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Article(id=1322607904369267257, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411363, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1731945600000, receivedDateStr=2024-11-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263897268, onlineDateStr=2026-10-29, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263897268, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263897268, creator=13701087609, updateTime=1793263897268, updator=13701087609, issue=Issue{id=1322607837742747790, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263881383, creator='13701087609', updateTime=1793264238791, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609336933794638, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609336933794639, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3743, endPage=3747, ext={EN=ArticleExt(id=1322607904553816634, articleId=1322607904369267257, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impact of community elderly care service on mental health of the elderly with chronic disease: the mediating role of social adaption, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of community-based elderly care service utilization on mental health outcomes and its underlying pathways among older adults with chronic diseases, providing evidence for targeted interventions in this population.

Methods

A descriptive statistical and correlation analysis was conducted on the use of community-based elderly care services, mental health, and social adaptability among 280 elderly individuals aged 60 and above with chronic diseases. The mediating effect of social adaptability was tested using the Bootstrap method.

Results

The service utilization rate reached 60% among participants, with a mean GHQ-12 score of 18.41±4.75. Significant positive correlations emerged between service utilization and social adaptation(r=0.288, P<0.001). Both service utilization and social adaptation demonstrated negative associations with psychological distress (r=-0.365,P<0.001;r=-0.464,P<0.001). The utilization of community-based elderly care services by older adults with chronic diseases negatively influences GHQ-12 scores by enhancing their social adaptability, with the mediating effect of social adaptability accounting for 30.81% of the total effect.

Conclusion

Community-based elderly care services exert beneficial effects on mental health in older adults with chronic diseases, partially mediated through enhanced social adaptability.

, authors=Jia-rui WU, Jia-mou WANG, Jun-zhu WANG, authorsList=Jia-rui WU, Jia-mou WANG, Jun-zhu WANG, authorCompany=null, correspAuthors=Jia-mou WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322607906407699007, articleId=1322607904369267257, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=患慢性病老年人社区养老服务使用对心理健康的影响及社会适应能力的中介作用, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

分析患慢性病老年人使用社区养老服务对心理健康的影响及作用路径，为患慢性病老年人群的相关研究提供参考。

方法

对280名60岁及以上患慢性病老年人的社区养老服务使用与心理健康和社会适应能力进行描述统计和相关性分析，用Bootstrap法对社会适应能力进行中介效应检验。

结果

患慢性病老年人使用社区养老服务的比例为60%，GHQ-12的平均得分为（18.41±4.75）。统计分析发现使用社区养老服务与社会适应呈正相关（r=0.288，P<0.001），社区养老服务使用、社会适应能力与GHQ-12得分均呈负相关（r=-0.365，P<0.001;r=-0.464，P<0.001），患慢性病老年人使用社区养老服务通过提高社会适应能力从而负向影响GHQ-12得分，且社会适应能力的中介效应占总效应的30.81%。

结论

患慢性病老年人使用社区养老服务对心理健康具有积极影响，且社会适应能力在两者间起中介作用。

, authors=吴嘉蕊, 王加谋, 王珺祝, authorsList=吴嘉蕊, 王加谋, 王珺祝, authorCompany=null, correspAuthors=王加谋, authorNote=

吴嘉蕊（2000—），女，硕士在读，研究方向：社会医学与卫生事业管理，老年健康

, correspAuthorsNote=
王加谋，E-mail:
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吴嘉蕊（2000—），女，硕士在读，研究方向：社会医学与卫生事业管理，老年健康

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(In Chinese), articleTitle=Study on the relationship between mental health and social support of the elderly, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322607907657601600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, xref=null, ext=[AuthorCompanyExt(id=1322607907691156033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, companyId=1322607907657601600, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, Hubei 430023, China), AuthorCompanyExt(id=1322607907779236418, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, companyId=1322607907657601600, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=武汉轻工大学医学与健康学院，湖北　武汉　430023)])], figs=[ArticleFig(id=1322607912166478431, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=EN, label=Fig.1, caption=Intermediary model and regression coefficient of social adaptation in the relationship between community pension service use and GHQ-12, figureFileSmall=RGWqstOFIcUdbsIz1cefyw==, figureFileBig=E3paXbMVEdOrZuuhhzH+BA==, tableContent=null), ArticleFig(id=1322607912221004384, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=CN, label=图1, caption=社会适应能力在社区养老服务使用与心理健康关系间的中介模型及回归系数

