ISSN 0439-755X
CN 11-1911/B
主办:中国心理学会
   中国科学院心理研究所
出版:科学出版社

心理学报, 2018, 50(9): 1061-1070 doi: 10.3724/SP.J.1041.2018.01061

研究报告

老年人孤独感及其影响因素的潜在转变分析 *

吴国婷1, 张敏强,1,2, 倪雨菡1, 杨亚威1, 漆成明1, 吴健星3

1 华南师范大学心理学院

2 广东省心理学会, 广州 510631

3 广州白云心理医院, 广州 510442

Changes in loneliness among elderly people and its effect factors: A latent transition analysis

WU Guoting1, ZHANG Minqiang,1,2, NI Yuhan1, YANG Yawei1, QI Chengming1, WU Jianxing3

1 School of Psychology, South China Normal University, Guangzhou 510631, China

2 Guangdong Psychological Association, Guangzhou 510631, China

3 Baiyun Mental Hospital, Guangzhou 510442, China

通讯作者: 张敏强, E-mail:zhangmq1117@qq.com

收稿日期: 2017-06-1   网络出版日期: 2018-09-15

基金资助: 获华南师范大学研究生创新计划项目资助.  2016wkxm91

Received: 2017-06-1   Online: 2018-09-15

摘要

采用潜在转变分析探讨老年人孤独感的类别转变及其影响因素。研究数据来源于美国Health and Retirement Study (HRS)项目组, 追踪5442名老年人4年, 两次测量其孤独感。潜在类别分析结果表明, 老年人孤独感存在4个潜在类别:低孤独感组、社交孤独组、情感孤独组和高孤独感组。潜在转变分析结果表明, 低孤独感组和高孤独感组稳定性较强, 其他两组转变程度较大。其中, 社交孤独组倾向于向低孤独感组转变, 情感孤独组倾向于向高孤独感组转变。进一步分析发现, 男性老年人更可能陷入情感孤独; 高水平社会支持、积极老化态度和生活态度取向等可能在一定程度上降低老年人的孤独感水平。结论是, 老年人孤独感可分4类, 不同类别间随时间推移发生转变, 且转变方向受各种影响因素影响。

关键词: 老年人 ; 孤独感 ; 潜在转变分析

Abstract

The high prevalence of loneliness and various accompanying adverse consequences (e.g., depression, higher blood pressure, insomnia, immune stress responses and worse cognition) are becoming serious public concerns. To provide insights on prevention and intervention programs, this study examines the properties and development of loneliness behaviors in elderly people. Taking a longitudinal perspective enables researchers to understand who is expected to transition to a higher risk status in the future, which will help to predict symptoms so that tailored interventions can be designed to protect the elderly from loneliness.
Two-wave longitudinal data over 4 years were derived from the American Health and Retirement Study (HRS). A total of 3238 women and 2205 men in their 50s were recruited. Latent class and latent transition models were used to identify meaningful subgroups of the elderly with different symptoms (i.e., lack of companionship, being left out, isolation from others, lack of belonging, and withdrawn from society) to describe transitions between those classes over the study period and to examine the effects of covariates on the latent transition model. Six covariates, including gender, marital status, attitudes toward aging, life orientation, social support and daily activities, were examined as potential predictors of loneliness.
Four loneliness subgroups were identified: Mild Loneliness (Class 1), Social Loneliness (Class 2), Emotional Loneliness (Class 3), and Severe Loneliness (Class 4). Mild Loneliness status was the most prevalent, barely showing any lonely behavior, while relatively serious loneliness occurred in Social Loneliness, Emotional Loneliness and Severe Loneliness. Specifically, individuals in Social Loneliness lacked social intercourse relation, individuals in Emotional Loneliness lacked a close relationship, and individuals in Severe Loneliness had a high probability of exhibiting all the above mentioned symptoms. Elderly people in Mild Loneliness and Severe Loneliness were highly stable, while Social Loneliness and Emotional Loneliness tended to change to other statuses rather than remaining in the original status. Particularly, the participants in Social Loneliness demonstrated a prominent trend to transition to a less problematic status (Social Loneliness to Mild Loneliness), and the participants in Emotional Loneliness tended to change to a more problematic status (Emotional Loneliness to Severe Loneliness). All participants in the four subgroups showed a strong willingness to communicate with others. Results of multinomial logistic regression revealed that elderly males were more likely to be in the Emotional Loneliness group. In addition, more social support as well as a positive attitude toward aging and optimistic life orientation were more likely to keep elderly people from entering more severe loneliness statuses, indicating an ameliorated trend of loneliness that was expected.
This study demonstrated a transition pattern in elderly people loneliness with an individual-centered approach. Differential treatment effects were found across baseline loneliness classes, suggesting the benefits of tailoring intervention programs to yield good outcomes in elderly people.

Keywords: elderly people ; loneliness ; latent transition analysis

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本文引用格式

吴国婷, 张敏强, 倪雨菡, 杨亚威, 漆成明, 吴健星. 老年人孤独感及其影响因素的潜在转变分析 *. 心理学报[J], 2018, 50(9): 1061-1070 doi:10.3724/SP.J.1041.2018.01061

WU Guoting, ZHANG Minqiang, NI Yuhan, YANG Yawei, QI Chengming, WU Jianxing. Changes in loneliness among elderly people and its effect factors: A latent transition analysis. Acta Psychologica Sinica[J], 2018, 50(9): 1061-1070 doi:10.3724/SP.J.1041.2018.01061

