維基百科

中國的老年抑鬱症

中国老年人的抑郁症影响因素

老年抑鬱症指老年人表現出長時間情緒低落或喪失興趣的一種精神障礙。利物浦大學進行的一項薈萃分析顯示，與西歐12%的患病率相比[1]，中華人民共和國的老年抑鬱症佔比為 3.86%[2]，這可能受到中國傳統文化、社會期望和生活條件等因素的影響。其中，研究中所報告的較低患病率是否因文化和傳統差異導致仍存在爭議[3]。

症狀和診斷

Yesavage和Brink編制的老年抑鬱量表(Geriatric Depression Scale; GDS) 是在眾多關於中國老年抑鬱症研究中最常見的方法[4]。而後,來自香港中文大學的Chu Lee Hing將其翻譯成了中文版本[5]。在香港的一項研究表明，其「簡潔的回答形式尤其適用於老年人」，並且提供了「令人滿意」的抑鬱症篩選結果[6]。

GDS分析了有關哭泣、食欲不振、睡眠、體重、記憶力、注意力、活力和愉悅等一系列簡單的行為症狀，然而僅針對情感的分析可能會根據文化環境產生不同的含義[7]。

一般健康問卷(The General Health Questionnaire; GHQ)[8]在某項研究中也被認為是可靠的，但不如GDS[9]敏感。本研究也以香港老年人為樣本。而另一種適用於中國老年人的評估方法是老年精神狀態量表(GMS)。這是一種評估65歲及以上老年患者精神病理的訪談法，根據症狀類型和該類型隨時間發生的變化進行分類[10]。在GMS中的分數可以使用計算機輔助診斷系統(Automated Geriatric Examination for Computer Assisted Taxonomy, AGECAT)進行進一步的詳細診斷[11][12][13][14]。

文化差異

長期以來，學者們一直在研究中西方對抑鬱症定義的差異。Science Magazine 雜誌的心理健康記者Greg Miller寫道:「在傳統中醫中，精神疾病通常被歸因於心臟類疾病[15]。」 Harvard Review of Psychiatry 發現，傳統中醫中沒有情緒障礙的概念；相反，它強調一種身體上的不平衡[16]。據報道，抑鬱症患者將自己描述為「情緒上…...加身體上的干擾，尤其是對心臟的影響…...這種身體上的不適並非僅僅是比喻；在哈佛大學的一項有關中國人抑鬱經歷的民族學的研究中，一些患者表示他們的抑鬱症表現為心臟不舒服[17]」。像「心慌」、「心煩」、「心痛」等短語是抑鬱症患者用來形容身體不適的詞語[18]。在這項研究中，患者很少將他們的感受描述為悲傷，因為它通常被視為是「可恥的」，是「性格軟弱」的表現[19]。因此，在宣揚堅忍的這種文化下長大的中國人更願意接受抑鬱症是身體上的疾病，比如心臟疼痛或失眠，而非情緒上的問題[20]。

神經衰弱，即「神經缺乏力量」，在20世紀初被引入中國大陸後就成為精神疾病的首選診斷結果。在漢語中，神經衰弱指整個身體的生命能量(氣)流動的虛弱[21]。這似乎更像是一種軀體疾病，包括疲勞、身體非特異性疼痛、頭暈、胃部不適、食欲不振、記憶力衰退和失眠等症狀[22][23][24]。直到鄧小平提出改革開放，政治上才允許「公共與私人空間界限的重新出現」[25]，從而提升了社會對這種疾病的接受度，承認了其本質上是情緒的問題，並開始針對情緒障礙進行研究和治療。 到了20世紀80年代，「神經衰弱」的標籤被去掉，改用西方的「抑鬱症」一詞[26]。

傳統觀念

在中國文化中，「養老」是很重要的概念[27]。在儒家思想中，子女們為長輩提供身體上、經濟上和情感上的照顧是一種表示尊敬的方式[28]。與此同時，老年人很期望能通過他們的建議和服務為社區做出貢獻，而不是自己接受這些建議和服務——這是一種「人情」[29]。對于堅持傳統的老年人來說，老年生活的目的和自我價值是通過對家庭的積極影響來衡量的[30]。

《中國醫學雜誌》(Chinese Medical Journal)的一項關於中國的孝道文化以及對老年人經濟照顧的研究顯示，在某個從中國大陸移民到加拿大的華人樣本中，23.2%的人被評估有抑鬱症狀。而在抑鬱組中，17.3%的人被認為處於「經濟狀況不穩定」的狀態[31]。

總體而言，在許多研究中，女性抽樣調查中抑鬱的人數比男性更多。這可能是由中國社會長久以來認為男性應該壓抑情感導致的，因為任何情感問題上的求助都被視為軟弱的表現[32]。此外，也有研究發現，城市社區中受教育程度低的寡婦患抑鬱症的風險更高。