注：c P<0.001。

, figureFileSmall=RGWqstOFIcUdbsIz1cefyw==, figureFileBig=E3paXbMVEdOrZuuhhzH+BA==, tableContent=null), ArticleFig(id=1322607912371999329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=EN, label=Table 1, caption=

Scores of community pension service use, GHQ-12, and social adaption for the elderly with different characteristics of chronic diseases(n=280)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n（%）社区养老服务使用GHQ-12社会适应能力
性别
男122（43.6）15.01±3.4318.35±4.8326.99±5.29
女158（56.4）15.57±4.9718.46±4.7027.57±5.76
t值-1.068-0.191-0.862
P值0.2860.8490.389
年龄（岁）
60~6970（25.0）13.40±2.1517.69±4.4928.24±5.74
70~79144（51.4）14.88±3.9018.02±4.6627.92±5.31
≥8066（23.6）18.33±5.4520.05±4.9025.02±5.34
F值25.6625.3787.861
P值<0.0010.005<0.001
文化程度
小学及以下111（39.6）15.76±4.5919.39±4.2825.94±5.14
初中89（31.8）14.96±3.6018.31±5.0327.17±5.34
高中55（19.6）15.38±5.3916.87±3.8829.91±5.64
大专及以上25（8.9）14.60±3.1517.84±6.4228.28±6.04
F值0.8073.7296.963
P值0.4910.012<0.001
婚姻状况
已婚168（60.0）14.01±2.6617.87±4.9728.26±5.43
其它112（40.0）17.30±5.5419.23±4.2925.91±5.47
t值-5.869-2.3733.530
P值<0.0010.018<0.001
个人月收入（元）
<1 00033（11.8）15.42±5.0120.70±4.2225.36±5.02
1 000~<3 000111（39.6）15.18±3.7418.61±4.5326.68±5.48
3 000~<5 000112（40.0）15.62±4.9717.53±4.7928.03±5.43
≥5 00024（8.6）14.50±2.9818.50±5.3529.63±6.18
F值0.4964.0433.949
P值0.6850.0080.009
居住状况
独居64（22.9）17.50±5.1919.89±3.7425.78±5.73
非独居216（77.1）14.68±3.8717.98±4.9327.77±5.43
t值4.0293.325-2.543
P值<0.0010.0010.012
患慢病种类（种）
1132（47.1）15.04±4.3417.42±4.4228.03±5.14
≥2148（52.9）15.58±4.3919.30±4.8726.68±5.85
t值-1.040-3.3562.038
P值0.299<0.0010.043
ADL是否受损
否197（70.4）14.99±3.9917.07±3.8929.07±4.70
是83（29.6）16.11±5.0721.60±5.0923.16±5.24
t值-1.781-7.2629.296
P值0.077<0.001<0.001
), ArticleFig(id=1322607912447496802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=CN, label=表1, caption=

不同特征患慢性病老年人社区养老服务使用、GHQ-12、社会适应得分情况(n=280)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量n（%）社区养老服务使用GHQ-12社会适应能力
性别
男122（43.6）15.01±3.4318.35±4.8326.99±5.29
女158（56.4）15.57±4.9718.46±4.7027.57±5.76
t值-1.068-0.191-0.862
P值0.2860.8490.389
年龄（岁）
60~6970（25.0）13.40±2.1517.69±4.4928.24±5.74
70~79144（51.4）14.88±3.9018.02±4.6627.92±5.31
≥8066（23.6）18.33±5.4520.05±4.9025.02±5.34
F值25.6625.3787.861
P值<0.0010.005<0.001
文化程度
小学及以下111（39.6）15.76±4.5919.39±4.2825.94±5.14
初中89（31.8）14.96±3.6018.31±5.0327.17±5.34
高中55（19.6）15.38±5.3916.87±3.8829.91±5.64
大专及以上25（8.9）14.60±3.1517.84±6.4228.28±6.04
F值0.8073.7296.963
P值0.4910.012<0.001
婚姻状况
已婚168（60.0）14.01±2.6617.87±4.9728.26±5.43
其它112（40.0）17.30±5.5419.23±4.2925.91±5.47
t值-5.869-2.3733.530
P值<0.0010.018<0.001
个人月收入（元）
<1 00033（11.8）15.42±5.0120.70±4.2225.36±5.02
1 000~<3 000111（39.6）15.18±3.7418.61±4.5326.68±5.48
3 000~<5 000112（40.0）15.62±4.9717.53±4.7928.03±5.43
≥5 00024（8.6）14.50±2.9818.50±5.3529.63±6.18
F值0.4964.0433.949
P值0.6850.0080.009
居住状况
独居64（22.9）17.50±5.1919.89±3.7425.78±5.73
非独居216（77.1）14.68±3.8717.98±4.9327.77±5.43
t值4.0293.325-2.543
P值<0.0010.0010.012
患慢病种类（种）
1132（47.1）15.04±4.3417.42±4.4228.03±5.14
≥2148（52.9）15.58±4.3919.30±4.8726.68±5.85
t值-1.040-3.3562.038
P值0.299<0.0010.043
ADL是否受损
否197（70.4）14.99±3.9917.07±3.8929.07±4.70
是83（29.6）16.11±5.0721.60±5.0923.16±5.24
t值-1.781-7.2629.296
P值0.077<0.001<0.001
), ArticleFig(id=1322607912535577187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=EN, label=Table 2, caption=