1 前言

近几十年来, 世界人口构成剧烈变化, 《2015全球老龄事业观察指数》指出全球60岁以上人口约9.01亿, 占世界人口12.3%, 预计到2050年, 60岁以上人口数将超过15岁以下人口数。中国、印度、美国已经成为老龄人口最多的国家。由于老年人群体中鳏孀比例较高, 迁居和都市化进程导致留守老人增多, 老年人孤独已成为全球关注的热点问题。孤独感指个体感受到被他人隔绝或孤立(Hays & DiMatteo, 1987)。美国多项研究表明孤独感在老年人群体中普遍存在(Iecovich & Biderman, 2012)。Victor, Scambler, Bond和Bowling (2000)指出, 9%~10%老年人容易产生孤独感。65岁以上老年人中, 约5%~16%易产生孤独感, 20%~40%偶尔会感到孤独(Pinquart & Sörensen, 2001)。此外, 多项纵向研究表明, 虽然随时间增长, 高孤独组老年人比例几乎不变, 但轻度孤独组老年人数增多, 不孤独组老年人数减少(Heikkinen & Kauppinen, 2011; Victor, Grenade, & Boldy, 2005)。我国也逐步进入老年社会, 研究者元分析发现, 中国老年人孤独感水平随着年代变迁逐渐上升(闫志民等, 2014), 中国老年社会追踪调查(China Longitudinal Aging Social Survey, CLASS)2014年基线数据显示, 24.78%老年人有不同程度的孤独感, 其中1.40%老年人有严重孤独感; 独居老人中有严重孤独感的比例高达5.12%。国内老年人孤独感现状不容乐观, 但国内目前缺乏对老年人孤独感的追踪研究, 所以借以美国数据为鉴。总体来说, 老年人孤独人群的比例不断增长, 关注老年人孤独感问题具有现实意义。

作为一种负向情绪情感体验, 孤独感对个体的身心健康有较大的影响。第一, 老年人孤独感与抑郁水平高相关(魏军, 2015; Cacioppo, Hawkley, & Thisted, 2010; Heikkinen & Kauppinen, 2004)。抑郁和孤独是两个独立的概念(Cacioppo, Hughes, Waite, Hawkley, & Thisted, 2006)。孤独是导致抑郁的风险因素之一, 抑郁的老年人不一定伴有孤独感, 但孤独老年人经常伴随抑郁表现。第二, 孤独感对老年人生理健康产生极大威胁。单一孤独感不会影响老年人死亡率, 但当孤独感与抑郁同时存在时, 死亡率将显著增加(Stek et al., 2005)。这可能是由于孤独感作为中介变量影响免疫系统和生理反应(Luanaigh & Lawlor, 2008), 容易导致老年人睡眠质量下降、心脑血管疾病发病率增加(Steptoe, Owen, Kunz- Ebrecht, & Brydon, 2004; Coyle & Dugan, 2012; Hawkley, Thisted, Masi, & Cacioppo, 2010)。Hawkley, Thisted和Cacioppo (2009)通过两年追踪调查也发现孤独感对老年人身体健康产生极大危害, 孤独感老年人参加运动的频率和持续时间都较无孤独感老年人少, 甚至之后几年出现完全不参加运动的现象。第三, 孤独感是老年人认知功能减退的风险因素之一。随时间发展, 孤独感老年人会比无孤独感老年人更容易发生认知功能减退(Shankar, Hamer, McMunn, & Stepoe, 2013; Tilvis et al., 2004)。因此, 研究老年人孤独感具有实践意义。

研究表明老年人孤独感受一系列因素影响。随年龄增大, 大多数老年人社交网络缩小, 社会交往频率降低, 获得社会支持减少(Rodrigues, de Jong Gierveld, & Buz, 2014)。多项研究指出社会支持能显著预测老年人孤独感, 良好的社会支持能减轻老年人孤独感(杨静, 董军, 严祥, 秦湘鑫, 2012; Ellwardt, Aartsen, Deeg, & Steverink, 2013)。此外, 对年龄增长以及未来生活保持积极态度的老年人, 感受到的孤独感更低(Castellano, 2014)。性别对孤独感的影响作用尚不明确, 一些研究表明, 女性老年人相对于男性更容易感受到孤独(谢国秀, 2013; Cohen-Mansfield, Hazan, Lerman, & Shalom, 2016; Dong & Chen, 2017), 也有一些研究表明男性老年人更容易感受到孤独(Borys & Perlman, 1985; Perlman, Gerson, & Sprinner, 1978)。因此, 应对老年人孤独感影响因素深入研究。

以往孤独感研究取得丰硕的成果, 但也存在以下两点不足:第一, 多数研究者通过量表总分或各维度总分对被试孤独感进行分类, 忽略了各题目上被试的表现, 没有深入挖掘数据。如1) Weiss (1973)提出将孤独感分为情感孤独和社交孤独, 社交孤独强调社会关系缺乏, 指与具有共同兴趣爱好的朋友缺乏交往, 导致社会交往未能满足而产生孤独感。情感孤独强调亲密关系缺乏, 指现有关系无法满足依赖、密切的需要而产生孤独感。《情感与社会孤独量表》(Russell, Cutrona, Rose, & Yurko, 1984)以该理论为指导, 分别针对两种孤独感维度设计条目, 按照各维度总分将孤独感分为社交孤独和情感孤独, 这种方法忽略了被试在各题目上的作答信息, 未能深度挖掘数据; 2) UCLA孤独感量表(Russell, Peplau, & Ferguson, 1978)认为孤独感由现有社会交往与实际水平的差距产生, 通过量表总分高低来判定被试的孤独感水平。但个体孤独感不仅只存在某单一维度, 而是各种维度的结合, 因此, 应进一步探讨是否存在不同孤独感表现模式的个体或群体。第二, 国内缺少针对老年人孤独感的纵向研究, 国外虽然有数据收集, 但是缺少探讨老年人孤独感发展规律的深入研究。我国对老年人的关注及帮助还没有建立起一个完整的体系, 对老年人各项数据收集也不足, 更缺乏纵向数据。以老年人孤独感为关键词对国内文献进行检索, 暂未发现关于老年人孤独感纵向实证研究。国内有纵向研究探讨了儿童孤独感(周宗奎, 赵冬梅, 孙晓军, 定险峰, 2006), 但老年人孤独感是否稳定不变、是否有其独特发展轨迹, 是尚未解决的问题。国外虽然有大量纵向研究探讨老年人孤独感对抑郁、死亡率、身体健康状况等因素的影响, 如Luo, Hawkley, Waite和Cacioppo (2012)采用交叉滞后法分析了老年人孤独感与健康和死亡率之间的关系, 但鲜有研究深入探究孤独感本身的发展规律。孤独感会随时间变化而改变(Heikkinen et al., 2011; Victor et al., 2005), 研究老年人孤独感变化规律有其独特价值, 可以依据变化状况提供不同的援助。

