老年人肥胖與憂鬱情緒相關性之探討：國家的多層次分析

Abstract

背景：全球人口老化情形漸趨嚴重，老年人肥胖與憂鬱盛行率亦大幅成長。肥胖與憂鬱之關係，目前尚有爭議。而1976年學者提出「Jolly Fat」假說，發現肥胖老年人有較低的憂鬱、焦慮等情形，後續不同國家的研究發現「Jolly Fat」有性別差異。時至今日，肥胖老年人是否仍具「Jolly Fat」現象，是值得更進一步探討的。 目的：探討老年人過重或肥胖對憂鬱情緒之影響，及性別與國家差異。 方法：本研究以「國際社會調查計畫(International Social Survey Program, ISSP)」中2011年健康模組(Module on Health)資料庫進行次級資料分析，並以65歲以上之老年人作為本研究之研究對象，共納入9,694人，橫跨歐美、亞洲等地區共31個國家。研究利用多階層線性模式(Hierarchical Linear Models)，並利用人類發展指數及肥胖盛行率作為國家層次變項，探討個人與國家層次肥胖與憂鬱情緒之關係。 結果：個人層次分析中，相較於體重正常者，肥胖老年人有較高的憂鬱情緒；若以性別來看，較於體重正常者，過輕的男性及肥胖的女性有較高的憂鬱情緒。但是，相較於體重正常者，過重的男性有較低的憂鬱情緒。國家層次分析發現，相較於體重正常者，過輕的老年人在肥胖盛行率愈高的國家，會有較高的憂鬱情緒，結果在女性老年人更為顯著。 結論：「Jolly Fat」現象僅呈現在過重的男性老年人。肥胖的老年人有較高的憂鬱情緒，過輕的男性、肥胖的女性會有較高的憂鬱情緒。體重過輕與憂鬱情緒的關係會受國家肥胖盛行率影響，產生跨層次脈絡調節效果。健康相關單位除了須注意老年人肥胖狀況，也須特別注意老年人過輕狀況。 關鍵字：老年人、肥胖、憂鬱、國家、多階層線性模式

Background: As the global aging population continues to grow, the prevalence of obesity and depression in elders are also increasing. The relationship between obesity and depression are controversial. In 1976, scholars have proposed 'Jolly Fat' hypothesis which found obese elderly to have lower levels of depression, anxiety, and other psychological distress. Many studies across different countries have shown support for gender differences in 'Jolly Fat'. However, further research is needed to explore whether the “Jolly Fat” phenomenon in elders still exist. Objective: To investigate the effect of overweight or obesity on depressed mood in elders, and whether there is a difference in gender and race. Methods: Data was analyzed from 2011 International Social Survey Program (ISSP) on health module with total of 9,694 subjects aged 65 or above, including 31 countries across America, Europe, and Asia. Hierarchical Linear Models were conducted to determine the association between obesity and depressed mood on individual- and country-level. The country-level variables were human development index and the prevalence of obesity. Results: Obese elderly have a higher level of depressed mood across countries as compared to normal weight elderly. In terms of gender differences, underweight men and obese women have a higher level of depressed mood as compared to normal weight counterparts. Only overweight male have a lower level of depressed mood as compared to normal weight counterparts. However, underweight elderly, especially females who lived in countries with high prevalence of obesity, presented a higher level of depressed mood. Conclusions: 'Jolly Fat' phenomenon only occurred in overweight male elderly. Obese elderly, underweight men, and obese women have a higher level of depressed mood. The association between underweight and depressed mood in the elderly was affected by the prevalence of obesity, resulting in cross-level interaction. Health-related departments should pay attention not only to obese, but also to underweight elderly. Keywords: elderly, obesity, depression, country, hierarchical linear models