党的二十大提出重视心理健康和精神卫生，提高老年人心理健康质量是增进民生福祉，提高人民生活质量的重要途径。中国老龄化形势严重，老年人口健康问题成为社会一大难题。数量庞大的老年人患有慢性病，老年人口整体身体健康水平偏低。此外，慢性病痛及家庭规模变化带来的空巢等问题也给老年人群心理健康带来负面影响，使其抑郁孤独情绪加重。为有效应对老龄健康问题，我国于2016年在承德、长春等15个城市启动长期护理保险试点，2020年将试点范围扩大到49个城市，覆盖了1.45亿人，为老年人的身体健康提供了相应保障的同时，也缓解了失能家庭的照护压力。已有许多学者针对长期护理保险进行了政策效果评估，多集中于健康效应和医疗效应以及对家庭照料、劳动力供给的溢出效应等方面，但是健康效应研究多侧重于生理健康层面，聚焦到老年人心理健康的影响研究较少，且缺乏围绕长期护理保险对老年人心理健康影响过程的机制分析，对此本文展开了深入探究。

厘清长期护理保险与老年人心理健康之间的关系，有利于扩充长期护理保险对老年人心理健康提升方面的研究内容，为长期护理保险的发展提供政策建议。在对国内外相关文献概述之后，本研究在政策评估的背景下，梳理了马斯洛需求层次、社会支持和自我决定三大理论基础。在此基础上，本研究选取2015年和2018年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）面板数据，通过建立双重差分模型（DID）实证分析长期护理保险能否有效改善老年人心理健康，并对回归结果做一系列稳健性检验。同时本研究分析了长期护理保险在老年人内部不同群体间研究效果的异质性，最后经过机制检验，剖析了长期护理保险影响老年人心理健康水平的渠道和作用机理。

本研究得出以下结论：首先，长期护理保险可以显著提升老年人心理健康水平；其次，异质性分析结果表明，长期护理保险对老年人心理健康的影响在性别、政策覆盖面方面均有差异性，尤其是对老年女性和保险全覆盖模式下老人的心理健康状况有显著改善作用。最后，本研究引入自我决定理论中的基本心理需求理论进行机制分析，检验长期护理保险对老年人心理健康的影响机制。结果表明：一方面，长期护理保险可以通过提供现金补贴或护理服务，改善老年人失能状况或者部分维持其身体机能，满足老年人的自主和能力心理需求，提升其心理健康水平；另一方面，长期护理保险也减轻了失能老人家庭的子女照料负担，增加了子女对老人的情感支持，满足了老人的情感关系需求，进而改善其心理健康状况。

结合上述研究成果，本研究提出以下政策建议：一方面，完善政策设计内容，丰富政策心理服务内容、扩大参保范围以及细化政策分级服务标准。另一方面，强化政策社会支持作用，重视家庭情感支持作用和发挥社区养老支持功能。

Paying attention to mental health and mental hygiene and improving the quality of mental health of the elderly is an important way to improve people's well-being and quality of life, the 20th National Congress of the Communist Party of China said. The aging situation in China is serious, and the health of the elderly population has become a major social problem. A large number of the elderly suffer from chronic diseases and the elderly are in poor health. In addition, problems such as chronic pain and empty nests due to changes in family size have a negative impact on the mental health of the elderly, exacerbating depression and loneliness. In order to effectively address the health problems of the elderly, China launched a long-term care insurance pilot in 15 cities in 2016, including Chengde and Changchun, and expanded the pilot to 49 cities in 2020, covering 145 million people, providing a corresponding guarantee for the physical health of the elderly, and relieving the care pressure of families with incapacitated elderly. A number of scholars have conducted policy impact assessments of long-term care insurance, focusing on health and medical effects and spillover effects on family care and labour supply. However, the health effects focus on the physical health aspect, the impact of long-term care insurance on the mental health of the elderly is less well studied, and lack mechanism analysis around the impact of long-term care insurance on the mental health of the elderly, so the thesis is thoroughly studied on this.

Clarifying the relationship between long-term care insurance and the mental health of the elderly is helpful to expand the research content of long-term care insurance for the improvement of the mental health of the elderly, and to provide policy recommendations for the development of long-term care insurance. After an overview of the relevant literature at home and abroad, this study combs through Maslow's hierarchy of needs, social support and self-determination theory in the context of policy assessment. On this basis, we selected China Health and Retirement Longitudinal Study (CHARLS) panel data in 2015, 2018 to empirically analyze whether long-term care insurance can effectively improve the mental health of the elderly in the pilot areas by establishing a dual differential model (DID), and performed a series of robust regression tests. At the same time, this study analyzes the heterogeneity of the effects of long-term care insurance among different groups of the elderly, and finally, after mechanism testing, analyzes the channels and mechanisms of long-term care insurance affecting the mental health of the elderly.

This study concludes as follows: First, long-term care insurance can significantly improve the mental health of the elderly; Secondly, the heterogeneity analysis shows that the effect of long-term care insurance on the mental health level of the elderly varies in terms of gender and policy coverage, especially for elderly women and the elderly who participate in urban workers' health insurance. Finally, this study introduces the theory of basic psychological needs in the theory of self-determination to examine the mechanism of long-term care insurance on the mental health of the elderly. The results show that, on the one hand, long-term care insurance can improve the mental health of the elderly by providing cash subsidies or nursing services, improving or partially maintaining the physical functioning of the elderly, satisfying their psychological needs of autonomy and ability; On the other hand, long-term care insurance also reduces the burden of children care for the families of the incapacitated elderly, increases emotional support of the children for the elderly, meets the emotional relationship needs of the elderly and improves their mental health.

This study puts forward the following policy suggestions: on the one hand, improve the policy content, enrich the content of policy psychological services, expand the scope of insurance participation and refine the service standards of policy grading. On the other hand, strengthen the role of the social support of the policy, attach importance to the role of family emotional support and leverage the function of community elderly care.