Correlation analysis between community elderly care services, GHQ-12, and social adaption of the elderly with chronic disease(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量社区养老服务使用GHQ-12社会适应能力
社区养老服务使用1.000
GHQ-12-0.365c1.000
社会适应0.288c-0.464c1.000
), ArticleFig(id=1322607912606880356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=CN, label=表2, caption=

患慢性病老年人社区养老服务使用、GHQ-12、社会适应能力相关性分析（相关系数r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量社区养老服务使用GHQ-12社会适应能力
社区养老服务使用1.000
GHQ-12-0.365c1.000
社会适应0.288c-0.464c1.000
), ArticleFig(id=1322607912669794917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=EN, label=Table 3, caption=

Verification results of mediating effect of social adaptation

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型效应值 LLCIULCI效应量
直接效应-0.2740.059-0.390-0.15869.19%
间接效应-0.1220.029-0.182-0.06830.81%
总效应-0.3960.061-0.517-0.275
), ArticleFig(id=1322607912804012646, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607904369267257, language=CN, label=表3, caption=

社会适应能力中介效应验证结果

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型效应值 LLCIULCI效应量
直接效应-0.2740.059-0.390-0.15869.19%
间接效应-0.1220.029-0.182-0.06830.81%
总效应-0.3960.061-0.517-0.275
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患慢性病老年人社区养老服务使用对心理健康的影响及社会适应能力的中介作用
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吴嘉蕊 , 王加谋 , 王珺祝
现代预防医学 | 基层卫生服务 2025,52(20): 3743-3747
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现代预防医学 |基层卫生服务 2025 , 52 (20) : 3743 -3747
患慢性病老年人社区养老服务使用对心理健康的影响及社会适应能力的中介作用
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吴嘉蕊, 王加谋 , 王珺祝
作者信息
  • 武汉轻工大学医学与健康学院，湖北　武汉　430023
通讯作者:
王加谋，E-mail:
作者简介:

吴嘉蕊（2000—），女，硕士在读，研究方向：社会医学与卫生事业管理，老年健康

Impact of community elderly care service on mental health of the elderly with chronic disease: the mediating role of social adaption
Jia-rui WU, Jia-mou WANG , Jun-zhu WANG
Affiliations
  • College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, Hubei 430023, China
出版时间: 2025-10-25 doi: 10.20043/j.cnki.MPM.202411363
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摘要
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目的

分析患慢性病老年人使用社区养老服务对心理健康的影响及作用路径，为患慢性病老年人群的相关研究提供参考。

方法

对280名60岁及以上患慢性病老年人的社区养老服务使用与心理健康和社会适应能力进行描述统计和相关性分析，用Bootstrap法对社会适应能力进行中介效应检验。

结果

患慢性病老年人使用社区养老服务的比例为60%，GHQ-12的平均得分为（18.41±4.75）。统计分析发现使用社区养老服务与社会适应呈正相关（r=0.288，P<0.001），社区养老服务使用、社会适应能力与GHQ-12得分均呈负相关（r=-0.365，P<0.001;r=-0.464，P<0.001），患慢性病老年人使用社区养老服务通过提高社会适应能力从而负向影响GHQ-12得分，且社会适应能力的中介效应占总效应的30.81%。

结论

患慢性病老年人使用社区养老服务对心理健康具有积极影响，且社会适应能力在两者间起中介作用。

老年人  /  慢性病  /  社区养老服务  /  心理健康  /  社会适应能力
Objective

To investigate the impact of community-based elderly care service utilization on mental health outcomes and its underlying pathways among older adults with chronic diseases, providing evidence for targeted interventions in this population.

