社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

原著

Gender differential on the structural relationship between
socioeconomic status, mental health and need for long-term care:
A cross-sectional study among tibetan elderly
社会経済要因、精神的健康と要介護度との関連構造―チベット高齢者における横断調査
Fanlei Kong1）, Bin Ai2）, Shuo Wang1）, Tanji Hoshi1）孔凡磊 1）、艾斌 2）、王碩 1）、星旦二 1）1）Graduate School of Urban Environment Science, Tokyo Metropolitan University, Japan
2）School of Ethnology and Sociology, Minzu University of China, China
1）首都大学東京

都市環境科学研究科

2）中央民族大学

民族学と社会学学部

ABSTRACT
Objective: The purpose of this study was to explore the structural relationship between socioeconomic status(SES), mental health and need for long-term care (NLTC), with the goal of providing useful information to prevent
the NLTC. Method: 1,836 (39.8% of male, 60.2% of female) respondents were conducted in Lhasa and Shigatsecity in Tibet from July to August in 2009. Descriptive analysis, factor analysis and structural equation modelingwere performed to identify the association between SES, mental health and NLTC. Results: Positive correlation
between SES and mental health was observed among the Tibetan elderly, while it was slightly stronger for the
Tibetan female elderly. There is a negative correlation between mental health and the NLTC among the Tibetan
elderly, and it was little stronger among the Tibetan male elderly. SES of the Tibetan elderly would not only
have a direct impact on the NLTC, but also have an indirect impact on the NLTC through mental health, andboth of the effects are negative. Conclusions: Slight gender differential were found on the structural association
between SES, mental health and NLTC. The results highlight the importance of enhancing the individual’s SES
and their mental health.
抄

録

目的：本研究の目的は、社会経済要因、精神的健康と要介護度との関連構造を明らかにすることにより、要介護人
口を減少するために活用される科学的エビデンスを提供することである。方法：2009 年の 7 月から 8 月まで、チベットのラサ市とシガツェ市にて調査を行った。1,836 人（男性 39.8％、女性 60.2％）の回答を収集した。記述分析、要因分析と構造方程式モデリングで社会経済要因、精神的健康と要介護度との関連構造を分析した。結果：チベッ
ト高齢者では、社会経済要因と精神的健康との正相関が明らかになり女性の正相関は、男性より強いことが示された。また、チベット高齢者では、精神的健康と要介護度との負の相関が明らかになり男性の負相関は、女性より強いことが示された。チベット高齢者の要介護度は、社会経済要因からの直接的な影響の他に、精神的健康を経由す
る間接的な効果が示され、直接効果と間接効果は共にマイナス効果になっていた。結論：本研究により社会経済要
因、精神的健康と要介護度との関連構造が明らかになり、性別差異が示された。要介護予防のためには、個人の社― 79 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

会経済要因と精神的健康の重要性が明らかになった。
Key words：SES, mental health, NLTC, gender differential, Tibetan elderly
キーワード：社会経済要因、精神的健康、要介護度、性別差異、チベット高齢者
1．Introduction

poverty-stricken areas reported a relatively higher

1.1 Population aging in China

unmet care needs than the other groups 6）. Hoi

United Nations defines the aged society as: if thele et al. studied the determinants of the Vietnam

population aged 60 years old and above accounts for

elderly aged 60 years or over and the results

more than 10% of the total population in a country

showed that SES, such as education level, working(or region), or the population aged 65 years old or

status, household income affects the NLTC among

over accounts for 7% of the total population, thethe elderly respondents7）. Laporte et al. found thatcountry or region could be recognized as entry of

the individual in the lower SES having a higher

1）

the aged society . According to the report of thepropensity and intensity of care needs among the

1% population sampling survey which conducted

Canada home-caring elderly8）. A long-term study

in 2005 by the Nation Bureau of Statistics of China,

among the 35,926 Finnish elderly conducted bythere were 144.08 million older persons who aged

Martikainen et al. suggests that the elderly in a

60 or over, accounting for 11.03 percent of the totallower SES are more likely to use the LTC; andChinese population. As for the population aged 65

shows the impact of SES on the entry of institutionaland more, the total number reached to 10,045 million,

care is stronger on the women than men. It should

2）

constituting 7.69 percent of the total population .

be noted that the possibility of women into the

From this perspective, China has entered the aged

pension agency receiving long-term care than men

society in 2005. Moreover, according to the data of

because of their age and the larger living alone havethe sixth national census of China in 2010, there werea higher likelihood9）.

