以路徑分析探討宗教信仰與憂鬱症狀對醫療利用之影響： 以台灣地區中老年人為例

Abstract

目的：本研究利用路徑分析探討因宗教活動參與度所帶來之社會支持程度、憂鬱症狀多寡、實際需要高低、自覺需要高低、以及可近性等效果，對中老年人醫療利用之影響。 方法：本研究係橫斷式與回溯性之次級資料分析，使用前衛生署家庭計畫研究所〈現為國民健康局人口與健康調查中心〉於民國88年所辦理的第四波「台灣地區中老年身心健康與生活狀況追蹤調查」資料，以55歲以上之社區居民為主，利用 AMOS 5.0進行路徑分析。 主要發現：住院次數、住院天數與西醫門診利用次數最終模式所獲得的指數顯示，模式是可以被接受的。整體效果的分析顯示，宗教活動參與度對醫療利用之影響達顯著性，而這些影響皆是透過中介機制而形成。三個醫療利用最終模式呈現出五條相同之影響路徑，西醫門診利用次數最終模式另外呈現出四條影響路徑。影響路徑分述如下〈路徑1-5之醫療利用包含住院次數、天數與西醫門診；路徑6-9之醫療利用僅指西醫門診，其中路徑8-9為新發現路徑，非概念性研究架構中的路徑〉： 1.宗教活動參與度→情感性社會支持→實際需要→增加醫療利用 2.宗教活動參與度→情感性社會支持→自覺需要→減少醫療利用 3.宗教活動參與度→情感性社會支持→憂鬱症狀→自覺需要→減醫 療利用 4.宗教活動參與度→情感性社會支持→憂鬱症狀→實際需要→減少 醫療利用 5.宗教活動參與度→實際需要→減少醫療利用 6.宗教活動參與度→憂鬱症狀→自覺需要→減少醫療利用 7.宗教活動參與度→憂鬱症狀→實際需要→減少醫療利用 8.宗教活動參與度→憂鬱症狀→減少醫療利用 9.宗教活動參與度→情感性社會支持→增加醫療利用 結論：整體而言，宗教活動參與度會間接地降低醫療利用。如同我們預期，實際需要與自覺需要會直接影響醫療利用，但是意外發現在西醫門診利用最終模式中，情感性社會支持和憂鬱症狀也會直接影響醫療利用。另外，宗教活動參與度透過情感性社會支持與憂鬱症狀等中介機制在降低醫療利用裡扮演重要的角色。 關鍵字：醫療利用、宗教信仰、憂鬱症狀、路徑分析

Objective: The objective of this study was to use path analysis to examine the effect of social support, depressive symptoms, actual need, self-perceived need and accessibility evolved from religious involvement toward medical utilization of persons aged 55 and over. Methods: The author used secondary data, namely 1999 Suvey of Health and Living Status of the Elderly in Taiwan. In the study, there were 3875 subjects living in the community aged 55 and over. Besides, this was a cross-sectional and retrospective study. Finally, We employed AMOS 5.0 to analyze data. Results: Overall fit indexes of the final models, including Medical admission, Average Length of Stay, and outpatient, revealed that all models are accepted. The total effects of all models show that the inffluence of religious involvement toward medicl utilization was statistically significant. What’s more, such an inffluence was formed by intermediary mechanism. The five paths were the same in the all final models; however, the final model of outpatient services additionally have other four paths. The significant paths are as follow (Paths1-5 include tree types of medical utilization; paths 6-9 only comprise the outpatient; paths 8-9 are new discoveries, they do not represent all the paths in the conceptual framwork): 1.religious involvement → emotional social support → actual need → increased utilization 2.religious involvement → emotional social support → self-perceived need → decreased utilization 3.religious involvement → emotional social support → depressive symptom → perceived-self need → decreased utilization 4. religious involvement → emotional social support → depressive symptom → actual need → decreased utilization 5. religious involvement → actual need → decreased utilization 6. religious involvement → depressive symptom → self-perceived need → decreased utilization 7. religious involvement → depressive symptom → actual need → decreased utilization 8. religious involvement → depressive symptom → decreased utilization 9. religious involvement → emotional social support → increased utilization Conclusion: By and large, religious involvement decreases medical utilization. indirectly As we expected, actual need and self-perceived need affect medical use directly; however, we found accidently that emotional social support and depressive symtoms inffluence the clinical utilizaiton directly as well. In addition, religious activities indirectly decrease medical use through social support and depressive symtoms and play an essential role in a intermediary mechanism.