Discussion:
In this study, the result showed that those of female, no schooling experience or in illiteracy, with other physical diseases and participated no social community activities were prone to get melancholia, which was consistent with past study results (10,11,13-17). In addition, in the study it showed that community participating was also an important factor influencing the mental health of senior people, which was identical to foreign investigation (18). It was worth to note that there was also strong correlation between social capital and the occurring of melancholia, however, in the past literature few people discussed it, though its mechanism and interactions were deserve to be further studied.
At present the governmental solving strategy of aged people problems lays particular stress on the level of the economy and living care, and with median to low income family or disabled old person as the main care objects. However, these aged people are only a small part of all senescent populations, and that in the providing of these services, the senior citizens act in a passive role without making them participating community activities actively, besides, it is easy to have the senior get the negative feeling, thus produce no attribution feeling when live in the community for old person. The cause of this phenomenon is the services now provided such as day-time resthome, aged care facility, in-family service etc. can’t be combined with the daily living experiences of senior people, together with that the inadequate popularization and neighborhood delivering of the service. (32)
Basically, the theory of social capital stresses of dynamic interacting relations among person to person, person and social structure rather than the static passive and no-choice relations. Individuals can acquire abundant wealth and gifts during this positive interaction. Thereby, it is also an idea of investing and rebound (33). From this point of view, it can be tried to develop the self-caring potential of senior citizens, encourage the motives of social participating, enhance the interacting path between community and senior citizens, for reducing the seniors’ social adaptation crisis and thus improve their physical and mental health, from which the senior citizens can actively participate community affairs or activities, and obtain the emotional support, sharing of information, and build the feeling of stand together thick and thin with the community, rather than lose the right of be satisfied of the human attribution feeling demand with disjointed with the social because of retirement or increasing of the ages. At the same time, the community can also set up mutually beneficial and abundant caring networks and resources, to provide a community for the senior citizens with capability of promoting physical and mental health, and most greatly satisfy the senior citizens in their life.
In other words, it is a transformation for senior people from passively accepting aids to actively fusing into the community and participating community activities to obtain best care and support (34-37), so in the item of senior well-being service providing, it is inadequate and there will be something not well-considered to depend only on the efforts of government. Hence the job of caring old people must combine the power of government and civil, and the most important needing is the actively and directly participation of senior citizens, and the best effects can be exerted from the services.
Old-age is not a substitute for social problems, and the cause of the senior problems exists in that the social structure is not favourable to senior citizens, so the very thing need to be changed is the fashion the community takes to deal with old people (38-40). To create community developing resources and accumulate community social capital is both the temporary solution and permanent cure positive action to promote the mental health and living satisfactory of senior people and further prevent the occurring of the senior citizens problems. As for how to cultivate this power and make it continuing and following the need of the changing time, it is needed to adjust present senior people service fashion, enlarge the object population of the service to healthy senior citizens, and change the unidirectional service providing manner, transform the passive role of senior citizens to active role, encourage the seniors actively express their need and participate the community affairs, increase the interacting chance between individuals and community, build the idea of mutual aid and cooperation, from which achieve the situation as senior people living with more quality and ensurence for the reason of community, and community becoming more rich and popular for the reason of senior citizens’ participation. This idea is basically a more practical and feasible method to disposition of the senior’s mental health and prevention and treatment of the seniors’ depression, and it can be also the reference for mental health policy establishing, medical network programming and medical resources applicating in the future.
Therefore, after we discussed in the whole social ecosystem environment, we can find that the mental health of individuals will be influenced by different level and variant factors, as personal social and economic status, community social capital etc., all will cause effect to individual mental health. Although the mechanisms and interactions etc. need to be further probed, it is no doubt that the cause of senior melancholia occurring might be complicated factors, and the influence of community social capital on individual mental health can not be neglected. The manage and intervention of mental health should give both consideration to individuals and community social environment, and should consider social structure factors with personal factors together, in other words, present predicament might be break through by operation to change social environment and individual life threads, and farther influence individuals to create a healthy life, develop a connection between macro and microstructure (41).