177,648,705 older adults aged 60 years old or over,
1.2.2

accounting for 13.26 percent of the total population

Association between mental health and
NLTC(of which 118,831,709 aged 65 years or over and3）

about 8.87 percent of the total population) . It

Previous researches showed that the sick or frailmeans, during these five years, the population aged

populations, such as stroke patients10）, those with60 years or over has increased by about 3,356 people

mental retardation11） or the elderly with dementia12）(the population aged 65 and above has increased by

are suffering higher likelihood of mental illness

about 1,838 million). Such a number is equivalent(such as tension and depression) , are in higher need4）

to the total population of Canada in 2011 . As thefor LTC. In addition to the general population, theaging trend proceed, researchers predict that the

researchers studied the veterans a lot. Sorrell andproportion of the elderly aged 65 years or more will

Durham found that the long-term care facilities whichreach 14.3 percent in 2025, and will further amountunder the United States Department of Veterans

5）

Affairs cannot meet the needs of those veterans withto 26 percent in 2050 .

cognitive decline and home caring service, the need
1.2
1.2.1

Literature review

to invest more resources in order to meet future

Relationship between socioeconomic

caring needs of an increasing number of veteransstatus (SES) and need for long-term careis urgent13）. Samuelsson et al. followed up the 192(NLTC)

elderly who received home care or institutional care

McKevitt et al. showed that, among the 1,251 UK

in southern Sweden for 25 years and showed thatelderly who caught the stroke, the elderly living inamong these older persons, 53 percent of them were

― 80 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

with dementia, 34 percent of them with more or less

2．Method
2.1

mental illness and only 12 percent of them were innormally mental conditions

14）

Hypotheses of the research

Based on the literature review and the objectives,.

the following hypotheses are proposed:
1.2.3

Hypothesis 1: There is a strong positive correlation

Correlation between SES and mental
healthbetween SES and mental health among the Tibet

Existing studies consistently showed that there isurban elderly. That is, a better socioeconomic status

an negative relationship between SES and mentalof a Tibet urban elderly would generally predict a

health, namely, the individuals with a lower SES

better status of his mental health. Moreover, gender

had a higher possibility of suffering from mental

difference will be found.

. In other words, people with

Hypothesis 2: A negative relationship would be

the lower SES had the higher likelihood of being

observed between mental health and NLTC among

health problems

15）

with mental illness

16, 17）. Specifically, individuals

the Tibetan urban elderly, which means a betterwith higher incomes, compared to those of lower

mental health of the Tibet urban elderly, will haveincome individuals, had a better mental health18, 19）;

the lower need for LTC. What is more, gender

those who were in employment would in a better

differential will be observed.
Hypothesis 3: SES could not only affect the NLTC

self-reported mental health than that of out. In addition, concerning thedirectly, but also exert an indirect effect on therelationship between education and mental health,

NLTC through the mental health. Here, the directa study conducted among the Japanese populationand indirect effects should be negative. Moreover,showed that there is a significant linear correlation

gender difference will be found.

of employment

20）

between the education of the female and their mental
2.2

health, while such an association does not exist in theJapanese male

21）

Study location and subjects

Tibet Autonomous Region has one prefecture-.

level city, six regions and 73 counties. A prefecture1.3

Summary of the literature and the objective

level city is also the capital of the Tibet Autonomous

In a word, the previous researches examined

Region -Lhasa city. In addition, a county-level city --the relationship between SES and mental health

Shigatse city is concluded in Shigatse region.

is relatively at most, followed by the researches

Concretely, seven counties, one region (named

focused on the relationship between SES and NLTC,

Chengguan District, include seven sub-district

while the studies clarified the association between

offices and 28 community committee) is under thethe mental health and NLTC was relatively least.

jurisdiction of Lhasa; while Shigatse city includes 10

However, to date, there is still no research clarified

townships, two sub-district offices (10 community

the relationship between SES, mental health andcommittee). Data used in this study was collected

NLTC at the same time.

from late July to late August in 2009, while subjects

Based on the summary of the previous researches,

included in the survey was the urban elderly aged

the purpose of this study can be summarized as

60 years or over in the two cities of the Tibet

follow:

Autonomous Region -- the city of Lhasa and Shigatse.

1）To what extent the NLTC of the Tibetan urban
2.3

elderly is satisfied?