潛在影響因素

軀體原因

Chong 等人的一項研究還發現，健康問題是老年人產生心理壓力的一大因素[33]。另一項研究發現，與沒有接受任何治療的老人相比，參加太極拳運動的中國老年人的抑鬱症狀有所減輕，這與《國際老年精神病學雜誌》（International Journal for Geriatric Psychiatry[34]）的發現相符。而香港中文大學的一項研究表明，體能和健康問題會影響病人的生活質量，而生活質量會影響抑鬱程度[35]。發表在《Stroke》雜誌上的一項研究數據證實，中風後的抑鬱症狀很常見。中風導致日常生活活動減少，對中國農村老年人抑鬱的嚴重程度有很大影響[36]。另一項在中國農村進行的研究發現，「未被發現的」高血壓與抑鬱症有顯著關係，這表明 "在老年群體中進行高血壓篩查可能對預防抑鬱症和心血管疾病有必要"[37]。

據一項針對香港華人老年人的研究發現，「吸煙者（當下/曾經）比不吸煙者更容易出現抑鬱症狀」 [38] 。

生活狀況

據調查，在1987 年， 65%的中國老人與兩代（有時是三代）家人同住，18%與一代同住，11%的老年夫婦沒有與子女同住，只有 4%的老人獨居（儘管他們有子女），2%單身[39]。研究發現，在香港，孤獨感對老年女性抑鬱症患病率的影響比老年男性更大。最後得出結論，這是因為大齡男性（因在香港找不到妻子）與內地女子跨境結婚，從而適應了兩地分居的生活方式[40]。

經濟原因

Li Hong和Martin Tracy的研究表明[41]，1999年，48%的中國老年人依賴配偶，40%依賴子女。克里夫蘭州立大學的Rongjun Sun說：「擔心沒有足夠的錢支付醫療費用是城市居民新的壓力來源。」Sun的研究結果表明，「醫療覆蓋的充足性對提升老年人的幸福感有實質性影響」，「在所有家庭支持措施中，子女的情感支持被發現對老年人的抑鬱有顯著的緩衝作用。[42]」

與收入不同，經濟壓力，也就是支付日常開支的能力和「出現意外支出需求」時感到的擔憂都會影響抑鬱症[43]。這項針對香港老年人的研究進一步發現，身體健康有問題的女性更容易因經濟壓力而加重抑鬱[44]。此外，研究還認為，社會支持增強並不一定會減輕經濟壓力對抑鬱的影響，這與上文提及的Sun的「緩衝效應」的發現相矛盾。1998年對武漢市老年人的一項研究發現，「對經濟支持的期望」（anticipated support）是減少經濟壓力對抑鬱症影響的來源。預期支持帶來安全感，而「獲得經濟支持」 （received support）通常會引發老年人的內疚感[45]。

有關抑鬱症的問題

一些人認為，由於文化差異，報道中的低患病率是有誤的，而另一些人則認為，文化差異是低患病率的原因。Gordon Parker等人認為，大多數中國人否認抑鬱症。「抑鬱症在中國人中似乎不太明顯，並且更有可能通過軀體表達[46]，這是一系列因素相互關聯的結果」，而Mjelde-Mossey等人則認為，「堅持傳統與抑鬱症呈負相關，因此這是一種對抗抑鬱症的方法[47]」。R. Chen等人基於對中國農村老年人的研究，給出了抑鬱症患病率較低的三個原因:

第一，中國老年人的社會支持和積極的生活價值觀水平較高。第二，農村地區的工作和生活環境更輕鬆(例如，工作壓力更小，體力勞動更多)。第三，群體內部疾病的原因可能不同於解釋群體之間差異的因素[48]。

Parker研究中造成低患病率的因素[49]：

  • 抑鬱症報告率低
  • 神經衰弱的「慣用報道」
  • 「缺乏基於標準的分類」導致抑鬱症篩查出現問題
  • 斯多葛主義、文化支持和較低城市化水平的應對機制

Mjolde-Mossey 研究中使用的中國傳統量表中項目的頻率分佈[50]：

中國傳統量表項目 同意度 %
生病時要依賴子女 79.4
因資金問題向子女求助 74.9
子女應承擔老人經濟需要的責任 71.6
子女收入來源 62.9
幫助周圍的人做家務 56.4
在有需要時獲得子女的經濟援助 51.5
當直系親屬情緒低落時安慰他們 50.1
其他人會與您討論重要決定 41.9
當親戚情緒低落時安慰他們 22.2

抑鬱症預後與發展

據預測，到22世紀中葉，中國老年人將佔世界老年人口的25%[51]。基於這樣的數據，了解如何預防中國老年人的抑鬱症，將有助於改善關於照顧老年人及其家人福祉上可能出現的一些問題。

Sun的研究發現，相較於與子女相隔遠的老年人，與子女同住的老人的幸福感更高[52]。由於人際關係的複雜性和不同測量方法帶來等變量帶來的影響，家庭支持對老年人的幸福感並沒有持續產生積極影響，然而，孫的研究證實，家庭關係在緩衝不良社會事件的影響方面發揮了關鍵作用[53]。考慮到中國未來的家庭狀況，獨生子女政策將會對獨生子女贍養父母帶來不少問題[54]。

Mjelde-Mossey等人的研究還得出了一個結論：由於恪守傳統可以減少抑鬱的產生，老年人可以通過將他們的傳統信仰應用到生活中的任何非傳統情況和關係中，以此在一定程度上達到穩定的精神狀態[55]。在這樣的背景下，中國老年人可能會被其他社會變化而影響，如獨生子女，家庭成員間接觸的缺乏以及對於青年自我中心化等西方傳統觀念的支持[56]。

引用

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