为解决上述问题, 本研究拟用潜在转变分析(Latent transition analysis, LTA)研究老年人孤独感发展规律。LTA是以个体为中心的纵向数据分析方法, 能够通过转变矩阵估计个体在不同时间点潜在状态的变化, 从转变概率的角度研究个体阶段性发展(王碧瑶, 张敏强, 张洁婷, 胡俊, 2015)。LTA不仅能科学地将老年人孤独感进行分类, 通过转变矩阵探讨老年人孤独感随时间的变化情况, 还能进一步探讨影响因素在不同类型孤独感以及孤独感转变中所起的作用。具体而言, LTA能够获得被试在每个孤独感题目上的作答特点及作答模式, 充分挖掘信息而且分类更加精确, 同时通过两个时间点上被试所属类别的变化情况, 从概率的角度描述老年人孤独感各个潜在状态随时间变化的方向。此外, LTA能将可能的风险因素作为协变量纳入模型中, 从时间发展的角度进一步验证影响因素在不同类型的老年人孤独感组中影响方向。

综上, 本研究借鉴美国数据库, 采用潜在转变分析方法, 深入挖掘纵向数据, 对老年人孤独感不同阶段及时间节点变化予以更为深刻、详尽的分析, 以启示如何更好地把握不同时间节点老年人孤独感各方面变化及需要帮助的关键点, 并对不同类型的孤独感给予针对性的干预方案及参考。鉴于此, 提出研究假设:(1)老年人孤独感随着时间会产生转变, 并且存在一定的转变规律; (2)老年人孤独感转变受性别、婚姻、社会支持、生活态度、老化态度以及日常活动因素的影响。

2 方法

2.1 被试

数据来源于美国密歇根大学健康与退休研究(Health and Retirement study, HRS), 该研究起始于1990年, 采用电话访谈、问卷、面对面访谈等方式调查美国50岁以上老年人的健康状况和经济状况, 每波调查18000~23000人。健康方面涉及老年人生理、心理、认知以及行为习惯等。研究组将所有被试分成两批, 每隔4年对同一批老年人进行调查研究。本研究选取该研究2010年和2014年老年人孤独感数据, 由于调查对象的迁徙、过世以及联系方式变更等, 2010年、2014年总作答人数分别约为8100名和7400名, 其中6874名老年人同时参与了该项调查。剔除缺失过多、规律作答、逻辑错误的样本, 共5442个有效样本, 平均年龄65(±10.47)岁, 其中女性3238人(59%), 男性2205人(41%)。

2.2 研究工具

HRS项目组采用以下研究工具:

2.2.1 孤独感量表(ULS-8)

孤独感量表(University of California Los Angeles, UCLA)简版量表(ULS-8) (Hays & DiMatteo, 1987)共8个条目, 采用3点计分(1=经常, 3=从来没有)。有孤独感表现编码1, 完全没有孤独感表现编码2, 并将积极表现的条目反向计分, 如:“有值得信赖的人”、“我想要与人来往”。两次测量其内部一致性信度良好, Cronbach’s α系数分别为0.81、0.80。

2.2.2 社会支持问卷(SSQ)

采用基线测量数据, 从社会支持问卷(Social Support Questionnaire) (Schuster, Kessler, & Aseltine, 1990)中选取7个条目, 从朋友、伴侣、孩子、亲戚四个方面考察老年人的社会支持状况。问卷为4点计分(1=总是, 4=从来不)。基线测量中, 问卷内部一致性信度良好, Cronbach’s α系数为0.84。

2.2.3 老化态度问卷(Attitudes toward personal aging)

老化态度问卷(Attitudes toward personal aging)来源于Lawton (1975)修正的费城老年中心道德量表(The Philadelphia Geriatric Center Morale Scale)中老化态度维度下的题目, 调查老年人对年龄不断增长的态度, 该维度共包含5个条目, 如:“我比去年更有活力”、“年纪越大, 觉得自己越没用”, 采用7点计分(1=完全不同意, 7=完全同意), 得分越高代表随着年纪的增长, 态度保持积极。基线测量中, 测试内部一致性信度良好, Cronbach’s α系数为0.73。

2.2.4 生活态度取向测试(LOT-R)

生活态度取向测试(the life orientation test, LOT-R)由Scheier, Carver和Bridges (1994)修订, 整个测验共包含6个条目(与3个填空条目), 用来评估老年人对所期待的结果持积极或消极态度, 如:“我对未来充满信心”、“我从来不指望好的事情会发生在我身上”。量表采用6级计分方式(1=完全不同意, 6=完全同意), 对反向条目进行反向计分, 分数越高代表越积极。基线测量中, 测试内部一致性信度良好, Cronbach’s α系数为0.77。

2.2.5 协变量

除上述因素外, 本研究还探讨了性别、婚姻状况(有伴和无伴)以及老年人日常活动情况(分数越高, 代表日常活动越多、越丰富)对老年人孤独感的影响。日常活动考察了老年人可能进行的活动, 例如下棋, 做志愿者, 读老年大学等。

2.3 数据处理

在SAS 9.2中使用PROC LTA (Lanza, Dziak, Huang, Wagner, & Collins, 2013)进行潜在转变分析。潜在转变分析中, 从零模型开始逐渐增加潜在类别的数目, 在参数限定的基础上运用极大似然法对各模型进行估计, 反复进行假设模型与观察数据之间的检验, 比较各模型的适配结果, 直至找到最佳模型(张洁婷, 焦璨, 张敏强, 2010)。模型一般采用赤池信息准则(Akaike Information Criterion, AIC)、贝叶斯信息准则(Bayesian Information Criterion, BIC)、一致赤池信息准则(Consistent Akaike Information Criterion, cAIC)等信息量统计指标来评价模型的拟合优度, 模型拟合指标数值越小代表模型拟合越好。统计检验提供p值, p值显著, 表明模型中每增加一个类别, 模型拟合优度显著提升。此外, 结合熵(Entropy)和分类误差(Error)等分类质量指标来进行综合比较选取最佳模型。熵值取值范围0~1, 越接近1, 模型分类越准确, 当熵值大于0.8时, 模型分类准确性达到90% (Lubke & Muthén, 2007)。