Sampling method2）To explore the relationship between the SES,As for the sampling method, firstly, we collected

mental health and NLTC among the Tibetan urban

the list of all community committees in Lhasa andelderly; and, whether there is gender differential

Shigatse, including 28 communities in the former

on the associations above.

city and 10 in the latter city. These 38 communities― 81 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

are then arranged from more to less in accordance

the same below); ② 1,000―2,999 RMB(147―440 USD);

with the number of the population. Thirdly, out of③ 3,000―5,999 RMB(441―881 USD); ④ 6,000 RMB(881

9 from 28 communities in Lhasa, out of 4 from 10

USD) and above.

communities in the city of Shigatse, with a total

The indicators for the mental health used in thisof 13 communities were selected at random bystudy are from the“Three Health Factors”, whichusing cluster sampling method. The aged persons

was created by Prof. Hoshi and concluded a total

who were 60 years old and above from these 13

of nine indicators to evaluate the mental health,communities were all concluded as the participants

physical health and social health separately 22―25）.

of this study. Specifically, there were 1437 older

The “Three Health Factors” index system waspersons in Lhasa, and 571 older adults in Shigatse,firstly originated from the analysis of the databasewith a total number of 2,008 elderly people in theseabout the health conditions of the Tokyo elderly, and13 communities of two cities. We aimed to collected

was also found to be equally applicable to evaluate

data from these 2008 older persons and issued one

the elderly from other cities in Japan, such as thequestionnaire to each older person, eventually, a total

Hanno city, Saitama Prefecture26）. Concretely, as forof 1836 questionnaires were effectively recovered,

the indicators of mental health, three questions arewith the valid response rate of 91.4%.

included: 1）How about your health condition thisThis study employed both the staffs of theyear? 2）Is your health status as good as last year?

community committee and the college students whose

3）Are you satisfied with your current lives? In themother language is Tibetan as the questionnaire

present study, 1）and 3）will be used as the two

investigator. All of them can expertly use bothindicators of mental health.

the Tibetan and Chinese, and switch these two

As stated previous, the quantitative studies

languages easily, in order to ensure that the language

focused on the LTC issues were relatively few intranslation had no impact on the authenticity andChina; although the empirical researches studied thecorrectness of the questionnaire. Meanwhile, before

LTC issues were relatively more, the indicators forthe start of the survey, investigators were conducted

the NLTC were different from one to another. Ina unified training to increase their knowledge andthis study, three questions will be used to measure

understanding about the purpose and contents of

the need for LTC: 1）the caring time of the firstthe survey, the structure of the questionnaire andcare provider; 2）the caring time of the second

skills and mastery on conducting a survey. During

care provider; 3）the caring time of the third care

the survey, the investigator mainly conducted theprovider. The same options are given to these three

face-to-face questionnaire survey in households, andquestions, namely: ① care just when needed; ② 2―3

recorded truthfully in accordance with the responses

hours per day; ③ half day per day; ④ almost all day

and answers of the elderly. In some communities,

long; ⑤ others.

the respondents were gathered together to fill in thequestionnaire.

2.5

Statistical approach

SPSS 17.0 was employed to present the basic
2.4

Measurement of the variables

distribution of the socioeconomic status, mental

The indicators of SES, in the present study, arehealth and the need for LTC of the Tibetan elderly,

education and household income. The answers for

specifically, about their absolute numbers andeducation includes: ① illiterate; ② elementary school;

percentage.

③ junior middle school ;④ senior middle school;

Amos version 17.0 statistical software package for⑤ vocational college and above. Options for the

Windows was used to perform the SEM, in order tohousehold incomes are: ① less than 1,000 RMB(147obtain the maximum-likelihood estimates of model

USD, as the average exchange rate of the year 2009;― 82 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

parameters and provide goodness-of-fit indices. In

factors in Tibet, such as the high altitude and theother words, whether the structural relationshiphighland climate, which forces the elderly of otherbetween socioeconomic status, mental health andnationalities (Han nationality or other nationalities)

the need for LTC among the Tibetan elderly is

to return to the Eastern China (or their hometown

corresponded with the hypotheses stated previously

other than Tibet) after their retirement.

will be clarified through the Amos.
Assessment of the model fitness calculates how

3.2

the proposed model might be consistent with the

3.2.1

The primary provider of the six basic
needs for LTC

empirical data. Maximum-likelihood estimation is

Table 2 presents the distribution of the primaryused to estimate the best-fitting model in this study.
2

NLTC of the Tibetan elderlyχ test, TLI, IFI, CFI and RMSEA were reported

providers of the six basic needs for LTC. We could

for the model fitness. The model are regarded to beacknowledge the important role of the family

good fitted when TLI>0.90
29）

CFI value >0.90

27）

28）

; IFI value close to 1
30）

and RMSEA<0.05;

members on caring the elderly based on informationin the table.

