Analysis of the influencing factors of death anxiety in rural elderly based on structural equation model_Chinese Journal of Evidence-Based Medicine

Authors：

LIN Xin , ZHANG Yujing , ZHANG Xinyi ,  GAO Xiaofeng

School of public health, North Sichuan Medical College, Nanchong 637007, P. R. China;

Corresponding?author：

GAO Xiaofeng, Email: gxf-8@163.com

Keywords：

Rural areas; Elderly; Death anxiety; Structural equation model

DOI：

10.7507/1672-2531.202507008

Video：

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Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of ?0.392, ?0.287, and ?0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=?0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=?0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=?0.119, P=0.004) and an indirect effect through subjective well-being (β=?0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=?0.278, P=0.001) and an indirect effect through subjective well-being (β=?0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.

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14.	朱海玲, 史寶欣. 死亡態度影響因素的研究進展. 中華護理雜志, 2010, 45(6): 569-571.
15.	吳丘云. 社區老年人生命意義感的影響因素及干預研究. 南充: 西華師范大學, 2023.
16.	馬燕. 老年人控制感和生命意義感與主觀幸福感的現狀及關系研究. 呼和浩特: 內蒙古師范大學, 2022.
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18.	楊詩彤, 王玉潔, 蔣俊佳, 等. 老年人社會網絡類型與主觀幸福感相關性研究. 中國健康教育, 2024, 40(6): 518-524.
19.	吳綠敏. 人際關系與主觀幸福感的關系研究. 漳州: 閩南師范大學, 2021.
20.	高斐. 大學生死亡態度、主觀幸福感和應對方式的相關研究. 濟寧: 曲阜師范大學, 2011.
21.	孟可強, 李鳳蘭, 王麗, 等. 童年社會經濟地位與農村成年居民心理健康: 希望感和主觀幸福感的作用. 心理科學, 2023, 46(5): 1148-1155.
22.	湯鵬暉. 子女數目對農村老人主觀幸福評價的影響. 黑龍江科學, 2022, 13(23): 27-29,33.
23.	高曉鳳, 劉敏, 段云. 四川省農村地區老年人健康貧困現況及影響因素研究. 現代預防醫學, 2024, 51(12): 2210-2214,2234.
24.	李嘉楠, 陳榮杰. 女兒數量、情感支持與老年父母健康—來自CHARLS的證據. 中國經濟問題, 2022, (4): 170-183.
25.	劉威, 劉昌平. 社會保險與農村老年健康: 參保會提升老年人健康水平嗎. —基于多元有序Logistic模型的實證研究. 社會保障研究, 2018, (2): 47-53.
26.	夏青, 肖鳳鳳, 彭心雨, 等. 自主性感知在農村老年人死亡焦慮和自我養老能力間的中介作用. 護理學報, 2022, 29(9): 52-57.

1. Soleimani AM, Bahrami N, Allen K, et al. Death anxiety in patients with cancer: a systematic review and meta-analysis. Eur J Oncol Nurs, 2020, 48: 101803.
2. Mina T, Ali K, Reza SM, et al. The association between death anxiety with spiritual experiences and life satisfaction in elderly people. Electron Physician, 2017, 9(3): 3980-3985.
3. Ali M S, Nasim B, Simin Z, et al. Predictors of death anxiety among patients with heart disease. Death stud, 2020, 44(3): 160-167.
4. 盧姣娣. 肺癌患者死亡焦慮現況調查及影響因素分析. 長沙: 中南大學, 2023.
5. 林鑫, 張心怡, 張雨婧, 等. 四川農村老年人死亡焦慮現況及其影響因素研究. 現代預防醫學, 2024, 51(9): 1625-1629.
6. Lee AH, Poon N, Dolan P, et al. Patients' subjective well-being: determinants and its usage as a metric of healthcare service quality. J Health Psychol, 2024, 30(3): 486-497.
7. Chen HL, Lee PF, Chang YC, et al. The association between physical fitness performance and subjective happiness among Taiwanese adults. Int J Environ Res Public Health, 2020, 17(11): 3774.
8. 邱恒, 黃晨, 劉倩, 等. 健康體適能評定量表的編制及在老年人群中應用的信效度. 中華行為醫學與腦科學雜志, 2021, 30(2): 173-179.
9. 劉仁剛, 龔耀先. 紐芬蘭紀念大學幸福度量表的試用. 中國臨床心理學雜志, 1999, (2): 44-45,47.
10. 楊紅. 死亡焦慮量表的跨文化調適及其應用的研究. 北京: 北京中醫藥大學, 2011.
11. 溫忠麟, 侯杰泰, 馬什赫伯特. 結構方程模型檢驗: 擬合指數與卡方準則. 心理學報, 2004, (2): 186-194.
12. Salum GA, Patrick DL, Isolan LR, et al. Youth quality of life instrument-research version (YQOL-R): psychometric properties in a community sample. J Pediatr, 2012, 88(5): 443-448.
13. 馮宇燕. 不同養老模式下老年人主觀健康與死亡焦慮的關系. 天津: 天津師范大學, 2021.
14. 朱海玲, 史寶欣. 死亡態度影響因素的研究進展. 中華護理雜志, 2010, 45(6): 569-571.
15. 吳丘云. 社區老年人生命意義感的影響因素及干預研究. 南充: 西華師范大學, 2023.
16. 馬燕. 老年人控制感和生命意義感與主觀幸福感的現狀及關系研究. 呼和浩特: 內蒙古師范大學, 2022.
17. 王萍, 尚錦云, 何姣姣, 等. 社會支持對農村老年人死亡焦慮的影響. 西北人口, 2021, 42(1): 85-96.
18. 楊詩彤, 王玉潔, 蔣俊佳, 等. 老年人社會網絡類型與主觀幸福感相關性研究. 中國健康教育, 2024, 40(6): 518-524.
19. 吳綠敏. 人際關系與主觀幸福感的關系研究. 漳州: 閩南師范大學, 2021.
20. 高斐. 大學生死亡態度、主觀幸福感和應對方式的相關研究. 濟寧: 曲阜師范大學, 2011.
21. 孟可強, 李鳳蘭, 王麗, 等. 童年社會經濟地位與農村成年居民心理健康: 希望感和主觀幸福感的作用. 心理科學, 2023, 46(5): 1148-1155.
22. 湯鵬暉. 子女數目對農村老人主觀幸福評價的影響. 黑龍江科學, 2022, 13(23): 27-29,33.
23. 高曉鳳, 劉敏, 段云. 四川省農村地區老年人健康貧困現況及影響因素研究. 現代預防醫學, 2024, 51(12): 2210-2214,2234.
24. 李嘉楠, 陳榮杰. 女兒數量、情感支持與老年父母健康—來自CHARLS的證據. 中國經濟問題, 2022, (4): 170-183.
25. 劉威, 劉昌平. 社會保險與農村老年健康: 參保會提升老年人健康水平嗎. —基于多元有序Logistic模型的實證研究. 社會保障研究, 2018, (2): 47-53.
26. 夏青, 肖鳳鳳, 彭心雨, 等. 自主性感知在農村老年人死亡焦慮和自我養老能力間的中介作用. 護理學報, 2022, 29(9): 52-57.

Chinese Journal of Evidence-Based Medicine

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