Methods

A descriptive statistical and correlation analysis was conducted on the use of community-based elderly care services, mental health, and social adaptability among 280 elderly individuals aged 60 and above with chronic diseases. The mediating effect of social adaptability was tested using the Bootstrap method.

Results

The service utilization rate reached 60% among participants, with a mean GHQ-12 score of 18.41±4.75. Significant positive correlations emerged between service utilization and social adaptation(r=0.288, P<0.001). Both service utilization and social adaptation demonstrated negative associations with psychological distress (r=-0.365,P<0.001;r=-0.464,P<0.001). The utilization of community-based elderly care services by older adults with chronic diseases negatively influences GHQ-12 scores by enhancing their social adaptability, with the mediating effect of social adaptability accounting for 30.81% of the total effect.

Conclusion

Community-based elderly care services exert beneficial effects on mental health in older adults with chronic diseases, partially mediated through enhanced social adaptability.

Older adults  /  Chronic disease  /  Community elderly care services  /  Mental health  /  Social adaptation
吴嘉蕊, 王加谋, 王珺祝. 患慢性病老年人社区养老服务使用对心理健康的影响及社会适应能力的中介作用. 现代预防医学, 2025 , 52 (20) : 3743 -3747 . DOI: 10.20043/j.cnki.MPM.202411363
Jia-rui WU, Jia-mou WANG, Jun-zhu WANG. Impact of community elderly care service on mental health of the elderly with chronic disease: the mediating role of social adaption[J]. Modern Preventive Medicine, 2025 , 52 (20) : 3743 -3747 . DOI: 10.20043/j.cnki.MPM.202411363
正文
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中国进入老龄化社会，老龄人口的数量和比例逐渐增加，据第七次人口普查显示，中国60岁及以上人口占18.70%，其中65岁及以上人口占13.50%。与此同时，老年人慢性病患病率增加，据调查我国社区老年人中有86.33%的老年人患有慢性病[1]。慢性病可以从生理、心理、社会等多维度影响老年人的健康，与健康老年人相比，患慢性病老年人其躯体功能和心理健康状况较差，从而面临更多的心理问题[2-3]，且慢性病导致的行动受限、社会角色转变等问题进一步降低老年人社会适应能力[4]。现有研究表明，患慢性病增强老年人对社区养老服务的需求，且患有慢性病的老年人对社区养老服务的利用率高于未患慢性病老年人[5-6]。研究发现，社区养老服务的使用对老年人健康具有积极影响，可以提高其主观福祉与生活质量、增加社会支持与生活满意度、促进身心健康状况[7-10]，因此，患慢性病老年人在使用社区养老服务过程中其健康也受到一定影响。值得注意的是，社会适应能力作为个体应对环境变化的关键因素，对心理健康具有显著影响。而慢性病老年人在使用社区养老服务中能增加社会活动参与度[11]，可能提升其社会适应能力。目前，关于患慢性病老年人健康与社区养老服务的研究中，社会适应能力在二者间的中介路径尚未明确。本研究旨在分析三者关系及作用路径，为健康管理提供依据。
1　资料与方法