本研究中首先根据模型拟合指标(AIC、BIC、cAIC和aBIC)、熵值以及模型实用性, 确定本研究的最佳模型。其次, 根据最佳模型中各潜在状态的条件概率对潜在状态进行命名。最后, 对老年人孤独感的潜在转变模型及其影响因素进行分析, 探讨老年人孤独感随时间发展的规律。

3 结果

3.1 共同方法偏差检验

通过Harman单因素检验(Harman’ s One-factor Test), 分别对两个时间点的研究数据进行未旋转的因素分析, 提取出12个特征值大于1的公因子, 时间点1第一个公因子解释的变异量为18.43%, 时间点2第一个公因子解释的变异量为17.52%, 不存在单一因子解释力度特别大的情形, 表明本研究不受共同方法偏差的影响。

3.2 确定潜在类别数目

表1呈现了2010年和2014年不同类别数量潜在类别模型的模型拟合指标和熵值。由表1可知, BIC、AIC、cAIC和aBIC值随着类别数目的增多不断减小, 当模型达到4类别时, BIC和cAIC值最小, 表明4类别模型与数据拟合最佳, 且熵值较大。两个时间点上, 模型表现一致, 随着类别数的增加, 统计检验均显著, 综合考虑模型简洁性与准确性, 本研究最终选取4类别潜在转变模型。

表1   T1、T2时间点上不同类别数量LCA模型的模型拟合指标及熵值

时间点类别数目BICAICcAICaBICEntropy R2p
T1152499.9352447.1252507.9352474.511.00< 0.01
243466.6143354.3843483.6143412.590.88< 0.01
341982.4541810.8042008.4541899.830.84< 0.01
440760.6340529.5740795.6340649.410.82< 0.01
540762.1040471.6240802.9640619.140.76< 0.01
T2153110.3353057.5253118.3353084.911.00< 0.01
244153.1744040.9444170.1744099.150.88< 0.01
342594.9542423.3042620.9542512.330.85< 0.01
441298.9941067.9241333.9941187.770.83< 0.01
541302.3041011.8141346.3041162.480.82< 0.01

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3.3 类别命名

对4类潜在类别模型两个时间点的结果进行分析, 以描述和命名这4个类别。根据8个项目的条件概率(即每个类别中的个体在每个项目上分别上选择1的概率)进行命名, T1和T2的项目条件概率见图1图2

图1

图1   T1时间点孤独感LCA分类结果


图2

图2   T2时间点孤独感LCA分类结果


根据图1图2所呈现各项目的条件概率, 将其分别命名为:低孤独感组、社交孤独组、情感孤独组和高孤独感组。低孤独感组被试在多数条目上的发生率都低于10%, 该组被试占总体比例随时间略有降低, 分别是44%和43%。高孤独感组在多数条目上的发生率大于70%, 该组被试占总体的比例随时间并未发生变化。社交孤独组被试在“缺少同伴”、“被他人忽略”、“被他人孤立”3个与社会交往相关的条目上发生率较高, 在与亲密关系相关的条目上发生率较低, 该组被试占总体比例随时间略有下降, 分别为21%和20%。情感孤独组的被试在“缺少同伴”、“被他人忽略”、“被他人孤立”3个条目上发生率较低, 在其他条目上发生率较高, 该组占总体的比例随时间略有上升, 分别为14%和16%。在“我想与人来往”这一条目上, 4组被试发生率均低于10%, 说明4组被试均表现出与人交往的需要。

3.4 老年人孤独感的发生率

表2呈现两个时间点上老年人孤独感的发生率, 除“被他人忽略”“被他人孤立”两个条目外, 其余条目发生率均随时间推移逐渐上升。且在“周围的人围着我但并不关心我”、“只要我需要, 就能找到伙伴”、“有值得信赖的人”、“因为孤僻我感到不开心”四个与情感孤独有关的条目上上升率较高, 两个时间点上发生率差异显著。

3.5 老年人孤独感的潜在转变模型

潜在转变分析结果如表3所示。转变矩阵的对角线表示被试在两个相邻时间点保持原潜在状态的概率。低孤独感组和高孤独感组的被试保持原组的概率较高, 分别为77%和60%, 而社交孤独组和情感孤独组在第二次调查中保持原组的概率较低, 分别为51%和45%, 社交孤独组倾向于随时间发展逐渐向低孤独感组转变(转变概率为24%), 情感孤独组倾向于随时间变化向高孤独感组转变(转变概率为31%)。

表3   T1、T2时间点的潜在状态概率和潜在转变概率

时间点低孤独感组社交孤独组情感孤独组高孤独感组
T10.440.210.140.21
T20.430.200.160.21
低孤独感组0.770.090.110.03
社交孤独组0.240.510.100.15
情感孤独组0.150.090.450.31
高孤独感组0.060.210.130.60

注:行为2010年的潜在状态, 列为2014年的潜在状态。

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3.6 老年人孤独感的影响因素

为探究性别、婚姻状态、日常活动、社会支持、老化态度、生活取向等因素对不同组别老年人孤独感的影响, 以高孤独感组作为参照组, 进行多元多项logistics回归分析, 得出被试属于低孤独感组、社交孤独组或情感孤独组的概率与属于高孤独感组的概率在协变量影响下的变化之比, 即发生比(Odds Ratio, OR)。具体结果见表4

表4   协变量影响下T1潜在状态概率的发生比

影响因素低孤独感组社交孤独组情感孤独组高孤独感组p
性别(0=女, 1=男)0.900.741.43**REF< 0.01
婚姻状态
(0=无伴, 1=有伴)
2.24**2.28**0.96REF< 0.01
老化态度2.23**1.37**1.68**REF< 0.01
生活态度取向2.41**1.51**1.33**REF< 0.01
社会支持3.07**1.94**1.65**REF< 0.01
日常活动1.15**1.20**0.89*REF< 0.01

注:1) 行为2010年的潜在状态, 列为2014年的潜在 状态;

2) 因变量参考类别为高孤独感组, 协变量性别、婚姻状态为类别变量, 参考类别分别为女性、无伴老年人, 老化态度、生活态度取向、社会支持以及日常活动为连续变量, 分数越高, 老化态度、生活态度取向越积极、支持水平越高、日常活动越丰富;

