노인의 자아존중감 및 사회적지지가 정신건강에 미치는 영향 연구

Abstract

20세기에 들어와서 출산률이 현저히 감소하였고, 의학 및 과학과 기술의 발달, 경제와 교육수준의 향상 등에 따른 현대인의 건강과 의료에 대한 인식변화와 삶의 질적 향상으로 인하여 평균수명이 연장됨에 따라 노인인구가 증가하게 되어 노인의 건강에 대한 관심이 사회적 문제로 부각되고 있다. 특히 노년기에는 신체적, 정신적 기능의 저하, 정년퇴직, 배우자 사별, 자녀의 독립 등으로 인한 다양한 상실을 경험하게 되므로 오늘날 노인의 정신건강 문제는 매우 중요하다고 할 수 있다. 따라서 본 연구는 일반 노인의 개인적 특성 및 자아존중감 정도와 사회적지지 정도를 함께 고려하여 정신건강 상태를 파악함으로써 노인 정신보건 향상을 위한 보건교육의 기초자료를 제공하는데 목적을 두고, 서울시에 거주하고 있는 일반 노인 204명을 대상으로 1999년 3월 31일부터 4월 28일까지 개인별 질문면접을 실시하여 분석한 결과는 다음과 같다. 1. 대상자의 자아존중감 정도는 총점범위 10-50점에서, 평균은 32.40점, 표준편차는 5.97로 나타나 중정도의 자아존중감 수준을 나타내었다. 2. 대상자의 사회적지지 정도는 총점범위 25-125점에서, 평균은 85.30점, 표준편차는 20.15로 나타나 중정도의 사회적지지 수준을 나타내었으며, 사회적 지지의 하위 영역별 지지정도 순위는 정서적 지지, 평가적 지지, 정보적 지지, 물질적지지 순으로 나타났다. 3. 대상자의 정신건강 상태는 총점범위 46-230점에서, 평균은 97.04점, 표준편차는 28.36으로 어느 정도의 정신 증상을 갖고 있는 상태로 나타났으며, 정신건강의 하위경역 9개 증상별 심한 정도 순위는 대인예민성, 신체화, 강박증, 적대감, 우울증, 불안, 정신증, 공포불안, 편집증 순으로 나타났다. 4. 일반적 특성 및 건강 특성에 따른 노인의 자아존중감 정도를 분석한 결과, 통계적으로 유의하게 연령이 적을수록, 교육수준이 높을수록, 종교가 있을 때, 직업이 있을 때, 배우자가 있을 때, 경제수준이 높을수록, 가입단체의 수가 많을수록, 의지하는 사람이 배우자일 때, 음악이나 운동과 같은 취미생활을 할 때, 현 생활만족도가 높을수록, 주관적 건강상태가 좋을수록, 질별이 없을 때 노인의 자아존중감 정도가 높은 것으로 나타났다. 5. 일반적 특성 및 건강 특성에 따른 노인의 사회적지지 정도를 분석한 결과, 통계적으로 유의하게 교육수준이 높을수록, 종교가 있을 때, 배우자가 있을 때, 가족과 함께 살 때, 가족수가 적당히 많을수록, 경제수준이 높을수록, 가입단체의 수가 많을수록, 운동이나 음악과 같은 취미생활을 할 때, 현 생활만족도가 높을수록, 주관적 건강상태가 좋을수록, 질병이 없을 때 노인의 사회적지지 정도가 높은 것으로 나타났다. 6. 일반적 특성 및 건강 특성에 따른 노인의 정신건강 상태를 분석한 결과, 통계적으로 유의하게 교육수준이 높을수록, 배우자가 있을 때, 가족과 함께 살 때, 가족수가 적당히 많을수록, 경제수준이 높을수록, 가입단체의 수가 많을수록, 의지하는 사람이 배우자일 때, 운동이나 음악과 같은 취미생활을 할 때, 현 생활만족도가 높을수록, 주관적 건강상태가 좋을수록, 질병이 없을 때 노인의 정신건강 상태가 양호한 것으로 나타났다. 7. 노인의 자아존중감과 정신건강과의 관계는 통계적으로 매우 유의한 역상관관계를 나타내었다(r=-0.545, p<0.001). 즉 자아존중감 점수가 높을수록 정신건강(9개의 증상차원 포함)의 점수가 낮은 것으로 나타나 자아존중감이 높을수록 정신건강 상태가 양호한 것으로 나타났으며, 자아존중감과 정신건강의 하위영역 9개 증상간의 관계 모두에서도 통계적으로 매우 유의한 역상관관계를 나타내고 있어(p<0.001) 자아존중감이 높을수록, 우울증, 적대감, 강박증, 공포불안, 불안, 신체화, 대인예민성, 편집증, 정신증 정도가 낮은 것으로 나타났다. 8. 사회적 지지와 정신건강과의 관계는 통계적으로 매우 유의한 역상관관계를 나타내었다(r=-0.592, p<0.001). 즉 사회적 지지의 점수가 높을수록 정신건강(9개의 증상차원 포함)의 점수가 낮은 것으로 나타나 사회적지지 정도가 높을수록 정신건강 상태가 양호한 것으로 나타났으며, 사회적 지지의 하위영역과 정신건강의 하위영역 9개 증상간의 관계 모두에서도 통계적으로 매우 유의한 역상관관계를 나타내고 있어(p<0.001) 정서적 지지, 정보적 지지, 물질적 지지, 평가적지지 각 항목이 높을수록 우울증, 적대감, 강박증, 공포불안, 불안, 신체화, 대인예민성, 편집증, 정신증 정도가 낮은 것으로 나타났다. 9. 사회적 지지와 자아존중감과의 관계는 통계적으로 매우 유의한 순상관관계를 나타내었다(r=0.494, p<0.001). 즉 사회적지지 정도가 높을수록 자아존중감 정도가 높은 것으로 나타났으며, 사회적 지지의 하위영역 모두와 자아존중감과의 상관관계에서도 통계적으로 매우 유의한 순상관관계를 나타내고 있어(p<0.001) 정서적 지지, 정보적 지지, 물질적 지지, 평가적지지 각 항목이 높을수록 자아존중감 정도가 높은 것으로 나타났다. 10. 노인의 정신건강에 영향을 미치는 중요변인으로는 사회적 지지, 자아존중감, 주관적 건강상태 순으로 나타났으며, 이들 3개의 예언변인들이 정신건강의 전체변량 중 47.1%를 설명하였다. ; Over the last few decades the population of the elderly has grown drastically as the average life expectancy has been increased constantly due to a number of reasons such as the advance of health science and the improvement of qualities of life while the birth rate has been decreased continuously since the beginning of the 20the century. In consequence, the health of the elderly has drawn much attention recently. In particular, the mental health of the elderly has arisen as an important social issue in consideration of the hardship of the elderly that they suffer from