Türkiye’de Algılanan Sağlık ve Duygusal İyi Oluşla İlişkili Etkenler: Sosyal Destek ve Finansal Zorlanmanın Rolü

Öz

Sağlığın belirleyicileri olan psikososyal ve maddi kaynakların ulusal düzeydeki rolleri nadiren birlikte incelenmektedir. Bu çalışmada, Türkiye Genel Sosyal Araştırması 2024 (TGSS-2024) verileriyle 2.615 yetişkinde algılanan sağlık ve duygusal iyi oluş (Cronbach’s α=0,88) ile ilişkili etkenler incelenmiştir. Sosyal destek (α=0,71) ve finansal zorlanmaya odaklanılarak demografik, sosyoekonomik ve yaşam tarzı değişkenleri modele dâhil edilmiştir. İlişkiler, verideki düzensizliklere karşı sonuçları koruyan dirençli (robust) standart hatalarla hiyerarşik regresyon kullanılarak incelenmiş; sosyal desteğin krizin etkilerini hafifletici koruyucu bir mekanizma olduğunu savunan stres-tampon hipotezi test edilmiştir. Bulgulara göre sosyal destek, her iki çıktıyla (iyi oluş: β=0,40; sağlık: β=0,25) en güçlü ilişkiye sahip faktördür. Finansal zorlanma ise algılanan sağlık (β=−0,15) ve iyi oluşla (β=−0,13) bağımsız ve olumsuz ilişkilidir. Sosyal destek, finansal zorlanma-iyi oluş ilişkisini anlamlı düzeyde hafifletmiş (etkileşim β=+0,07, p=0,002); yüksek sosyal destekte stresin etkisi yaklaşık üç kat zayıflamıştır. Ancak bu düzenleyici etki sınırlı düzeydedir (ΔR²=%0,6) ve algılanan sağlık üzerinde bulunmamıştır. Kesitsel nitelikteki bu bulgular, sosyal desteğin toplum sağlığıyla en güçlü ilişkiye sahip kaynak olduğuna işaret etmekte ve ekonomik zorluklara yönelik müdahalelerde psikososyal destek sistemlerinin de dikkate alınabileceğini düşündürmektedir.

Anahtar Kelimeler

• Sosyal destek
• finansal zorlanma
• algılanan sağlık
• duygusal iyi oluş

Destekleyen Kurum

Bu araştırma, kamu, ticari veya kâr amacı gütmeyen sektörlerdeki herhangi bir finansman kuruluşundan özel bir destek almamıştır.

Etik Beyan

Bu çalışma, kamuya açık ve tümüyle anonimleştirilmiş Türkiye Genel Toplumsal Araştırması 2024 (TGSS-2024) veri setinin ikincil analizine dayanmaktadır; kapsamında insan katılımcılarla yeni bir etkileşim kurulmamış ve kimlik belirleyici hiçbir bilgiye erişilmemiştir. Helsinki Bildirgesi ilkeleri uyarınca, kamuya açık ve anonim verilerin ikincil analizine dayanan, yeni veri toplanmayan bu tür çalışmalar etik kurul onayından muaftır; bu nedenle ayrıca etik kurul onayı alınmamıştır. Verilerin asıl toplanmasındaki gerekli izinler ve katılımcı onamları Türkiye İstatistik Kurumu tarafından alınmıştır.

Factors Associated with Self-Rated Health and Affective Well-Being in Türkiye: The Roles of Social Support and Financial Strain

Öz

Health reflects not only material circumstances but also psychosocial resources, yet their relative roles are rarely examined together in national data. Using the Turkish General Social Survey 2024 (TGSS-2024), a national survey of 2,615 adults, we examined the factors associated with two separate outcomes, self-rated health and affective well-being (a ten-item affect battery indexing predominantly low psychological distress; Cronbach’s α=0.88), focusing on social support (α=0.71) and financial strain, with healthy lifestyle behaviours and demographic and socioeconomic covariates, and religiosity examined descriptively. Associations were estimated with hierarchical linear regression using heteroscedasticity-consistent (HC3) robust standard errors, and the stress-buffering hypothesis was tested as a social support × financial strain interaction; robustness checks included post-stratification weighting, regional fixed effects, region-clustered standard errors, and a marker-variable common-method check. Social support was the factor most strongly associated with both outcomes, and more so with affective well-being (β=0.40) than self-rated health (β=0.25). Financial strain was independently associated with worse self-rated health (β=−0.15) and lower well-being (β=−0.13). Social support significantly moderated the financial strain–well-being association (interaction β=+0.07, p=0.002), which was about three times weaker at high than at low support (β=−0.07, p=0.03 versus β=−0.21, p<0.001) attenuated but not eliminated, and modest in size (ΔR²=0.6%); no moderation was found for self-rated health. Men reported higher scores on both outcomes, and the dimensions diverged across age. These cross-sectional findings identify social support as the resource most strongly associated with population health, warranting attention in responses to economic strain.

