Social Capital and Depression of Senior Citizens in Community
Introduction:
The population of senior citizens had broken through 7 percent at the end of 1993, which meant that we had formally stridden into the assembly of aged area (1), following which comes the problem of health care of aged people especially the topic of mental health, which will become a great ordeal we face.
According to the statistics of health service office, there were totally 2471 cases of suicides in Taiwan area in the year of 2000 and the aged people were a high risk group (2). The investigation found that there were 16% to 58% aged people had the tendency of depression (3, 4), while the prevalence rate of melancholia is from 1.3% to 13% (5-10), and different prevalence rate existed in different community social conditions and different population groups (11). 98% of death cases from suicide had suffered from one mental disease diagnosis, 87% death cases had melancholia during life, and 15% of melancholia patients died for suicide, so the dealing of depression will be the key point to prevent suicide.
Generally to aged people, higher prevalence rate exists in those with worse cognition function, worse daily activity, more chronic diseases, more aged, females, low education level and widowed (10). Furthermore, there are apparent correlation between senior depression with the conditions of family function, social network and supporting, social service, and participating of association or recreation activities etc. (11, 13, 17). It is obvious that there are close relations between senior mental health and their mutual communication and social relationships in their dwelled community. Therefore, how to promote the senior mental health and prevent and treat of the melancholia will be great challenges we face after entering into the 21st century, and also will be an important topic of domestic public health.
There are many factors influencing senior citizens’ mental health. The dealing of aged physical and mental health in the past in our region was also endeavor to the aim of “satisfying daily life need for all aged people, and expanding the social supporting networks for aged people”, however, the method implemented was only to make the seniors passively receive the aid without assistance of them to fuse into the community and participate the community’s activities actively. In fact, community participating is an important factor influencing senior’s mental health. The aged people with more frequent participation of group activities have better mental health (18). There were other studies finding that now the main form of senior supporting network was family members with limited functions exerted for the small scale of social network and its constraint in families, in contrast, there were only about 10% of seniors taking part in group activities with very low frequency, and to those without any special interested activity or hobby there were as high percentage as 65% (20). It is obvious that the lacking of sub-social networks and social participating so not capable of assembling social resources is an important course of living predicament of community seniors and influencing their mental health.
Social capital is refer to the positive emotions produced in the systemized social structure through social participating in which they can be deeply trusted, work together with one heart, comply with the same specification and inter-supported with so-called “life community”; the main elements including: information providing (information), influence employing (influence: structure hole), human relationships and connections ( social credentials: weak tied), team identifying and attribution feeling and sharing of resources ( reinforcement ), and tolerance & trust (21). Therefore, this is a primary human relations network surpassing the traditional tripping with emphasis on positive and benefit social structure produced secondary network (22-24).
A investigation has been done by Yang Ming-Ren in 1999 at the Renwu region of Gaoxiong county to probe the relations between social unequal, social capital and hypochondria with the finding that the prevalence rate of depression tendency in past 1 week was 26.5% and higher depression tendency showed in the population above 60 years old, with low income, spouseless, resident in advanced social and economy community and those with low social capital, in which the highest depression prevalence rate existed in those with low social capital and low income, and lowest depression prevalence rate existed in those with high social capital and high income, furthermore, interactions significantly appeared between social capital and individual social and economy status(25).
The social participation of community resident is the base of congregating power of community social, which not only created social capital and empowerment of it, but also promoted the development of physical and mental health of the residents and the economy, hence the health condition of the resident is better in the regions with more sufficient community social capital, that is, regions with high degree of trusting between residents, capable of helping each other and more community participating etc. (26-29). The statistical analysis showed that every 10% increasing of trusting degree between residents in community companied with 0.6% lowering of the death rate per thousand members every year (26-29).
To date, present studies in our region are still limited to the observation of the influence of senior physiology, psychology and social life to hypochondria, and the investigations taking social capital as measurement are scarcely seen. In view of this, in this study the inter-relations between social capital and community senior citizens depression will be probed, and in the future it will be tried to implement the community operation, i.e., the rebuilding of social capital, to effectively reduce the depression tendency of senior citizens and achieve the aim of promoting the physical and mental health of aged people.