various losses including retirement, the death of their spouse, separation from their children and deterioration of their physical and mental ability. The main purpose of this study is to investigate the Mental Health Condition of the Elderly in connection with the Individual Characteristics, the Degree of Self-Esteem, and Social Support so that our research may provide a basic informative data in the health education for the improvement of the mental health of the elderly. In order to accomplish what we aim to do, a sample of 204 Seoul residents who are over 60 was randomly selected and personal interviews regarding the questionnaire relevant to this topic were conducted to each individual from the 31st of March, 1999 to the 28th of April, 1999. Conclusions reached by analyzing the results of this study were summarized in the following. 1. Measuring the degree of self-esteem on the scale of 10-50 scores, the mean was 32.40 with the standard deviation of 5.97, which indicates that participants are about of medium level in their self-esteem. 2. Measuring the degrees of social support on the scale of 25-125 scores, the mean was 85.30 with the standard deviation of 20.15, which shows that participants have social support of about medium level. Furthermore, the ranks of components that comprise social support were shown to be in the order of Emotional Support, Appraisal Support, Informational Support, and Materials Support. 3. Measuring the mental health condition on the scale of 46-230 scores, the mean was 97.04 with the standard deviation of 28.36, which indicated that participants had psychotic symptoms to some extent. The ranks of 9 symptoms that were used to measure mental health were Interpersonal Sensitivity, Somatization, Obsession, Hostility, Depression, Anxiety, Psychoticism, Phobic Anxiety, and Paranoia. 4. Analyzing the degree of self-esteem in relation to the individual characteristics, the results showed, with statistical significance, that the elderly had relatively higher self-esteem when they were younger, when their education level was higher, when they had religion, when they had job, when they had spouse, when their economic level was higher, when they had job, when they had spouse, when their economic level was higher, when their subjective health condition was better, when they had no illness, when they had more memberships to certain organizations, when they depended on spouse, when they kept up with hobbies such as musical activities and sports, and when they were more satisfied with their current life. 5. Analyzing the degree of social support in relation to the individual characteristics, the results showed, with statistical significance, that the elderly has relatively higher social support when their education level was higher, when they had religion, when they has spouse, when they lived with their family, when the size of their family was appropriately larger, when their economic level was higher, when their subjective health condition was better, when they had no illness, when they had more memberships to certain organizations, when they depended on spouse, when they kept up with hobbies such as sports and musical