.

Spouse is always the most important primary care
3．Results
3.1

provider on any type of these six basic caring needs.

Characteristics of the subjects

On the item of being cared when sick, 38.2 percent

Table 1 shows the need for LTC of the Tibetanof it was provided by the spouse, accounting for theurban elderly. Among the total number of the 1,836

relatively highest proportion among all the providers.

elderly included in the survey, 1,310 of them are

As one kind of the informal care providers, althoughfrom Lhasa, with the remaining of 526 are fromthe proportion of its provision to the cash or things

Shigatse. Of those who were surveyed, more thandecreased to 19.2 percent, but still play the mosthalf are female (60.2%). On the age distribution, 58.7%

important role.

of the subjects are aged from 60 to 69. As for the

Son takes the secondary role on satisfying thenationality, 99.0% of the participants are Tibetan

needs of “Cared when sick” (20.1%), “Cash orelderly. Perhaps it is related to the environmental

things” (19.2%) and “Discuss important things”

Table 1. Characteristic of the Subjects― 83 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014(17.3%) for the elderly. These percentages are lower

54.7%, 58.2%, 55.8% respectively (Table 3). Therefore,

than the spouse’s, but higher than the daughter’s,

except“Cash or things”, more than half of other fivein spite of the gap on percentage between sons andkinds of needs for LTC could be“always”satisfied.
Although the percentage of the need for“Cash or

daughters is not large on these three items (20.1% vsthings”being“always”satisfied was lower than half

17.9%; 19.2% vs 16.2%; 17.3% vs 15.9%).
Comparing with the son, daughter plays a(27.0%), but in term of being“Frequently”satisfied,more important role on satisfying the needs of

its proportion is the highest. As for other five kinds“Housework”(19.4%),“Talk heartily”(17.4%),“Goingof needs for LTC, including the“Cared when sick”,

outside together”(15.7%). Particularly, the gap on“Housework”,“Talk heartily”,“Discuss importantthe provision of“Housework”(19.4% vs 13.4%) isthings”and“Going out together”, their proportion

significantly greater than that of“Talk heartily”

was 19.3%, 21.6%, 24.4%, 21.6%, 20.4% separately.

(17.4% vs 16.3%) and“Going outside together”(15.7%

As could be seen from the Table 3, comparing withvs 13.1%).

the needs could be “Always” and “Frequently”

Compared to these three main informal caresatisfied, the remaining four ones, namely

providers, the role of other care providers as the“Sometimes”,“Seldom”,“Never”and“Not needed”

primary provider (such as the Brothers or sisters,

separately, their proportion is relatively low. To

other relatives) is relatively lower among all of thesome extents, this represents the satisfaction of

respondents.

the six basic needs for LTC is in relatively goodcondition among the Tibetan elderly.

3.2.2

The satisfaction of the six basic needs
3.3

for LTC

Gender differential on the structural

Among these six basic needs for LTC, including

relationship between SES, mental health“Cared when sick”,“Housework”,“Cash or things”,

and NLTC among the Tibetan urban elderly“Talk heartily”,“Discuss important things”and

3.3.1“Going outside together”, the percentage of their

Table 4 shows the results of the factor analysis

Factor analysis

being“always”satisfied was 71.2%, 60.1%, 40.5%,of the corresponding variables. After the principal

Table 2. Distribution of the first care provider of the six basic needs for LTC― 84 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

Table 3. The satisfaction of the six basic needs for LTC

Table 4. Factor Analysis of Observed Variables

component analysis by using orthogonal rotation,“Socioeconomic status”(including two variables:

the seven variables, including“Caring time of the

Education, Household income).

third care provider”,“Caring time of the second careprovider”,“Caring time of the first care provider”,

3.3.2		 Fitness of the hypothetical model“Life satisfaction,“Subjective health”,“Education”,

The model fitness indices were shown in Figure“Household income”, were divided into three main

1 and Figure 2. The calculated value of CFI, TLI

factors with a cumulative contribution rate ofand IFI were 0.992, 0.984 and 0.992 respectively. All

79.850%.

of them were higher than the recommended level,

Here, we named these three main factors aswith the absolute value of 0.9. The calculated value“need for LTC”(including three variables: Caringof the RMSEA was 0.040, which was lower thantime of the third care provider, Caring time of

the recommended level of 0.05. All of these indicesthe second care provider and Caring time of theindicated the hypothetical model fit the empiricalfirst care provider),“mental health”(including two

data ideally.

variables: Life satisfaction, Subjective health) and― 85 ―

Concerning the p-value of the chi-square test

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

in this study, the relatively large numbers of thethe value of -0.203), although both of the effect wereparticipants concluded in this study resulting in

fairly weak.

a small value of it (with the value of p<0.001).
3.3.4

Consequently, it would not be used as the fitness

Gender difference on the association
between SES and NLTC

indices in this study, although it was reported as

As illustrated in Table 5, Figure 1 and Figure 2,

other researchers did.