Anahtar Kelimeler

• Social support
• financial stress
• self-rated health
• affective well-being

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Etik Beyan

This study is a secondary analysis of the publicly available and fully anonymised Turkish General Social Survey 2024 (TGSS-2024) dataset; it involved no new interaction with human participants and no access to identifying information. In accordance with the principles of the Declaration of Helsinki, secondary analyses of publicly available, anonymised data that do not involve the collection of new data are exempt from ethics-committee approval; accordingly, no separate ethics-committee approval was sought. The necessary permissions and participant consent for the original data collection were obtained by the Turkish Statistical Institute.

Kaynakça

1. Rutter M. Implications of resilience concepts for scientific understanding. Ann N Y Acad Sci. 2006;1094:1-12. DOI:10.1196/annals.1376.002.
2. Netuveli G, Wiggins RD, Montgomery SM, Hildon Z, Blane D. Mental health and resilience at older ages: bouncing back after adversity in the British Household Panel Survey. J Epidemiol Community Health. 2008;62(11):987-91. DOI:10.1136/jech.2007.069138.
3. Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol. 2014;5:25338. DOI:10.3402/ejpt. v5.25338.
4. Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310- 57. DOI:10.1037/0033-2909.98.2.310.
5. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. DOI:10.1371/journal.pmed.1000316.
6. Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci USA. 2013;110(15):5797-801. DOI:10.1073/pnas.1219686110.
7. Nitschke JP, Forbes PAG, Ali N, Cutler J, Apps MAJ, Lockwood PL, et al. Resilience during uncertainty?Greater social connectedness during COVID-19 lockdown is associated with reduced distress and fatigue. Br J Health Psychol. 2021;26(2):553-69. DOI:10.1111/bjhp.12485.
8. Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51(1 Suppl):S41-S53. DOI:10.1177/0022146510383499.

9. Kağıtçıbaşı Ç. Family, self, and human development across cultures: theory and applications. 2nd ed. Mahwah: Lawrence Erlbaum Associates; 2007.
10. Berkman LF, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000.
11. Koenig HG, King DE, Carson VB. Handbook of religion and health. 2nd ed. New York: Oxford University Press; 2012.
12. Pargament KI. The bitter and the sweet: an evaluation of the costs and benefits of religiousness. Psychol Inq. 2002;13(3):168-81. DOI:10.1207/S15327965PLI1303_02.
13. Pargament KI. The psychology of religion and coping: theory, research, practice. New York: Guilford Press; 1997.
14. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with major life stressors. J Sci Study Relig. 1998;37(4):710-24. DOI:10.2307/1388152.
15. Penedo FJ, Dahn JR. Exercise and well-bein a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2):189-93. DOI:10.1097/00001504-200503000-00013.
16. Nişancı Z, Kılavuz MT, Aysan MF, Ovayurt MET, Yüce B, Aydın AB, et al. Türkiye Genel Sosyal Saha Araştırması (TGSS) 2024 [dataset]. Zenodo; 2026. DOI:10.5281/zenodo.18721350.
17. Turkish Statistical Institute (TÜİK). Address-Based Population Registration System Results, 2024. Ankara: TÜİK; 2025.
18. Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385-401. DOI:10.1016/S0277-9536(99)00390-1.
19. Addis ME, Mahalik JR. Men, masculinity, and the contexts of help seeking. Am Psychol. 2003;58(1):5-14. DOI:10.1037/0003-066X.58.1.5.
20. Pinkhasov RM, Shteynshlyuger A, Hakimian P, Lindsay GK, Samadi DB, Shabsigh R. Are men shortchanged on health? Perspective on life expectancy, morbidity, and mortality in men and women in the United States. Int J Clin Pract. 2010;64(4):465-74. DOI:10.1111/j.1742-1241.2009.02289.x.
21. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002;359(9302):248-52. DOI:10.1016/S0140-6736(02)07451-2.