activities, and when they were more satisfied with their current life. 6. Analyzing the mental health condition in relation to the individual characteristics, the results showed, with statistical significance, that the elderly kept relatively better mental health condition when their education level was higher, when they had spouse, when they lived with their family, when the size of their family was appropriately larger, when their economic level was higher, when their subjective health condition was better, when they had no illness, when they had more memberships to certain organizations, when they depended on spouse, when they kept up with hobbies such as sports and musical activities, and when they were more satisfied with their current life. 7. The relation between self-esteem and mental health of the elderly was shown, with statistical significance, to b negatively correlated(r=-0.545, p<0.001). To be more specific, it was shown that the higher the score of self-esteem was the lower that of mental health(including 9 symptoms) was, which can be interpreted as when they have higher self-esteem they have better mental health condition. In addition, the relations between self-esteem and 9 symptoms measuring mental health were all shown, with statistical significance, to be negatively correlated(p<0.001) so that when the elderly had higher self-esteem they had lower Interpersonal Sensitivity, Somatization, Obsession, Hostility, Depression, Anxiety, Psychoticism, Phobic Anxiety, and Paranoia. 8. The relation between social support and mental health of the elderly was shown, with statistical significance, to be negatively correlated(r=-0.592, p<0.001). To be more specific, it was shown that the higher the score of social support was the lower that of mental health(including 9 symptoms) was, which can be interpreted as when they have higher social support they have better mental health condition. In addition, the relations between 4 components of social support and 9 symptoms of mental health were all shown, with statistical significance, to be negatively correlated(p<0.001). Therefore, when the elderly had higher scores in Emotional Support, Appraisal Support, Informational Support, and Material Support, respectively, they were relatively much more free from Interpersonal Sensitivity, Somatization, Obsession, Hostility, Depression, Anxiety, Psychoticism, Phobic Anxiety, and Paranoia. 9. The relation between self-esteem and social support was positively correlated with statistical significance(r=0.494, p<0.001). To state precisely, when the score of social support was higher, that of self-esteem was higher. Moreover, the relations between 4 components of social support and self-esteem were all shown to be positively correlated with statistical significance(p<0.001) so that when the elderly had higher Emotional Support, Appraisal support, Informational Support, and Material Support, respectively, they had higher self-esteem. 10. The important variables that affected the mental health of the elderly were Social Support, Self-Esteem, Subjective Health Conditions in this order. These three variables accounted for 47.1% of the total variate of mental health.