors T0-T1), those with persistent high levels of loneliness and social isolation and low levels of perceived social support and social capital (Social Isolates T0-T1), and those who shifted towards a poorer social environment (Bad Transition) were more likely to experience depression, anxiety and stress at T2. Sustained subjective social isolation (Subjective Social Isolates T0-T1) was associated with more severe depressive symptoms at T2.
Our study indicated that adverse psychosocial environment worsened mental health in older adults. These findings highlight the importance of early identification of older individuals at long-term psychosocial risk and development of tailored interventions to improve their social environment and mental health.
研究发现社会心理因素对老年人心理健康有深远影响，但当前文献主要聚焦于这些因素的某一特定方面。本研究旨在基于四种社会心理因素（孤独感、社会隔离、感知到的社会支持和社会资本）确定老年人的潜在类别以及这些类别在6个月内的转变情况。我们还试图评估这些类别变化在18个月随访时对抑郁、焦虑和压力的预测作用。
我们分析了来自中国上海581名社区居住老年人的纵向数据。数据于2021年3月至2023年4月期间在基线（T0）、6个月随访（T1）和18个月随访（T2）时收集。使用潜在类别分析，我们确定了样本的三个潜在类别（社会连接者、主观社会隔离者和社会隔离者）。我们还使用潜在转变分析从T0到T1建立了五个转变类别（社会连接者T0 - T1、主观社会隔离者T0 - T1、社会隔离者T0 - T1、良好转变和不良转变）。采用逻辑回归分析来检验这些转变类别与随后的抑郁、焦虑和压力症状之间的时间关系，并对年龄、性别、教育程度、婚姻状况、家庭收入水平、睡眠质量、健康状况以及T0时的结果变量进行了调整。
多变量分析表明，与社会环境持续良好的老年人（社会连接者T0 - T1）相比，那些孤独感和社会隔离程度持续较高且感知到的社会支持和社会资本水平较低的老年人（社会隔离者T0 - T1），以及那些转向较差社会环境的老年人（不良转变）在T2时更有可能经历抑郁、焦虑和压力。持续的主观社会隔离（主观社会隔离者T0 - T1）与T2时更严重的抑郁症状相关。
我们的研究表明，不良的社会心理环境会使老年人的心理健康恶化。这些发现凸显了早期识别长期存在社会心理风险的老年人以及制定针对性干预措施以改善其社会环境和心理健康的重要性。