We supply Mandarin Chinese into English Translation Service. The Document was translated from Chinese to English in 2002 for a Medical scholar in Beijing.
社会资本与社区老人忧郁
前言
民国八十二年底我国老年人口数突破百分之七大关，正式迈入老年国[1]。然随之而来老人的健康照护问题，尤其是心理健康课题，将是我们所面临的重大考验。
根据卫生署统计，89年台湾地区总共有2471人死于自杀，老人是高危险群[2]。研究调查发现，台湾社区老人16%-58%有忧郁倾向[3,4]，忧郁症的盛行率则为1.3%-13%[5-10]，社区社会状况差异与族群不同会有不同的盛行率[11]。自杀死亡者中98%生前患有任一精神疾病诊断，87%死亡个案生前患有忧郁症，有15%的忧郁症患者死于自杀[12]；可见忧郁的处遇将是自杀预防的重要关键。
一般以老人而言，认知功能愈差、日常功能不佳、慢性病症愈多、年纪愈大、女性、低教育程度、或鳏寡者，有较高的忧郁盛行率[10]。再者，家庭功能、社会网络与支持之好坏，社会服务、社团与休闲活动之参与等等也都与老人忧郁有明显的相关[11,13-17]。可见老人心理健康与居住社区之人际互动、社会关系是息息相关。因此，如何促进老人心理健康，以及忧郁症的防治将是迈入二十一世纪我们所将面临的重大挑战，也是国内公共卫生的重要课题。
影响老人心理健康因素很多，过去国内关于老人身心健康的处遇，也是朝着「满足所有老人日常生活的需求，拓展老人的社会支持网络」而努力，但其使用的方法只是让老人被动地接受援助，并无法帮助其主动融入社区，参与社区活动。事实上，社区参与是影响老人心理健康的重要因素，社团活动参与频率愈频繁的老人，有较好的心理健康[18]。另有研究也发现，老人支持网络主要以家人为主，社会网络规模小且局促于家庭成员[19]，所发挥的功能相当有限；相对的，仅约一成左右有参与社团活动，但活动频率仍低，至于无特别感兴趣之活动或嗜好者则高达65%[20]。可见，缺少次级社会网络与社会参与，不能凝聚社会资源，是造成目前社区老人生活困境，影响心理健康的一个重要原因。
社会资本，是指制度化的社会结构下，人们透过社会参与所产生可以信任之生死与共、和衷共济、遵守共同规范、和相互扶持的所谓「生命共同体」的正向情感；其主要的成份包含有：信息的提供(information)、影响力的运用(influence: structure hole)、人情与关系(social credentials: weak tie)、团体的认同 － 归属感与资源的分享(reinforcement)、及容忍与信任(tolerance & trust)[21]。因此，这是超越传统黏稠的初级人际关系网络，强调正向、有益的社会结构所产生的次级网络[22-24]。
杨明仁在1999年曾于高雄县仁武乡进行调查研究，探讨社会不均、社会资本与忧郁症之关系。结果发现：过去一个星期有忧郁倾向之盛行率为26.5%，年龄超过60岁、低收入、无偶、高社经社区居民、以及低社会资本者有较高的忧郁倾向；其中以低社会资本之低收入者有最高的忧郁盛行率，高社会资本之高收入者忧郁症盛行率最低，社会资本与个人社经状况出现有明显地交互作用[25]。
然而社区居民之社会参与是社区社会凝聚力的根本，不仅创造了社会资本并给予赋能(empowerment)，进而促进居民之身心健康与经济发展；因此，社区社会资本愈充分的地区－居民间感受彼此信任程度愈高、可以互相帮忙、有较多地团体参与等，则其居民亦有较佳健康情况[26-29]。当社区居民感受彼此信任、互相帮忙、团体参与等愈高地区，其居民健康情况也较佳；统计分析显示，当社区之人际信任程度每增加10%，每年每千人死亡率降低0.6[26-29]。
目前为止国内现有的研究仍仅限于老人生理、心理、社会生活对忧郁症之影响的探讨，鲜少以社会资本为向度的考量。有鉴于此，本研究将探讨社会资本与社区老人忧郁之相互关系，未来试图借着对社区的操作－社会资本的重建将以有效的减少老人忧郁倾向，达到促进老人身心健康的目的。