Huayiwang Chinese translation Company provides translation services of medical academic documents between main languages in the world. This document in the field of Depression of Senior Citizens was translated by a medical translator of our Chinese translation Company.
讨论
在本研究中，结果发现发女性、不识字或未就学、身体有其它疾病、无参与社会团体活动较易发生忧郁症，这与过去的研究结果是一致的[10,11,13-17]。另，在研究中，发现社区参与也是影响老人心理健康的重要因素之一，此与国外的研究发现相吻合[18]。值得注意的是，社会资本与忧郁症的发生也有着强烈的关联，但在过去的文献中，甚少有人探讨，然这其间的机转以及交互作用是值得未来进一步探究的。
目前政府在老人问题解决策略上，也较偏重于经济与生活照顾的层面，照顾的对象以中低收入户或失能的老人为主。然而这群老人仅占所有老年人口的一小部分，且这些服务的提供，老人是居于被动的角色，无法让老人主动参与社区的活动，并且容易让老人有被卷标的负向感受，因此老人生活在社区中没有归属感。此种现象的肇因乃目前所提供的服务内容如日间托老、养护机构、居家服务等，这些内容无法与老人日常生活经验结合，再加上服务输送不够普及和就近所致[32]。
基本上，社会资本的理论，强调的是人与人、人与社会结构间之动态的互动关系而非静态的被动与无奈。个人可以在这正向的互动过程中，取得丰富的资源与回馈。因此，这也是一种投资与回报的观念[33]。依此思考角度，为减少老人社会适应的危机，进而增进其身心的健康，可尝试开发老人自我照顾的潜能，鼓励社会参与的动机，增强社区与老人之间的互动管道，藉此老人可由主动参与社区事务或活动，得到情感的支持，讯息的分享，与社区之间建立休戚与共的感觉。而不因退休或年龄的增加而与社会脱节，失去满足人类归属感需求的权利。而社区也能建构出互惠的、丰富的照顾网络与资源，提供老人一个能够促进身心健康的社区，让老人获得生活中最大的满足。
换言之，将老人被动地接受援助的情形，转化成助其主动地融入社区，参与社区活动，以获得最好的安养照顾[34-37]，所以在老人福利服务的提供上，单靠政府的力量是不够的，而且也有不周延之处。故老人照顾的工作必须结合政府与民间的力量，最重要的需要老人主动直接的参与，方能将服务发挥最大的效果。
老年不是社会问题的代名词，老人问题的发生在于社会结构不利于老人社会，因此需要改变的是社区对待老人的方式[38-40]。为促进老人心理的健康，提升老人生活满意度，进而预防老人问题的发生，建立社区发展资源，累积社区的社会资本，是治标又治本的积极作为。至于如何培养出这股力量，并让这份能力生生不息永续经营，又能因应时代变迁的需要，则就需要调整现行的老人服务方式，将服务的目标人口群扩及健康的老人，并改变单向的服务提供方式，让老人由被动的角色转换主动的角色，鼓励老人主动表达其需求并参与社区事务，增加个人与社区的互动机会，建立社区内互助合作的意识，藉此达到老人因社区而使生活更有品质与保障，社区也因着老人的参与而更丰富。基本上，这样的观点对于老人心理卫生处遇以及老人忧郁的防治将是一较为现实可行的方法，亦可以形成将来心理卫生政策制定、医疗网络之规划及医疗资源应用的参考。
因此，将分析的对象置于整体社会生态环境下来讨论后，可以发现个人之心理健康将受到不同层次之各种因素的影响，个人的社会经济状况、社区社会资本等等，都将对个人心理健康造成效应。虽然其间的机转以及交互作用等还须进一步的深入探讨，但不容置疑的是，造成老人忧郁症发生可能是一复杂因素所造成的结果，社区社会资本对于个人心理健康的影响实在令人不可忽视。在心理健康的处遇与介入处理必须兼顾个人与社区社会环境，把社会结构因素与个人因素列入共同考虑，换言之，以借着操作改变社区环境与个人生活脉络，进而影响个人创造一个健康的生活，建立一个巨观与微观的连结，才有可能突破目前的困境[41]。