3) *代表p < 0.05, **代表p < 0.01。

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表4可以看出, 与女性相比, 男性在情感孤独组中比例更高。除性别、婚姻状态、日常活动外, 其余影响因素的发生比都大于1, 说明这些影响因素都可能使孤独感水平降低, 但程度不同。其中积极老化态度、生活态度和高社会支持水平的被试属于低孤独感组的概率更高, 分别为高孤独感组的2.23倍、2.41倍和3.07倍。无伴的老年人更可能出现在高孤独感组。日常活动对孤独感的影响相对较低, 分别为高孤独感组的1.15倍、1.20倍。

在探究各因素对老年人孤独感类型影响的基础上, 进一步探究各因素对老年人孤独感类型间转变的影响。将保持原潜在状态的被试作为参照组, 此时, 发生比指被试转变到其他组的概率与保持原组概率的变化之比。发生比大于1表示在协变量影响下, 被试发生该转变的概率增加, 反之则减小。

表5中可以看出, 男性老年人由低孤独感组转变为情感孤独组的概率增加(OR = 1.52); 在生活态度因素影响下, 较多高孤独感组的被试转变到低孤独感组(OR = 1.51); 在积极老化态度和社会支持影响下, 社交孤独组、情感孤独组以及高孤独感组的被试转变为低孤独感组的人增多, 且具有积极老化态度的老年人更容易保留在低孤独感组; 日常活动丰富的低孤独感组老年人更容易保持在低孤独感组。这表明高水平社会支持、积极老化态度和生活取向在一定程度上是降低被试孤独感水平的积极因素, 日常活动丰富在一定程度上也有利于低孤独感被试维持原有孤独感水平。

表5   协变量影响下转变概率的发生比

影响因素潜在状态低孤独感组社交孤独组情感孤独组高孤独感组p
性别(0=女, 1=男)低孤独感组REF0.67*1.52**1.13< 0.01
社交孤独组1.37REF1.491.30> 0.05
情感孤独组0.740.53REF0.64> 0.05
高孤独感组0.41**0.730.95REF< 0.01
婚姻状态(0=无伴, 1=有伴)低孤独感组REF0.850.49**0.85< 0.01
社交孤独组1.40REF0.820.70< 0.05
情感孤独组1.281.73REF0.88> 0.05
高孤独感组0.951.570.99REF> 0.05
老化态度低孤独感组REF0.67**0.900.73*< 0.01
社交孤独组1.28*REF0.990.86< 0.01
情感孤独组1.22*0.76REF0.74*< 0.01
高孤独感组1.40*1.051.41**REF< 0.01
生活态度取向低孤独感组REF1.000.80**0.69**< 0.01
社交孤独组1.16REF1.010.83*< 0.05
情感孤独组1.050.98REF0.71*< 0.05
高孤独感组1.51**1.27*0.99REF< 0.01
社会支持低孤独感组REF0.80*0.72**0.55**< 0.01
社交孤独组1.18REF0.73*0.73**< 0.01
情感孤独组1.30*1.23REF0.85< 0.05
高孤独感组1.38*1.44**1.54**REF< 0.01
日常活动低孤独感组REF0.960.861.02> 0.05
社交孤独组1.22*REF0.830.92< 0.05
情感孤独组1.28**1.18REF1.25*< 0.05
高孤独感组0.841.160.94REF> 0.05

注:1) 行为2010年的潜在状态, 列为2014年的潜在状态;

2) 因变量参考类别为保留原组的被试, 协变量性别、婚姻状态为类别变量, 参考类别分别为女性、无伴老年人, 老化态度、生活态度取向、社会支持以及日常活动为连续变量, 分数越高, 老化态度、生活态度取向越积极、支持水平越高、日常活动越丰富;

3) *代表p < 0.05, **代表p < 0.01。

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4 讨论

本研究根据老年人孤独感表现确定了老年人孤独感的潜在状态以及在2010~2014年间的潜在转变模式, 并且检验了性别、婚姻状态、社会支持等因素对孤独感的影响。

4.1 老年人孤独感的分类

表2结果表明, 老年人孤独感发生率随时间推移轻微升高。根据老年人孤独感表现的特征和发展状态, 老年人孤独感可划分为4个潜在类别:低孤独感组、社交孤独组、情感孤独组和高孤独感组。这与以往研究结果相似。Shevlin, Murphy和Murphy (2014)运用潜在类别分析将青少年孤独感分为4组:低孤独感组、两个中等组以及高孤独感组。本研究依照被试在各题目上的作答模式将中间两组命名为社交孤独组、情感孤独组。与低孤独感组相比, 社交孤独组的被试在“缺少同伴”、“被他人忽略”、“被他人孤立”三个与社会交往缺失有关的条目上发生率较高, 在与亲密关系缺失有关的条目上发生率较低, 而情感孤独组则相反。值得注意的是, 4组被试在“我想与人交往”这一条目上均得分较高, 说明绝大多数老年人都表现出想与人交往的愿望, 这是以往多数研究采用孤独感总分将被试直接归类所忽视的内容。此外, 孤独感量表(UCLA)根据单维特质设计, 对被试评价指标以总分形式呈现, 但根据本研究结果, 在简版量表(ULS-8)中可能存在着多维结构, 提取社交和情感两个因子, 进一步进行验证性因素分析发现, 最终模型拟合度良好(CFI = 0.981, TLI = 0.970, SRMR = 0.031)。表明ULS-8量表是多维度量表, 为孤独感量表的多维结构提供了证据。

表2   T1、T2时间点孤独感表现的发生率

孤独感条目T1T2χ2
缺少同伴43.40%43.90%0.272
被他人忽略40.90%40.00%1.031
被他人孤立32.30%31.80%0.331
周围的人围着你但并不关心你51.30%53.30%4.296*
只要我需要, 就能找到伙伴35.10%38.30%11.703**
有值得信赖的人35.20%37.90%8.678**
因为孤僻, 我感到不开心32.40%34.90%7.503**
我想要与人来往5.30%5.90%1.463

