Doctoral Dissertation Research: Social Interaction Barriers and Mental Health among Older Adults with Physical Disabilities.

摘要：该项目将探索身体残疾的老年人在社会交往中的感知障碍，以了解这些感知如何塑造心理健康。这项研究将加强对残疾和老年人心理健康的基本了解，超越将身体残疾与较差的精神健康直接联系起来的理解，强调残疾如何以及为什么会影响情绪健康。这些发现将通过以下方式对老年人健康的各个利益相关者产生积极影响：为康复医院的干预策略提供信息；帮助家庭为康复提供支持性环境，提高福祉；允许医疗保险公司制定早期有效的做法，减少额外的心理和身体健康下降；以及告知建筑师和设计师身体残疾的老年人遇到物理环境的方式，以优化《美国残疾人法》(ADA)的实施。在美国，超过三分之一的老年人身体残疾。残疾可能会限制参与人际互动的能力，因此，身体残疾的老年人的心理健康可能反映出未得到满足的社会需求。了解导致肢体残疾人士社交互动减少的过程非常重要，因为社交孤立不仅与心理健康状况不佳有关，还与自我评价较低的健康状况、更多的医疗保健使用和成本，甚至死亡率有关。该项目的主要目标是确定和探索社会互动中被认为的人际和环境障碍如何影响身体残疾的老年人的心理健康。为此，拟议的项目将采用混合方法设计。对来自国家社会生活、健康和老龄化项目(NSHAP)的具有全国代表性的调查数据的分析将与对患有身体残疾的老年人的深入访谈相结合。调查数据将被用来建立身体残疾、社会交往和心理健康之间的联系。然而，由于社会互动的个人化性质，对社会互动的感知障碍的评估很难通过大型调查的标准化封闭式问卷设计来实现。因此，将使用对60名患有肢体残疾的老年人的半结构化访谈，他们是中西部康复中心的(前)患者，以允许对个人进行详细的探索？对使社交变得困难的因素的看法。这一项目的进展和结果将测试一个扩展的理论模型，该模型整合了生物、心理、社会和压力过程理论，以确定社交互动中感知到的人际和环境障碍是情境依赖的，从而形成塑造肢体残疾老年人心理健康的间歇性压力来源。

Abstract:This project will explore perceived barriers to social interaction among older adults with physical disabilities in order to understand how these perceptions shape mental health. This research will enhance basic understanding of disability and older adult mental health by moving beyond understanding physical disability as directly linked to poorer mental health to emphasize how and why disability compromises emotional well-being. The findings will have a positive impact through their utility for various stakeholders of older adults' health by: informing intervention strategies of rehabilitation hospitals; helping families provide a supportive environment for recovery that enhances well-being; allowing health insurers to develop early and effective practices that reduce additional mental and physical health declines; and informing architects and designers of the ways in which older adults with physical disabilities encounter the physical environment to optimize implementation of the Americans with Disabilities Act (ADA). Over a third of older adults in the U.S. are physically disabled. Disablement likely restricts the ability to engage in interpersonal interactions and thus the mental health of older adults with physical disabilities may reflect unmet social needs. Understanding the processes that lead to lower social interaction among those with physical disabilities is important because social isolation is associated with not only poor mental health but also lower self-rated health, greater healthcare use and cost, and even mortality. The main objective of the project is to identify and explore how perceived interpersonal and environmental barriers to social interaction shape mental health among older adults with physical disabilities. To do this, the proposed project will employ a mixed methods design. Analyses of nationally representative survey data from the National Social Life, Health, and Aging Project (NSHAP) will be combined with in-depth interviews with older adults with physical disabilities. The survey data will be used to establish the association between physical disability, social interaction, and mental health. However, assessment of perceived barriers to social interaction, given their individualized nature, would be difficult to achieve through the standardized closed-response questionnaire design of large surveys. Consequently, semi-structured interviews with 60 older adults with physical disabilities who are (former) patients at a rehabilitation center in the Midwest will be used to allow for detailed exploration of individuals? perceptions of factors that make social interaction difficult. This project advances and the findings will test an expanded theoretical model that integrates biopsychosocial and stress process theories to identify perceived interpersonal and environmental barriers to social interaction as situationally dependent and thus intermittent stressors that shape the mental health of older adults with physical disabilities