SES could not only influence the NLTC directly, but
3.3.3

Gender difference on the relationshipalso exerted the indirect effect onto the NLTC both

between mental health and NLTC

for the Tibetan male elderly and Tibetan female

The gender difference on the relationship between

elderly. Specifically, the direct standardized effectmental health and NLTC among the Tibetan elderly

from SES upon the NLTC was -0.172 for the Tibetan

was presented in Table 5, Figure 1 and Figure 2.

male elderly and -0.136 for the Tibetan female

Mental health exerted negative and direct effect onto

elderly, while the indirect standardized effect was

the NLTC both for the Tibetan male elderly and-0.122 for the male and -0.112 for the female.

female elderly. Concretely, the total standardized

It means both the direct and indirect effect from

effect of mental health onto the NLTC was slightly

SES upon the NLTC was slightly stronger among thestronger for the Tibetan male elderly (with the

Tibetan male elderly than their female counterparts.

value of -0.250) than their female counterparts (withConsequently, the total standardized effect was also

Table 5 Structural relationship between SES, Mental Health and NLTC by gender among the Tibetan elderly

Figure 1 Structural relationship between the SES, mental

Figure 2 Structural relationship between the SES, mental

health and NLTC among the Tibetan male elderly

health and NLTC among the Tibetan female elderly― 86 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

NLTC

slightly stronger among the Tibetan male elderly

Negative correlation between mental health and(with a coefficient of -0.294) than the female ones (withthe need for LTC is the most important finding ofa coefficient of -0.248).

this study; because there are only few researches
3.3.5

Gender difference on the correlation

explored the relationship between mental health andbetween SES and mental healththe NLTC and no existing studies had examined the

The correlation between SES and mental healthgender differential on the association. Many existing

was presented in Table 5, Figure 1 and Figure 2.

studies had mainly investigated the NLTC of the

Positive and relatively strong effect exerted fromelderly who suffered from physical disability, such

the SES onto mental health was observed both foras Wolfe et al. conducted a 10-year follow-up study

the Tibetan male elderly and female elderly. Whileon the NLTC of the stroke patients in south London

the association between SES and mental health wasof UK 10） . Among the few studies involving thefounded to be slightly stronger among the Tibetan

relationship between mental health and the NLTC,

female elderly (with the value of 0.552) than theirresearchers just introduced the distribution of NLTC

male counterparts (with the value of 0.489).

of the elderly, without exploring the relationshipbetween mental health and need for LTC. Such as,

3.3.6

Critical Ratios for Differences between

Kim et al. studied the NLTC of the patients withParameters

dementia12）; Reid et al. investigated the influencing

Critical Ratios for Differences between Parametersfactors of the mental disorders and the NLTC by(CRdiff) indicates the ratios between the parameters

the adult patients 11）. In addition, the study also

difference and the estimated standard error of

explains why there were 53 percent of the patients

this difference. The CRdiff value squared is anwith dementia, 34 percent with mental healthapproximation for how much the chi-square test

problems and only 12 percent were in good mental

would increase if one imposed the constraint on thehealth among the patients who were using the homemodel parameters. The CRdiff tests can be appliedcare and institutional nursing care services in one

when testing equality constraints between two

study, this is because there is a negative correlation

previously free parameters. If ¦CRdiff¦<1.96, the test

between mental health and the NLTC.

is statistically non-significant ( α =0.05), which meansthat two parameters are equal and cannot reject the

3.4.2		 Correlation between SES and NLTC

hypothesis that the two variances are equal in the

Negative correlation was observed between

population.

SES and the NLTC among the Tibetan elderly,

In this study, the CRdiff value for the relationshipwhich means that the higher of the individual’s

between SES and NLTC, between mental healthsocioeconomic status, the less of his need for LTC;

and NLTC among the Tibetan male and female

while for those with lower socioeconomic status,

elderly were 9.755 and 2.250 separately. As for thetheir need for LTC is higher. Hoi le et al. conductedassociation between SES and mental health among

a survey on the 2,240 Vietnamese elderly aged 60

the Tibetan male and female elderly, its CRdiff

years or over and found out that the socioeconomic

value was 2.720. All of these three CRdiff values arestatus of the elderly (such as education, household

greater than 1.96, indicating that the difference on

income) could affect their needs for LTC 7）, thethe three above relationships between Tibetan male

results of his study were almost same to this study.

and female elderly was statistically significant.