注:*代表p < 0.05, **代表p < 0.01。

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4.2 老年人孤独感的转变

从潜在状态概率上看, 随时间推移, 低孤独感组老年人比例降低, 社交孤独和情感孤独组老年人增多, 高孤独感组老年人保持不变, 这与以往研究结果一致(Heikkinen et al., 2011; Victor et al., 2005)。从潜在转变概率可知, 社交孤独组和情感孤独组的老年人有很大可能性转变到其他组(转变概率分别为51%和45%), 说明这两个组稳定性较弱, 其中, 30%老年人从社交孤独组转为低孤独感组, 即社交孤独组大多数老年人的孤独感表现逐渐减少或消失; 24%老年人从情感孤独转为高孤独感组, 即情感孤独组大多数老年人的孤独感表现更加明显。这些表现说明, 与情感孤独组相比, 社交孤独组的老年人孤独感更容易得到缓解, 而情感孤独组老年人状况更容易恶化, 这可能是由于情感缺失产生的孤独很难由社会关系所填补(Weiss, 1973)。

4.3 老年人孤独感的影响因素

研究证实了性别、老化态度、社会支持等一系列因素对老年人孤独感的发生有预测作用。其中, 男性老年人与女性相比更容易出现在情感孤独组, 这可能是由于与女性相比, 男性在建立亲密社交关系、构造社会网络、获得社会支持等方面较为薄弱(Mullins & Mushel, 1992; Cohen-Mansfield et al., 2016; Dong & Chen, 2017)。在生活取向和老化态度两个因素上, 与高孤独感组相比, 生活取向、老化态度积极的老年人在低孤独感组、社交孤独组和情感孤独组的比例更高, 这与以往研究结果一致(Castellano, 2014), 即积极老化态度和生活取向的老年人感受到的孤独水平更低。此外, 社会支持也是对孤独感影响较大的因素之一, 老年人孤独感与其获得的社会支持之间呈显著负相关关系(Ellwardt et al., 2013; 王希华, 周华发, 2010), 社会支持高的老年人在高孤独感组中的比例最低。

4.4 老年人孤独感转变的影响因素

以往研究者仅从单一时间点的截面数据来研究影响因素和孤独感之间的关系, 本研究则进一步探讨随时间发展, 性别、老化态度、社会支持等因素对不同类别老年人孤独感发展过程的影响。结果表明, 就性别因素而言, 随时间发展, 男性老年人更容易从低孤独感组转变到情感孤独组, 进一步证实了与女性相比, 男性老年人更容易产生情感缺失, 感受到情感孤独, 难以建立密切的人际关系(Mullins & Mushel, 1992; Cohen-Mansfield et al., 2016; Dong & Chen, 2017); 积极老化态度对老年人孤独感影响较大, 不仅能使低孤独感组老年人保持原有低孤独感, 还能促使其他组老年人转变为低孤独感组。此外, 研究还发现, 具有积极生活态度及高社会支持水平的老年人从高孤独感转变为低孤独感组、社交孤独组和情感孤独组的概率大幅上升, 孤独感表现得到改善, 从时间发展的角度证实了生活态度、社会支持会降低老年人孤独感, 与孤独感之间呈负相关(Chalise, Kai, & Saito, 2010; 朱琳颖, 2015; 张翔, 苏少贞, 谢芳, 张兰月, 韦磐石, 2017)。另外, 日常运动丰富的老年人, 更容易稳定在低孤独感组, 且更容易从情感孤独组转为低孤独感组。上述结果表明, 老化态度、生活取向、社会支持和日常活动等因素能够有效的降低及预防老年人的孤独感。

4.5 本研究对改善老年人孤独感的指导意义

研究结果可以为老年人孤独感改善提出一定指导意见。第一, 通过问卷、访谈等形式对老年人孤独感情况进行调查, 识别出属于社交孤独组、情感孤独组和高孤独感组的老年人, 针对其稳定性较弱的特点进行合适的引导和干预, 促进其向低孤独感组转变; 第二, 高孤独感的老年人占总体比例很高, 达到21%左右, 严重的孤独感可能会引发高血压、睡眠质量下降, 免疫应激反应以及老年人认知功能等疾病, 且低孤独感的老年人亦有可能向高孤独感转变, 相关人员应该对老年人孤独感给予充分重视和警惕; 第三, 利用能够改善老年人孤独感的因素, 可对老年人进行适当的指导和干预, 比如社会支持、日常活动等; 大多数老年人表现出想与人交往的愿望, 应多开展活动, 满足老年人发展朋友的需要, 建立更多老年人社交场所, 让老年人有聚会交流的机会, 减轻老年人孤独感, 同时在一定程度上也可让老年人向低孤独感转变。关注独身老年人, 及时对其进行心理疏导, 鼓励并帮助其建立稳定的社交关系; 第四, 应多关注男性老年人的孤独感状况, 相对于多数女性, 部分男性由于缺乏稳定、密切的社交关系而更容易感受到孤独。

4.6 对国内孤独感研究启示

本研究采用美国老年人数据, 研究结论在一定程度上为国内老年人孤独感研究提供了参考。中国是人口老龄化问题最严重的国家之一。目前国内对老年人关注度逐渐上升, 如国内正在积极开展实施中国老年社会追踪调查。孤独感作为影响老年人生活质量的重要因素, 也越来越受到国内研究者重视。有研究者采用中国老年社会追踪调查2014年基线数据发现, 24.78%老年人有不同程度的孤独感, 老年人孤独人群占比较高, 形势较为严峻。

研究显示, 美国老年人孤独感存在不同类型, 老年人所属孤独感类型会随时间发展按照一定规律发生转变, 且老年人孤独感发生、发展会受到各种因素的影响, 那么国内老年人孤独感是否也具备同样的规律, 还有待进一步研究。随着中国社会追踪调查数据的完善, 研究者有机会深入了解中国老年人的心理健康状况及发展变化情况, 从时间发展的角度, 探讨国内老年人孤独感的发生、发展规律。本文介绍的潜在转变分析方法适合于纵向研究, 且得到了有意义的结论, 可为国内相关研究提供方法借鉴。

5 结论

(1)根据老年人孤独感的表现, 老年人孤独感可划分为4个潜在类别:低孤独感组、社交孤独组、情感孤独组和高孤独感组。老年人孤独感表现出不稳定性, 随时间发展, 社交孤独组更容易向低孤独感组转变, 情感孤独组更容易向高孤独感组转变。

(2)绝大多数的老年人表现出想与人交往的愿望。

(3)社会支持、生活取向、老化态度是影响老年人孤独感以及孤独感转变的重要因素, 日常活动在一定程度上可以稳定低孤独感组老年人的孤独感水平。

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心理研究, 8( 4), 36-43.]