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1.1　资料来源
本文资料来源于2024年6至7月课题研究调查数据，该课题为了解老年人社区居家养老服务使用情况采用分层抽样结合便利抽样方法，从武汉市武昌区随机抽取3个街道，每个街道中随机抽取3个社区，在每个社区中利用便利调查法选取40~50位符合纳排标准的老年人进行问卷调查。纳入标准为年龄≥60岁、在当地社区居住时长≥1年且自愿参与调查的老年人；排除标准为由于各种原因导致听力、沟通、认知等障碍无法完成调查的老年人。调查问卷内容包含三个部分，第一部分为基本情况（年龄、性别、婚姻状况、受教育程度、平均月收入、居住状况、 患慢性病情况、是否失能），第二部分为社区居家养老服务使用情况（医疗健康类、生活照料类和精神慰藉类，共12个条目），第三部分为老年人健康状况（自评身体健康、心理健康、老年人社会适应量表）。该课题调查研究获得武汉轻工大学生物医学伦理委员会批准（批准号：BME-2025-1-15），并获得所有参与者的知情同意书。
根据Green（1991）提出的多元线性回归分析的样本量估算方法：N>50+8m（N为样本量，m为自变量数量），本文研究自变量个数为20（基本情况8题，社区养老服务使用情况12题），同时考虑实际调查中20%的无效问卷，因此本文研究所需样本量至少为263份。本文根据条目“您患慢性病种类数为几种？”，剔除选择0种（即无慢性病）的参与者，最终纳入280名参与者，提取其基本情况、社区养老服务使用情况、心理健康和社会适应能力的相关数据进行分析研究。
1.2　研究工具
1.2.1　一般资料
问卷一般资料调查内容包括年龄、性别、文化程度、平均月收入、婚姻状况、居住状况等。
1.2.2　社区养老服务使用量表
由研究者自行设计，其中社区养老服务分为三类，即医疗健康类、生活照料类和精神慰藉类，共12个条目。采用李克特五点计分法：从不使用=1、很少使用=2、一般使用=3、较常使用=4、总是使用=5，总分范围为12~60分，其中12分为未使用社区养老服务，>12分为使用过社区养老服务，分值越高则社区养老服务使用程度越高。本研究中测得该量表的Cronbach α为0.766。
1.2.3　心理健康量表
心理健康状况评价采用GHQ-12量表[12-13]进行测量，量表包含6题积极性表述和6题消极性表述两个维度，共12个条目。采用李克特4点计分法：从不=1、偶尔=2、经常=3、总是=4，其中6题积极性表述条目进行反向计分，总分范围为12~48分，分值越高表明心理健康状况越差。本研究中测得该量表的Cronbach α为0.831。
1.2.4　社会适应能力量表
采用陈勃（2008）[14]编制的老年人社会适应能力量表进行测量，量表分为社会发展适应和精神文化适应两维度，共8个条目。采用李克特五点计分法：完全不符合=1，比较不符合=2，一般=3，比较符合=4，完全符合=5，其中5~8题进行反向计分，总分范围为8~40分，分值越高表明老年人社会适应程度越高。本研究中测得该量表的Cronbach α为0.843。
1.3　质量控制
采取现场面对面一对一问答的方式收集问卷，调查开始前两名调查人员统一培训，根据预调查结果对问卷进行调整。调查时严格按照纳排标准选择对象，解释研究目的并获取知情同意后开展问卷调查。双人核对问卷数据并进行收录，剔除无效问卷，控制问卷质量。
1.4　统计学方法
使用Epidata 3.0进行数据双录入，使用SPSS 27.0软件进行描述性分析，其中运用t检验、方差分析进行样本差异性分析，Pearson相关分析探讨社区养老服务使用、心理健康和社会适应能力之间的相关性。使用插件Process(Model 4）进行简单中介分析，并用偏差校正的非参数百分位Bootstrap法检验中介效应，随机重复抽样5 000次，若效应估计值的95%置信区间（CI）不包括0，则中介效应显著[15]。双侧检验，检验水准α=0.05。
2　结果
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2.1　基本情况
280名患慢性病老年人年龄60~90岁，平均年龄为（74.23±6.98）岁；男性122例（43.6%），女性158例（56.4%）；患有两种及以上种类慢性病的老年人有148例（52.9%）；使用社区养老服务的有168例（60.0%），其中平均服务使用种类为（3.01±1.71）种；患慢性病老年人社区养老服务使用平均得分为（15.33±4.36），GHQ-12平均得分为（18.41±4.75），社会适应能力平均得分为（27.32±5.56）。见表1。
2.2　患慢性病老年人社区养老服务适应、心理健康与社会适应能力的单因素分析
在280名不同特征的患慢性病老年人中，不同年龄、婚姻状况、居住状况的患慢性病老年人的社区养老服务使用情况不同，差异具有统计学意义（P<0.05）；不同年龄、文化程度、婚姻状况、个人月收入、居住状况、患慢性病种类、ADL是否受损的患慢性病老年人的心理健康和社会适应能力不同，差异具有统计学意义（P<0.05）。见表1。
2.3　共同方法偏差分析
为控制共同方法偏差问题，采用Harman单因素探索性因子分析，纳入所有量表条目，运用主成分分析提取特征根值>1的9个公因子。第一个公因子的方差解释率为21.24%（<40%），说明不存在明显的共同方法偏差。
