中高齡者之社經因素與憂鬱的關係－社會支持之調節及中介效果

The Relationship Between Socioeconomic Factors and Depression Among the Elder People－The Moderating and Mediating Effects of Social Support

高郁棉(YU-MIEN KAO)

指導教授 ： 李妙純

國立中正大學/社會科學院/社會福利學系/碩士(2016年)

摘要

在全球高齡化的趨勢之下，中高齡者憂鬱已成為社會福利政策重要的議題。已有相關研究指出社經因素和社會支持是中高齡憂鬱的高預測因子。因此，本研究將聚焦於主、客觀社經因素與中高齡憂鬱之關係，以及社會支持在其中所扮演的角色。本研究採用「民國96年台灣地區中老年身心社會生活狀況長期追蹤(第六次)調查」中54歲以上中高齡者，運用多元廻歸與路徑分析，探討主、客面向之社經因素與中高齡憂鬱的關係，以及探討社會支持在不同面向之社經因素與中高齡憂鬱之間關係的角色。有效樣本4,534人。本研究以教育程度為客觀的社經因素指標與自覺經濟狀況為主觀社經因素。社會支持則分為工具性支持與情緒性支持，中高齡憂鬱以憂鬱量表(CES-D)計分。結果顯示，在控制了性別、年齡、婚姻、獨居與否及失能程度後，首先，相較於客觀的社經因素指標(例如教育)，主觀的自覺經濟對中高齡憂鬱的影響較大；自覺經濟越好，其憂鬱程度會越低。第二，社會支持的調節、中介兩種效果皆存在於自覺經濟與中高齡者憂鬱之關係中。社會支持越多的人，其不好的自覺經濟對憂鬱的影響效果較小。而教育與中高齡憂鬱的關係中，社會支持只存在中介效果。意味著，工具性支持可以改善憂鬱的教育不平等現象。由於教育程度大多已於生命早期完成，教育所造成的憂鬱差異已存在於中高齡者之間，但可透過工具性支持的介入，改善中高齡者不同教育之間憂鬱程度的差異。第三，在自覺經濟對憂鬱的影響中，情緒性支持比工具性支持之調節/中介效果較大。推測可能是情緒性支持與憂鬱同屬心理層面的變項。另外，結果顯示社會支持的調節效果比中介效果大，意味著社經因素不必然與社會支持存有因果關係，社會支持的多寡不是由社經因素衍生而來的資源，可以由外在政策或環境提供，也可能是個人對社會支持的需求才獲取。

關鍵字

社經因素 ； 社會支持 ； 中高齡憂鬱

並列摘要

Under the circumstance of global trends in population ageing, the health of older adults has emerged as a key issue in social welfare policy. Related research has pointed out that socioeconomic factors and social support are important predictors of depression among the elderly adults. This study focused on the relationship between the subjective and objective socioeconomic factors associated with depression among the elderly adults, and the role of social support in moderating and mediating these associations. This study uses data from a nationally representative sample of 4,534 older adults in Taiwan aged 54 and above in 2007. Socioeconomic factors included educational attainment and self-perceived economic status. Measures of social supports included instrumental support and emotional support; and depression was measured by Center of Epidemiological Studies: Depression Scale (CES-D Scale). Results show than when adjusting for sex, age, marriage, living alone, and disability, effects of self-perceived economic status on depression are greater than that of education. That is, higher self-perceived economic status leads to a lower level of depression. We found the social support has both moderating and mediating effects on the association between self-perceived and depression. The social support diminished the effect of self-perceived economic status on depression. But for the relationship between education and depression, social support demonstrated only a mediating effect. This implies that social support can reduce the educational inequality in depression. The educational gap of depression can be narrowed through the intervention of instrumental support. Moreover, results reveal that the emotional support had a greater effect on the relationship between self-perceived economic status and depression than that of instrumental support. Its explanation might be because that both the emotional support and depression are psychological variables. In addition, the moderating effect of social support was stronger than its mediating effect. This implies that it is not necessarily that there is causal relationship between socioeconomic factors and social support. The level of social support can be derived not only from socioeconomic status, but also from policy intervention or need-driven.

並列關鍵字

self-perceived economic status ； instrumental social support ； emotional social support ； depression

參考文獻

葉濬彰(2011)。社區老人的主觀社會地位、自尊、自我掌控信念與憂鬱之關係。 中原大學心理學研究所學位論文，1-77。

朱哲生、葉慶輝(2010)。老人憂鬱症。家庭醫學與基層醫療，25(6)，226-233。

林怡君、余豎文、張宏哲(2004)。新店地區機構和非機構老人憂鬱情形及相關因素之調查。臺灣家庭醫學雜誌，14(2)，81-93。

邱亨嘉、謝穎慧、陳正宗(1998)。喪偶對社區老人身體、精神及社會功能之影響。 中華公共衛生雜誌，17(5)，423-431。

林藍萍(2007)。老人憂鬱情形：流行病學與防治策略初探。臺灣老人保健學刊，3(1)，53-64。