The results of this study also explained the residentsof Ontario, Canada, whose socioeconomic status were

3.4
3.4.1

Discussion

lower tended to have a higher intention of being

Relationship between mental health andcared and use caring services more frequently8）. In― 87 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

addition, to a certain extent, the results also explicate

to obtain medical services, more easily to build andwhy those from the underdeveloped areas reported

maintain their social relationships and more likely tomore unmet care needs among the 1,251 British

live in good communities, such group will eventually

6）

have a higher level of health 36, 37）. It should be

stroke patients .

emphasized that, from a macro perspective, the
3.4.3

Association between SES and mental

impact of individual’s socioeconomic status on healthhealthis not simply caused by socioeconomic status only,

The relationship between SES and mental healthbut caused by various factors combined together,was found to be positive among the Tibetan elderly.

including the individual’s lifestyle, environmental

The result indicates that the higher level of the one’s

factors and the social factors and so on 38, 39）. Of

socioeconomic status, the better status of his mental

course, there are also researchers believe that

health; while for those with lower socioeconomic

ecological factors also play an important role in thestatus, their mental health are worse. Positive

process40）.

correlation between socioeconomic status and mental

The influence of socioeconomic status on thehealth is the same to the results of the previous

health narrated above, combining with the structural

studies: 1) people with lower socioeconomic statusanalysis of the association between socioeconomic

15）;

status, mental health and the need for LTC among

2) individuals from the higher socioeconomic status

the older persons in this study, the process of thegroups are more likely to have a better mentalsocioeconomic status exerting its effect on the need

tend to experience more mental health problems

16, 17）

healthfor LTC can be further specifically summarized.

as follows: those elderly who are on different
3.4.4

Structural relationship between SES,

socioeconomic status live in different communities,

mental health and NLTC

they have different lifestyle, owning different ability

Using the structural equation modeling, this study

to obtain medical services and various degrees of

explored the relationship among socioeconomic

social support. All of these lead to their different

status, mental health and the need for LTC. As

mental health conditions, and eventually, they haveshown in the results, the socioeconomic status could

different levels of the need for LTC.

not only have a direct impact on the need for LTC,
but also could indirectly influence the need for LTC

3.5

Main conclusions

via mental health. It also, to some degree, shows theFirstly, members are the major providers of thesix basic needs for LTC in this study. The spouse

importance of socioeconomic status.
Existing studies consistently showed that thereis the most important primary care provider in any

is a positive correlation between the individual’

kind of the basic needs. Sons, following the spouse,s socioeconomic status and their health (including

take the secondary role on satisfying the needs ofmental health), which means that a higher“Cared when sick”,“Cash or things”and“Discusssocioeconomic status of the individual, his health will

important things”for the elderly. While for the

31―34）. Specifically, the difference ondaughters, following the spouse, take the secondarysocioeconomic status usually means the differencesrole on satisfying the needs of “Housework”,

of the ability on obtaining the medical services,“Talk heartily”and“Going outside together”foroccupational risks, social support, and life stress.

the elderly. Comparing with these three main

These differences ultimately led to the different

informal care providers, the role of others as thebe relatively betterlevel of individual’s health35）. Some researchers

also give a similar explanation as below: those whocare providers is relatively lower among all of the
respondents.

have higher socioeconomic status are more likely― 88 ―

Secondly, among these six basic needs for LTC,

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

including“Cared when sick”,“Housework”,“Cash orReferences:

things”,“Talk heartily”,“Discuss important things”

1）Lin Xu. Social welfare problems and the strategy

and“Going outside together”, the percentage of theirin the deprived areas of China. Xi’an, People’s
Press of Shanxi Province, 1998：98.

being“always”satisfied was 71.2%, 60.1%, 40.5%,
54.7%, 58.2% and 55.8% respectively. Therefore,2）National Bureau of Statistics of the People’s

except the“Cash or things”, more than half of other

Republic of China. Report of the 1% population

five kinds of needs for LTC could be always satisfied.

sampling survey of China in 2005. 2006.

