노인의 의료 이용과 삶의 만족도의 관계 :우울감의 매개효과와 생존분석을 중심으로

다국어 초록 (Multilingual Abstract)

Purpose: This study aimed to confirm the mediating effect of depression on the relationship between life satisfaction and healthcare utilization in the elderly and to explore changes in life satisfaction and the risk of decline over time. Methods: Data were extracted from the Korea Welfare Panel Study (KoWePS) 10th (2015) to 19th (2024) data, comprising 2,493 elderly individuals aged 65 years or older who responded for 10 consecutive years. The independent variables were the number of outpatient visits and the number of hospitalized days, the dependent variable was life satisfaction, and the mediating variable was depression. The Hausman test confirmed the suitability of the fixed-effects model, and the Baron & Kenny (1986) panel regression analysis and the Sobel-test were used to verify the mediating effect. Kaplan-Meier analysis and the Cox proportional hazards model were used to identify the probability and risk of decline in life satisfaction. Results: Depression showed a complete mediation effect on the relationship between the number of outpatient visits and life satisfaction, and a partial mediation effect on the relationship between the number of hospitalization days and life satisfaction. A 1-unit increase in the logarithm of the number of outpatient visits was associated with a 1.15-fold increase in the risk of decline in life satisfaction. Subgroup analysis examined the risk of decline in life satisfaction according to depression status. The non-depressed group showed a 1.11-fold increase in risk, while the depressed group showed a 1.37-fold increase. Meanwhile, the change in life satisfaction and the risk ratio for decline according to the number of hospitalization days were not statistically significant. Conclusions: Depression's mediating effect on the relationship between healthcare utilization and life satisfaction in older adults was confirmed, suggesting that managing depression is crucial for maintaining life satisfaction. Therefore, to improve life satisfaction in older adults, it is necessary to address depression and mental health issues in addition to healthcare utilization.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구 배경 1
• 2. 연구 목적 3
• Ⅱ. 이론적 배경 4
• 1. 초고령사회와 노인 4
• 2. 삶의 만족도 5
• 3. 의료 이용(외래진료 횟수와 입원 일수) 6
• 4. 우울감 7
• 5. 의료 이용, 우울감, 삶의 만족도 간의 관계 8
• 1) 의료 이용이 삶의 만족도에 미치는 영향 8
• 2) 의료 이용이 우울감에 미치는 영향 9
• 3) 우울감이 삶의 만족도에 미치는 영향 10
• 4) 우울감을 매개로 의료 이용이 삶의 만족도에 미치는 영향 10
• Ⅲ. 연구 방법 12
• 1. 연구 설계 12
• 1) 연구 자료 12
• 2) 연구 대상자 13
• 3) 연구 모형 14
• 4) 윤리적 고려 14
• 2. 변수 선정 15
• 1) 독립변수(외래진료 횟수, 입원 일수) 15
• 2) 종속변수(삶의 만족도) 16
• 3) 매개변수(우울감) 17
• 4) 통제변수 18
• 3. 분석 도구 및 방법 20
• 1) 기술통계 및 상관분석 20
• 2) 하우즈만 검증 20
• 3) 패널 회귀분석 21
• 4) 매개효과 검증 22
• 5) 생존분석 23
• Ⅳ. 연구 결과 24
• 1. 연구 대상자의 특성 24
• 2. 주요 변수 간의 상관관계 28
• 3. 의료 이용, 우울감, 삶의 만족도 관계에 대한 검증 30
• 1) 하우즈만 검증 30
• 2) 고정 효과모형을 이용한 패널 회귀분석 32
• 3) 우울감의 매개효과 검증 34
• 4. 생존분석 35
• 1) 우울감(매개변수) 35
• 2) 외래진료 횟수, 입원 일수(독립변수) 37
• 3) 통제변수 41
• Ⅴ. 논의 55
• Ⅵ. 결론 60
• 참고문헌 61
• ABSTRACT 72