Study On The Relationship Between Socioeconomic Status And Depression Of The Elderly And Its Mechanism

Objective:The purpose of this study is to understand the current status and severity of depression symptoms of the elderly in Shanxi Province,to explore the relationship between socioeconomic status and depression of the elderly,and to verify the mediation effect of health promoting lifestyle on the relationship between socioeconomic status and depression,so as to provide theoretical reference for formulating scientific and reasonable intervention measures and effectively preventing and alleviating depression of the elderly.Methods:This study was conducted in 11 cities of Shanxi Province from June 2016 to July 2017.The eligible elderly was selected by multistage random cluster sampling.By using self-designed general situation questionnaire,Self-rating Depression Scale(SDS),Health Promoting Lifestyle Scale(HPLP-C)and other survey tools,9000 elderly people were investigated face-to-face by uniformly trained researchers.A total of 8526 valid questionnaires were collected.Independent sample t-test,ANOVA and Welch test were used to compare the differences of depression scores of the elderly under different demographic characteristics.The multiple linear regression was used to analyze the relationship between the socioeconomic status and health promoting lifestyle,logistic regression model was used to analyze the relationship between socio-economic position,health promoting lifestyle and depression,mediation effect test process was used verify the mediating mechanism of health promoting lifestyle.Results:1.Basic demographic characteristics of the respondents: the survey involved 8526 elderly people in Shanxi Province,including 5543(65.0%)in rural areas,2983(35.0%)in urban areas,in terms of gender distribution,there were slightly more women(51.8%)in rural and more men in urban(52.5%).The majority of the elderly are 60-70 years old(54.2% and 53.3%).70.8% of the elderly were married.Primary education accounted for the majority(62.8%),home-based care for the majority(95.4%)and 2772(32.51%)suffer from one or more chronic diseases.2.Depression status of the respondents: This survey shows that the average depression score of the elderly in Shanxi Province was(52.05 ± 10.35).There are 5294(62.1%)elderly people who have depression symptoms,among which the mild depression is the most,accounting for 35.6%(3034),the moderate depression is 2031(23.8%),and the severe depression is 229(2.7%).The results showed that there were significant differences in depression scores among the elderly with different empty nest status,sex,age,residence,marriage status,BMI,exercise frequency,physical examination frequency,daily diet rules,self-care ability and chronic disease(P < 0.05).3.Logistic regression analysis showed that socioeconomic status and health promoting lifestyle were the important influencing factors of depression among the elderly(P < 0.05).Compared with the elderly who received primary education,the risk of depression in the elderly in secondary education and higher education was lower(OR-middle=0.727,OR-higher=0.846).The risk of depression of the elderly without income was 2.069 times that of the elderly with income over 3000 yuan.The healthier the lifestyle,the lower the risk of depression(OR=0.973).In addition,the analysis on the relationship between socioeconomic status and health promoting lifestyle of the elderly shows that the higher education level(?=4.395,P<0.001),the higher monthly income(?=2.404,P<0.001),the healthier lifestyle of the elderly.4.The results of mediating effect analysis showed that the total effect of socioeconomic status on depression(path c)was-1.001(95% CI:-1.160,-0.842).The indirect path of health promoting lifestyle between socioeconomic status and depression were: socioeconomic status—health promoting lifestyle(path a: 4.238,95%CI: 3.947,4.528),and health promoting lifestyle—depression(path b:-0.149,95% CI:-0.160,-0.138).The indirect effect(path a × path b)was-0.631,bootstrap 95% CI:-0.702,-0.563,which proved that the model of health promoting lifestyle as mediation effect between social economic status and depression was established,and the mediating effect was accounted for(a*b/c)63.1%.Conclusions:There are different degrees of depression in the elderly in Shanxi Province,and there are more mild depression,which should be paid more attention to.The socioeconomic status has a significant impact on the elderly depression,especially the education level and monthly income.The lower the socioeconomic status,the higher the risk of depression.Health promoting lifestyle mediates the relationship between socioeconomic status and depression.It is suggested that the elderly should be encouraged to abandon their bad life behaviors and cultivate healthy behavior lifestyles in order to maintain a positive and optimistic psychological state and stay away from depression.