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纵向研究是心理与社会研究领域的一种重要方法。当研究对象的外显变量和潜在变量都属于类别型数据时,可以用潜在转变模型对数据进行分析。潜在转变模型是一种个体定向的纵向数据分析方法,能够通过转变矩阵估计个体在不同时间点潜在状态的变化,从转变概率的角度研究个体的阶段性发展。本文在系统地介绍了潜在转变模型的原理和优点的基础上,结合青少年冲动行为发展的实例介绍具体的分析方法,展示了该方法对纵向数据分析的适用性。

Wang, X. H., & Zhou, H. F . ( 2010).

The status quo of life quality, loneliness and happiness in elderly people and its relationship

Chinese Journal of Gerontology, 30( 5), 676-677.

[ 王希华, 周华发 . ( 2010).

老年人生活质量、孤独感与主观幸福感现状及相互关系

中国老年学杂志, 30( 5), 676-677.]

DOI:10.3969/j.issn.1005-9202.2010.05.043      URL     [本文引用: 1]

目的研究漳州市城乡老年人的生活质量、孤独感和主观幸福感的现状及其相互关系。方法采用生活质量、孤独感、主观幸福感量表分别施测于城乡老年人。结果漳州市城乡老年人的生活质量、孤独感和主观幸福感在性别、年龄上不存在显著差异;城乡比较发现,农村老年人主观幸福感、生活质量显著低于城市老年人,在孤独感方面显著高于城市老年人;老年人的主观幸福感与生活质量各因素存在显著正相关;孤独感与主观幸福感、生活质量各因素间存在显著负相关。结论城乡差异对老年人生存质量、孤独感和主观幸福感有重要影响;老年人主观幸福感对老年人生活质量有正向预测作用,老年人孤独感对老年人生活质量有负向预测作用。

Wei, J. ( 2015).

The loneliness and depression of elderly people in country area

The Journal of Medical Theory and Practice, 28( 15), 2104-2105.

[ 魏军 . ( 2015).

农村老年人的孤独感与抑郁

医学理论与实践, 28( 15), 2104-2105.]

URL     [本文引用: 1]

目的:探讨农村老年人孤独与抑郁的关系。方法:对121例农村老年人进行UCLA孤独量表和老年抑郁量表测评,用相关分析和线性回归分析老年人孤独与抑郁的关系。结果:UCLA孤独量表和老年抑郁量表评分呈显著正相关(r=0.45,P<0.001),线性回归控制社会人口学变量对抑郁的影响后,孤独量表评分对老年抑郁评分的回归系数依然显著(标化β=0.31,P<0.001)。结论:孤独感是老年人抑郁的危险因素之一,减少老年人的孤独感有助于预防和减轻老年人的抑郁情绪。

Weiss R. S. (Ed).( 1973). Loneliness: The experience of emotional and social isolation Cambridge, MA, USA: MIT Press The experience of emotional and social isolation. Cambridge, MA, USA: MIT Press.

[本文引用: 2]

Xie, G. X . ( 2013).

The relationship of loneliness in socialization of aged support agencies

Science of Social Psychology, 28( 7), 88-92.

[ 谢国秀 . ( 2013).

社会化养老机构中老年人孤独感之关系调查分析

社会心理科学, 28( 7), 88-92.]

URL     [本文引用: 1]

采用情绪—社会孤独问卷(ESLI)对406名老年人进行调查,探讨老年人孤独感的状况。其结果表明:(1)养老院老人的孤独感在性别上差异较大,且女性显著高于男性;(2)居住在城市的老年人孤独感低于农村老年人;(3)老年人的孤独感在是否丧偶上有显著差异,丧偶老人孤独感指数显著高于未丧偶老人;(4)老年人的孤独感在睡眠质量上有显著差异,睡眠质量好,孤独感体验较低。

Yan Z. M., Li D., Zhao Y. H., Yu L., Yang X., Zhu S. R., & Wang P . ( 2014).

Increasing loneliness in old people: A cross-temporal meta-analysis from 1995 to 2011

Advances in Psychological Science, 22( 7), 1084-1091.

DOI:10.3724/SP.J.1042.2014.01084      URL    

Due to the dramatic social change, Chinese older people may have experienced increasing loneliness in recent decades. Wecomprehensively reviewed 25 studies using cross-temporal meta-analysis which were published from 1995 to 2011 and involved 13,280 old people. Results showed that(1) a positive relationship between loneliness and the year was found with 0.95 SD increased from 1995 to 2011;(2) loneliness scores for married and non-married groups had been increasing significantly,also to male and female groups;(3) the difference was significant betweennon-married and married people, but no difference was found between males and females.

[ 闫志民, 李丹, 赵宇晗, 余林, 杨逊, 朱水容, 王平 . ( 2014).

日益孤独的中国老年人: 一项横断历史研究

心理科学进展, 22( 7), 1084-1091.]

[本文引用: 1]

Yang J., Dong J., Yan X., & Qin X. X . ( 2012).

A study on the relationship of the senior in-patients’ loneliness and social support

Psychological Exploration, 32( 6), 570-573.

URL    

To study on the relationship between social support and loneliness of the senior in-patients.Using general information,Social Support Rating Scale(SRSS),and UCLA Loneliness Scale of 487 cases of a questionnaire-based elderly patients.Social support of the senior in-patients was significantly related to and controlled by sex,religious belief and marriage(p0.05),Loneliness of the senior in-patients was significantly related to and controlled by marriage(p0.05).Loneliness and social support(r=-0.281)、Objective support(r=-0.175)、Subjective support(r=-0.248)、the degree of using social support(r=-0.122) was negatively correlated(p0.01).Objective support(R2=0.073)and Subjective support(R2=0.062)can predict the senior in-patients’ loneliness significantly(p0.05).Good social support can reduce the senior in-patients’ loneliness,the family and nursing personnel should help the senior in-patients use and establish effective social support system,so as to alleviate their loneliness.

