Relationship Between Social Isolation And Psychological Clistress Of Rural Olcler Adults

BackgroundWith the deepening of China’s aging and the acceleration of urbanization,the size of rural families in China has been shrinking,and the intergenerational relationship has changed.The social isolation and mental health of older adults in rural areas have become social and public health problems that cannot be ignored.Social isolation has been proved to be associated with multiple adverse health outcomes in older adults,including increased risk of death and cardiovascular disease,cognitive decline,depression and anxiety.The COVID-19 pandemic may exacerbate social isolation and psychological distress among rural older adults.To our knowledge,there is no relevant research on the association between social isolation and psychological distress of rural older adults in the context of the COVID-19 pandemic.ObjectiveBased on the two wave panel data,this study firstly aimed to explore the changes in the psychological distress of the rural older adults during the baseline and follow-up.Second,to explore the relationship between social isolation and psychological distress of the rural older adults during the baseline and follow-up.Third,to explore the impact of changes in social isolation at baseline and during the follow-up period on psychological distress in the context of the COVID-19 pandemic.Finally,to provide an important theoretical basis for intervening in the social isolation of older adults and alleviating the negative effects of social isolation on mental health among rural older adults.MethodsUsing multi-stage random sampling method,3,600 rural older adults were selected from three rural counties in Shandong Province(Qufu in Jining,Laoling in Dezhou,and Rushan in Weihai),and questionnaires were conducted in May 2019 and August 2020 respectively.The questionnaire was self-designed and completed in the form of face-to-face interviews.Data entry and analysis were performed using Epidata3.0,SPSS25.0 and STATA15.0.Descriptive analysis of the general sociodemographic characteristics,health behaviors and health status of the older adults in rural areas was carried out.Multiple linear regression equations were used to explore the cross-sectional relationship between social isolation and psychological distress.Generalized estimation equation with identity link,Gaussian distribution,and unconstrained related work structure is used to explore the longitudinal relationship between social isolation and psychological distress,and the relationship between social isolation transitions and psychological distress.Time variables are introduced into the model,and the interaction between independent variables and time variables is used to test the change of psychological distress between different social isolation change groups.ResultsAmong the 2,749 older adults included in the analysis,1,517 were in non-social isolation at baseline,accounting for 55.18%,and 1,232 were in social isolation,accounting for 44.82%.The cross-sectional analysis results showed that gender,education level,annual household income per capita,smoking,drinking,activities of daily living,chronic disease status,physical activity and social isolation were all related to psychological distress,and the differences were statistically significant(P<0.05).The K10 score of the older adults at baseline was 16.64±7.44,and the K10 score at follow-up was 18.23±8.06,and the changes were statistically significant(P<0.001).From baseline to follow-up,the percentage of the older adults with higher and higher risk of psychological distress increased from 23.54%to 31.36%(P<0.001).After adjusting for confounding factors,these older adults who were socially isolated had larger changes in K10 score at follow-up than those who were non-socially isolated(b=0.88,P<0.001).After adjusting for confounding factors,these older adults in the "non-socially isolated to socially isolated" group(b=1.03,P<0.001)and "remains socially isolated" group(b=1.11,P<0.001),the K10 score increased greater than those in the "remains non-socially isolated" group.Conclusions and suggestionsConclusionsCompared with the baseline,the mental health status of rural older adults showed a downward trend at follow-up.Psychological distress was positively correlated with social isolation among rural older adults,and those older adults who were social isolation at baseline had poorer mental health status at follow-up.From baseline to follow-up,in addition to those who remained socially isolated,older adults who became from non-socially isolated to socially isolated also had a downward trend in mental health.Suggestions1.Strengthen the mental health work of older adults in rural areas and alleviate psychological distress.2."Ecological co-governance strategy" reduces the risk of social isolation of older adults in rural areas.3.Paying attention to addressing the social isolation and psychological distress of the older adults in rural areas during the COVID-19 pandemic.