抑郁对中老年慢性病人群医疗服务利用的影响研究

A study on the influence of depression on medical service utilization in middle⁃aged and elderly people with chronic diseases

理解中老年慢性病人群抑郁状况及其与医疗服务利用的关系,对优化医疗资源配置有重要现实意义。文章根据中国健康与养老追踪调查(CHARLS)2015数据,运用Logistic回归模型,以自评健康为中介,从门诊、住院双维度考察抑郁对慢性病人群医疗服务利用的影响机制。结果发现,抑郁情绪使得中老年慢性病人群医疗服务利用率显著提高,门诊服务利用率提高8.4%,住院服务利用率提高4.8%。自评健康发挥部分中介作用,影响门诊服务和住院服务利用的中介效应分别占总效应的46.02%和63.92%。抑郁情绪可直接预测,亦可通过自评健康间接预测中老年慢性病人群医疗服务利用。增加针对慢性病人群抑郁情绪的干预,关注中老年人群自我健康状态的认知能力,提高健康认知水平,以期促进医疗服务资源的合理有效配置。

Understanding the depression status of middle⁃aged and elderly patients with chronic diseases and its relationship with the utilization of medical services is of great practical significance to optimize the allocation of medical resources.Based on CHARLS 2015,using Logistic regression,we explored the influence of depression on the utilization of medical services of chronically ill people from two dimensions of outpatient and inpatient services,and tried to explain the influence mechanism by taking self⁃reported health as the mediating variable.The conclusions include:①Depression significantly increased the probability of medical service utilization in middle-aged and elderly people with chronic diseases.The probability of outpatient and inpatient service utilization increased by 8.4 percentage points and 4.8 percentage points,respectively.②Self⁃rated health played a partial mediating role,and the mediating effect affecting outpatient and inpatient service utilization accounted for 46.02%and 63.92%of the total effect,respectively.Depression can directly predict the medical service utilization in middle⁃aged and elderly people with chronic diseases or indirectly predict the medical service utilization via self⁃rated health as the mediating variable.It is suggested to increase the intervention for depression of patients with chronic diseases,pay attention to the cognitive ability of self⁃rated health status of middle⁃aged and elderly people,and improve the level of health cognition,so as to promote the rational and effective allocation of medical service resources.