[ 杨静, 董军, 严祥, 秦湘鑫 . ( 2012).

老年住院患者孤独感与社会支持的关系

心理学探新, 32( 6), 570-573.]

DOI:10.3969/j.issn.1003-5184.2012.06.017      URL     [本文引用: 1]

该研究采用社会支持评定量表和 UCLA孤独量表对487名老年住院患者进行调查分析。结果显示,老年住院患者的社会支持在性别、宗教信仰、配偶等方面的差异显著,老年住院患者的孤独感 在配偶方面的差异显著。孤独感与社会支持、客观支持、主观支持和对支持的利用度呈显著负相关。客观支持和主观支持能够显著预测老年住院患者的孤独感。良好 的社会支持能够减轻老年住院患者的孤独感。

Zhang J. T., Jiao C., & Zhang M. Q . ( 2010).

Application of latent class analysis in psychological research

Advances in Psychological Science, 18(12), 1991-1998.

DOI:10.3724/SP.J.1142.2010.40521      URL    

Latent class analysis is a statistical technique used to identify subtypes of related cases.In the method,statistic model is built according to relationship between categorical observed and latent variables,and then manifest performances of each latent classes are respectively described based on the related parameters in the model.The analytical approach is mainly used in(1) classification of psychological or behavioral traits;(2) controlling the systematical error of cognitive experiments caused by individual differences;(3) assessing accuracy of clinical psychology diagnostics;(4) analyzing difficulty,discrimination,reliability and structure of psychology measurement.Both strong and weak points are considered,which indicates that,in respect of future development in the psychometric application,the method will be combined with other theoretical frameworks of measurement and also applied to longitudinal and multilevel data.Moreover,the application still sees room for improvement in its methodological technique.

[ 张洁婷, 焦璨, 张敏强 . ( 2010).

潜在类别分析技术在心理学研究中的应用

心理科学进展, 18( 12), 1991-1998.]

[本文引用: 1]

Zhang X., Su S. Z., Xie F., Zhang L. Y., & Wei P. S . ( 2017).

The social support, loneliness and happiness in empty-nest elderly people and its correlation

Chinese Journal of Gerontology, 37( 1), 191-194.

[ 张翔, 苏少贞, 谢芳, 张兰月, 韦磐石 . ( 2017).

农村空巢中老年人社会支持、孤独感与主观幸福感及相关性

中国老年学杂志, 37( 1), 191-194.]

[本文引用: 1]

Zhou Z. K., Zhao D. M., Sun X. J., & Ding X. F . ( 2006).

Children’s experiences with peers and loneliness: A two- year longitudinal study

Acta Psychologica Sinica, 38( 5), 743-750.

[ 周宗奎, 赵冬梅, 孙晓军, 定险峰 . ( 2006).

儿童的同伴交往与孤独感: 一项2年纵向研究

心理学报, 38( 5), 743-750.]

URL     [本文引用: 1]

Evidences from researches on both primates and human supported the hypothesis that problems in early peer relationship could lead to subsequent psychosocial maladjustments, including externalizing and internalizing problems (such as feelings of loneliness and depression). While children’s experiences with peers can be best understood by referring to several levels of social complexity: within individuals, within interactions, within relationships, and within groups. Previous researches had revealed that loneliness was associated with a variety of peer variables at each of the four levels. Most existing researches had focused on the influences of peer variables on loneliness. Less examined was the impact of loneliness on peer variables. The present study was designed to explore the interaction between loneliness and peer variables using a 2-year longitudinal design. This study examined 274 children from Grade 3 to Grade 4 in 2002 and 2004. This study used the measures auch as the Perceived Competence Scale for Children, the Revised Class Play, Friendship Nomination and Friendship quality Questionnaire, Sociometric Nominations, and Children’s Loneliness Scale to assess self-perceived social competence, social withdraw and peer victimization scores, mutual friends number and best friendship quality, positive nomination and negative nomination, and loneliness score, respectively. Cross-lagged regression analysis was conducted to examine the mutual predicative relations between loneliness and peer variables within each of the four levels. The results indicated that (1) there is a mutually predictive relations between peer variables and loneliness during the two-year interval such that (a) at the group level, after controlling other variables at Time 1, no significant cross-lagged effects were found between “liked most” nomination, “like least” nomination, and loneliness; (b) at the relationship level, after controlling other variables at Time 1, there was a significant cross-lagged effect between friendship quality and loneliness, suggesting that early friendship quality significantly predicted loneliness two years later, and early loneliness also significantly predicted friendship quality two years later; additionally, number of early mutual friends significantly predicted loneliness two years later, whereas early loneliness didn’t predict number of mutual friends two years later; (c) at the interaction level, after controlling other variables at Time 1, no significant cross-lagged effect was found between passive withdraw, peer victimization, and loneliness; (d) at the individual level, after controlling other variables at Time 1, there was a significant cross-lagged effect of self-perceived social competence on loneliness and vice versa, indicating that early self-perceived social competence significantly predicted loneliness two years later, and early loneliness also significantly predicted self-perceived social competence two years later. (2) With respect to the stability of peer variables and loneliness during the 2-yealr interval, the “like most” nomination, “like least” nomination, peer victimization, passive withdraw and number of mutual friends were highly stable, while best friendship quality, self-perceived social competence, and loneliness showed moderate stabilitie. Conclusions: Forst, mutual predictive relation between self-reported peer variables and loneliness were more stronger than that between peer-rated peer variables and loneliness. Second, the peer-rated variables (i.e., “like most” nomination, “like least” nomination, peer victimization, passive withdraw and mutual friends number) were more stable than those of self-reported variables (i.e., friendship quality, self-perceived social competence and loneliness). Third, once the characters of peer variables merged, they would show continued stability

Zhu, L. Y . ( 2015).

The research on relations of elderly social support, loneliness and life satisfaction (Unpublished doctorial dissertation)

Henan University.

[ 朱琳颖 . ( 2015).

老年人社会支持、孤独感与生活满意感的关系研究(博士学位论文)

河南大学.]

[本文引用: 1]

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