Comparing with the needs could be“Always”and3）National Bureau of Statistics of the People’s“Frequently” satisfied, the remaining four ones,

Republic of China. Report of the Sixth National

namely “Sometimes”, “Seldom”, “Never”, “NotPopulation Census in 2010（no. 1）. 2011.
4）Government of Canada. 2011 Census: Populationneeded”, their proportion is relatively low.

and Dwelling Counts. 2012.

Thirdly, there is a positive correlation between5）An Xie. The status, trends and characteristics ofsocioeconomic status and mental health both for
the Tibetan male and female elderly. That is, theChina’s population ageing. Statistical Research,higher socioeconomic status of the Tibetan urban

2004；08）：50―53.

elderly, the better of their mental health; the lower6）C. Mckevitt, N. Fudge, J. Redfern, et al. Self-

socioeconomic status of the Tibetan urban elderly,

reported long-term needs after stroke. Stroke,

the worse of their mental health. Slight difference

2011；42（5）：1398―403.

was observed on the correlation between SES

7）V. Hoi Le, P. Thang, L. Lindholm. Elderly careand mental health, while it was slightly stronger

in daily living in rural Vietnam: need and its

among the Tibetan female elderly than their malesocioeconomic determinants. BMC Geriatr,

counterparts.

2011；11：81.

Fourthly, there is a negative correlation between

8）A. Laporte, R. Croxford, P. C. Coyte. Can amental health and the NLTC both for the Tibetan

publicly funded home care system successfully

male and female elderly. Namely, better mental

allocate service based on perceived needhealth of the Tibetan urban elderly would mainly

rather than socioeconomic status? A Canadianindicate their fewer NLTC; while for those whose

experience. Health Soc Care Community, 2007；

mental health is worse, their NLTC would be more.

15（2）：108―19.

Subtle difference was found about the relationship

9）P. Martikainen, H. Moustgaard, M. Murphy,

between mental health and the NLTC, and it was

et al. Gender, living arrangements, and social

little stronger among the Tibetan male elderly thancircumstances as determinants of entry into andthe female ones.

exit from long-term institutional care at older

Fifthly, Tibetan male and female elderly would

ages: a 6-year follow-up study of older Finns.

not only have a direct impact on the need for LTC,

Gerontologist, 2009；49（1）：34―45.

but also have an indirect impact on the need for10）C. D. Wolfe, S. L. Crichton, P. U. Heuschmann,

LTC through mental health, and both the direct

et al. Estimates of outcomes up to ten years

and indirect effect are negative. That is to say, theafter stroke: analysis from the prospective Southhigher socioeconomic status of the Tibetan urban

London Stroke Register. PLoS Med, 2011；8（5）：elderly, the less their needs for the LTC; the lower

e1001033.

socioeconomic status of them, the more needs for11）K. A. Reid, E. Smiley, S. A. Cooper. Prevalence

the LTC. Minor distinction was observed on theand associations of anxiety disorders in adults

association between SES and the NLTC, while thewith intellectual disabilities. J Intellect Disabil

total effect was slightly stronger among the Tibetan
male elderly than their female counterparts.

Res, 2011；55（2）：172―81.
12）Nae-Hwa Kim, Georges El Hoyek, Diane Chau.

― 89 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

Long-Term Care of the Aging Population with

with focusing on the personal dream andIntellectual and Developmental Disabilities. Clinthought. Japanese Journal of Health Education

Geriatr Med, 2011；27（2）：291―300.

and Promotion, 2012；20（4）：307―312（in13）J. M. Sorrell, S. Durham. Meeting the mental

Japanese）.

health needs of the aging veteran population. J23）Tanji Hoshi, Naoko Sakurai. Social support

Psychosoc Nurs Ment Health Serv, 2011；49（1）：setworks and health. The Quarterly of Social

22―5.

Security Research, 2012；48（3）：304―318（in14）G. Samuelsson, G. Sundstrom, O. Dehlin, et al.

Japanese）.

Formal support, mental disorders and personal24）T. Hoshi, C. Takagi, N. Inoue, et al. Causal

characteristics: a 25-year follow-up study of aeffect of socioeconomic variables on the“three

total cohort of older people. Health Soc Carehealth factors”among elderly urban dwellers.

Community, 2003；11（2）：95―102.

Japanese Journal of Health education and15）F . G o n g , J . X u , D . T . T a k e u c h i . B e y o n dpromotion. Japanese Journal of Health Education

conventional socioeconomic status: examining

and Promotion, 2012；20（3）：159―170（insubjective and objective social status with self-

Japanese）.

reported health among Asian immigrants. J25）Miki Kubo. A structure analysis of socioeconomic

Behav Med, 2012；35（4）：407―19.

factors and health states for the urban elderly16）G. V. Mavrinac, D. M. Sersic, A. Mujkic.

dwellers with cardiovascular diseases. Bulletin

Cardiovascular and behavioral risk factorsof Social Medicine, 2012；30（1）：13―24（inin relation to self-assessed health status. Coll

Japanese）.

