河南省老年人社会经济地位对精神健康的影响研究——以医疗保险和居住安排为中介变量

目的 分析河南省老年人社会经济地位与精神健康的关系。方法 使用多阶段分层整群抽样方法，以河南省18个省辖市的5 570名60岁及以上老年人为研究对象，采用有序logistic回归模型分析社会经济地位对老年人精神健康的影响，探讨医疗保险和居住安排的中介效应。结果 河南省老年人精神健康受损1 999人，受损率35.89%。有序logistic回归分析显示社会经济地位的三个维度均对老年人精神健康有显著影响(均P＜0.05)，月收入水平（OR = 0.598，95%CI:0.446 ~ 0.801）和受教育程度（OR = 1.617，95%CI:1.004 ~ 2.604）越高，老年人精神健康水平越好；原来职业的层级越高（OR = 1.325，95%CI:1.155 ~ 1.520），老年人精神健康水平越差。影响路径分析显示，城镇职工医保对老年人精神健康有促进作用（低SES:OR = 0.609，95%CI:0.422 ~ 0.878;高SES:OR = 0.380，95%CI:0.248 ~ 0.582），城乡居民医保对高SES老年人精神健康有促进作用（OR = 0.285，95%CI:0.181 ~ 0.448）;此外，与配偶/伴侣居住（OR = 0.610，95%CI:0.483 ~ 0.769）、与子女居住(OR = 0.646，95%CI:0.520 ~ 0.803)缓解了社会经济弱势地位对老年人精神健康的负面影响。结论 河南省老年人精神健康受损率较高，社会经济地位的三个维度影响老年人的精神健康水平，医疗保险和居住安排在社会经济地位与老年精神健康的关系中具有显著的中介效应。

Impact of socioeconomic status on mental health in the elderly in Henan: taking medical insurance and residential arrangement as mediating variables

Objective To analyze the relationship between social economic status and mental health of the elderly in Henan Province. Methods A multi-stage stratified cluster sampling method was used to study the influence of social and economic status on the mental health of 5 570 elderly people aged 60 and over in 18 cities in Henan Province. The order logistic regression model was used to analyze the mediating effect of medical insurance and housing arrangement on the mental health of elderly people. Results There were 1 999 elderly people with impaired mental health in Henan Province, with an impairment rate of 35.89%. Logistic regression analysis showed that the three dimensions of socioeconomic status had a significant impact on the mental health of the elderly (P<0.05). The higher monthly income level (OR=0.598, 95%CI: 0.446-0.801) and education level (OR=1.617, 95%CI: 1.004-2.604) were associated with better mental health of the elderly. The higher level of occupation (OR=1.325, 95%CI: 1.155-1.520) was associated with worse mental health of the elderly. Impact path analysis showed that urban employee medical insurance had a positive effect on mental health of the elderly (low SES: OR=0.609, 95%CI: 0.422-0.878; high SES: OR=0.380, 95%CI: 0.248-0.582), urban and rural residents’ medical insurance could promote the mental health of the elderly with high SES (OR=0.285, 95%CI: 0.181-0.448). Living with a spouse/partner (OR=0.610, 95%CI: 0.483-0.769) and children (OR=0.646, 95%CI: 0.520-0.803) alleviated the negative impact of socioeconomic vulnerability on the mental health. Conclusion The rate of impaired mental health of the elderly in Henan Province is high. The three dimensions of social economic status affect the mental health of the elderly. Medical insurance and housing arrangement have a significant mediating effect on the relationship between social economic status and mental health of the elderly.