2.4　社区养老服务与心理健康和社会适应能力的相关性分析
经偏相关分析发现，患慢性病老年人社区养老服务使用与GHQ-12得分呈显著负相关（r=-0.365,P<0.001），与社会适应能力呈显著正相关（r=0.288,P<0.001），社会适应能力与GHQ-12得分呈显著负相关（r=-0.464,P<0.001）。见表2。
2.5　社会适应能力在社区养老服务使用和心理健康之间的中介作用
为探讨患慢性病老年人的社区养老服务使用对心理健康显著影响的内在机制，在研究中进一步引入社会适应能力作为中介变量代入结构方程模型。通过采用SPSS宏程序PROCESS中的Model4进行中介效应检验。社会适应在社区养老服务使用与心理健康间的路径系数如图1所示。
利用非参数百分位Bootstrap检验法验证社会适应能力在社区养老服务使用与心理健康得分之间的中介效应。设置Bootstrap随机抽样5 000次，结果显示社区养老服务使用对心理健康得分以及社会适应能力的中介效应的Bootstrap 95%置信区间均不包含0，社区养老服务使用与GHQ-12得分之间的直接效应为-0.274，社会适应能力中介效应为-0.122，中介效应在总效应中占30.81%。见表3。
3　讨论
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本文研究结果显示，患慢性病老年人社区养老服务使用比例为60%，使用程度处于中上水平，高于以往研究所得出的社区养老服务总体利用率的结果[9]。可能原因是，本研究对象为患慢性病老年人，由于慢性病患病增强老年人对社区护理、健康管理等相关服务需求[7]，且本文研究对象所在的武汉市武昌区是全国社区养老服务示范地区，社区相关服务和设施、政策保障等方面都在一定程度上影响慢性病老年人的服务利用率。相关性分析结果得出，社区养老服务使用与GHQ-12得分呈显著负相关，说明患慢性病老年人的社区养老服务使用程度越高，心理健康状况越好，这与已有相关研究结果相符[16-17]。社区养老服务提供照顾服务和活动设施，老年人使用社区养老服务可改善生活质量、增加生活满意度[10,18]，促进心理健康状况。社区养老服务使用与社会适应能力呈显著正相关，患慢性病老年人使用养老服务、参与社区活动、与人互动等，均能促进其社会融入，提高社会适应能力[19]。此外，社会适应能力与GHQ-12得分呈显著负相关，表明患慢性病老年人的社会适应能力越高，其心理健康状况越好。老年人退休后社会转型、行为观念、角色改变等所带来的压力和挑战致使老年人容易出现心理问题，而具有良好社会适应能力的老年人往往能积极的应对问题和挑战，避免消极因素对其产生的不利影响[20-21]。
中介效应分析结果显示，社会适应能力在社区养老服务使用和心理健康间起部分中介效应，中介效应占比为30.81%。表明患慢性病老年人使用社区养老服务可以直接影响心理健康，同时也可以通过社会适应能力间接影响其心理健康。在社区养老服务使用过程中，不同服务类型均能让老年人参与到社会活动中，增加个人与社会环境的互动，提高积极的情绪水平[22-23]。社会感染理论认为，社区开展的各类活动可以调动老年人社会参与的积极性，社会参与使得老年人可以同步适应社会环境变化，降低社会排斥与孤独感[24]。也有研究表明，各种类型的社会参与模式对老年人心理健康有促进作用[25-26]，不仅能满足老年人的多元化需求，同时社区对老友好的氛围也能提高老年人的社会融合感和幸福感[27]，减少负面情绪的发生。
本研究也存在一定局限性。首先，样本来源可能导致结论外推受限，研究结论主要反映城市社区背景下相关研究的作用路径，对农村/非城市社区的适用性需谨慎评估。其次，本文为横断面研究，不能明确因果关系。此外，研究可能存在未被纳入的混杂因素（如服务可及性、家庭支持和健康行为模式等）带来的偏倚。
综上所述，患慢性病老年人社区养老服务使用对心理健康具有促进作用，社会适应在两者间存在中介作用。因此，社区在提供养老服务时，需要满足患慢性老年人的服务需求，提供个性化的养老服务，并且开展多元化的社区活动以提高其社会适应能力，从而促进患慢性病老年人的心理健康状况。在未来研究中，可扩展研究对象与范围，或在多中心样本基础上验证该中介机制并引入纵向设计明确因果方向，进一步探讨社区养老服务与心理健康间的影响机制。

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doi: 10.20043/j.cnki.MPM.202411363
  • 接收时间：2024-11-19
  • 首发时间：2026-10-29
  • 出版时间：2025-10-25
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  • 收稿日期：2024-11-19
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    武汉轻工大学医学与健康学院，湖北　武汉　430023

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王加谋，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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