Antropol, 2009；33 Suppl 1：99―106.

26）Naoko Inoue. The chronological trend of the17）F. Sani, M. E. Magrin, M. Scrignaro, et al. In-

bedridden status and preventive factors andgroup identification mediates the effects ofcumulative survival rate during three years insubjective in-group status on mental health. Br J

the Japanese urban elderly dwellers. Bulletin

Soc Psychol, 2010；49（Pt 4）：883―93.

of Social Medicine, 2012；30（1）：1―12（in18）T. Huijts, T. A. Eikemo, V. Skalicka. Income-Japanese）.

related health inequalities in the Nordic

27）L.―T. Hu, P.M. Bentler. Cutoff criteria for fit

countries: examining the role of education,indexes in covariance structure analysis:

occupational class, and age. Soc Sci Med, 2010；

Conventional criteria versus new alternatives.

71（11）：1964―72.

Structural Equation Modeling: A Multidisciplinary
Journal, 1999；6（1）：1―55.

19）I. Theodossiou, A. Zangelidis. The social gradientin health: the effect of absolute income and28）Peter M Bentler, Douglas G Bonett. Signi?cancesubjective social status assessment on thetests and goodness of fit in the analysis ofindividual’s health in Europe. Econ Hum Biol,covariance structures. Psychological bulletin,

2009；7（2）：229―37.

1980；88（3）：588―606.

20）O. Baron-Epel, G. Kaplan. Can subjective and29）Tai.Sheng. Rong. Amos and Research Method.

objective socioeconomic status explain minority

Second edition ed. Chongqing, ChongqingUnivers

health disparities in Israel? Soc Sci Med, 2009；

ityPress, 2010：128（in Chinese）.

69（10）：1460―7.

30）Michael W Browne, Robert Cudeck. Single21）K. Honjo, N. Kawakami, T. Takeshima, et al.

sample cross-validation indices for covariance

Social class inequalities in self-rated health andstructures. Multivariate Behavioral Research,

their gender and age group differences in Japan.

1989；24（4）：445―455.

J Epidemiol, 2006；16（6）：223―32.

31）D. S. Brennan, K. A. Singh. Dietary, self-reported

22）Tanji Hoshi. Health promotion for the people― 90 ―

oral health and socio-demographic predictors of

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014

general health status among older adults. J Nutr
Health Aging, 2012；16（5）：437―41.
32）D. Fiorillo, F. Sabatini. Quality and quantity:
the role of social interactions in self-reported
individual health. Soc Sci Med, 2011；73（11）：1644―52.
33）M. J. Hwang, D. P. Yoon, W. Shim, et al. The
impact of social status and risk behaviors on
health status among elderly individuals in Korea.
Soc Work Public Health, 2010；25（2）：223―36.
34）A. Wengler. The health status of first- andsecond-generation Turkish immigrants inGermany. Int J Public Health, 2011；56（5）
：493
―501.
35）S. Kagamimori, A. Gaina, A. Nasermoaddeli.
Socioeconomic status and health in the Japanese
population. Soc Sci Med, 2009；68（12）：2152―
60.
36）E.C. Bird, P. Conrad, A.M.(Eds.) Fremont J.
Mirowsky, C.E. Ross, J. Reynolds. Links betweensocial status and health status. Handbook of
medical sociology. Upper Saddle River,New
Jersey, Prentice-Hall. 2000：47―67.
37）E.C. Bird, P. Conrad, A.M.(Eds.) Fremont S.A.
Robert, J.S. House. Socioeconomic inequalities
in health: An enduring sociological problem.
Handbook of medical sociology. Upper Saddle
River, New Jersey, Prentice-Hall. 2000：79―97.
38）Lisa F Berkman, Ichiro Kawachi. A Historical
Framework for Social Epidemiology. NewYork,
Oxford University Press, 2000.
39）Michael Marmot, Richard Wilkinson. Social
determinants of health. NewYork, Oxford
University Press, 1999.
40）I. Kawachi, B. P. Kennedy. Health and social
cohesion: why care about income inequality?
BMJ, 1997；314（7086）：1037―40.

― 91 ―

社会医学研究．第 31 巻 2 号．Bulletin of Social Medicine, Vol.31（2）2014― 92 ―