The mediating role of depression in the relationship between social engagement and cognitive function in older persons
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摘要:
目的 分析抑郁在老年人社会参与和认知功能间的中介作用。 方法 基于2018年中国健康与养老追踪调查数据，筛选出符合标准的研究对象7 403人，采用结构方程模型分析抑郁在老年人社会参与和认知功能间的中介作用。 结果 患认知功能障碍的老年人有2 332(31.50%)人。社会参与和认知功能呈正相关(r=0.103, P < 0.001)；社会参与和抑郁呈负相关(r=-0.050, P < 0.001)；抑郁与认知功能呈负相关(r=-0.242, P < 0.001)。结构方程模型各项拟合指标结果显示：χ2=4.094，P < 0.001，渐进残差均方和平方根(root mean square error of approximation, RMSEA)=0.020，比较拟合指数(comparative fit index, CFI)=0.985，塔克-刘易斯指数(Tucker-Lewis Index, TLI)=0.979，增量拟合指数(incremental fit index, IFI)=0.985，模型拟合较好。社会参与对认知功能的直接效应为0.380(95% CI: 0.292~0.467)，以抑郁为中介的间接效应为0.050(95% CI: 0.027~0.073)。 结论 社会参与与老年人认知功能正相关，抑郁与老年人认知功能负相关，抑郁在社会参与和认知功能关系中起部分中介作用。 Abstract:Objective To analyze the mediating effect of depression on the relationship between social engagement and cognitive function in older persons. Methods Based on data from the 2018 China Health and Retirement Longitudinal Study, 7 403 participants were screened for meeting the criteria. Structural Equation Model was used to verify the mediating effect of depression on the relationship between social engagement and cognitive function in older persons. Results There were 2 332 (31.50%) subjects with cognitive dysfunction among older persons. Social engagement was positively correlated with cognitive function (r=0.103, P < 0.001), social engagement was negatively correlated with depression (r=-0.050, P < 0.001), and depression was negatively correlated with cognitive function (r=-0.242, P < 0.001). The results of each fitting index of structural equation model showed that: χ2=4.094, P < 0.001, root mean square error of approximation (RMSEA)=0.020, comparative fit index (CFI)=0.985, Tucker-Lewis Index (TLI)=0.979, incremental fit index (IFI)=0.985, indicated the model fits well. The direct effect of social engagement on cognitive function was 0.380 (95% CI: 0.292-0.467), the indirect effect mediated by depression was 0.050 (95% CI: 0.027-0.073). Conclusion Social engagement positively affects cognitive functioning in older persons, depression negatively affects cognitive functioning in older persons, and depression has a partly mediating effect on the relationship between social engagement and cognitive functioning. -
Key words:
- Cognitive function /
- Social engagement /
- Depression
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图 1 抑郁在老年人社会参与和认知功能之间的中介效应模型
注：a P < 0.001。
Figure 1. Mediating effect model of depression between social engagement and cognitive function in older persons
表 1 研究对象认知功能的基本情况[n(%)]
Table 1. Basic information on the cognitive function of the participants [n(%)]
变量 n(%) (x±s) t/F值 P值 变量 n(%) (x±s) t值 P值 性别 16.188 < 0.001 饮酒状况 -11.454 < 0.001 男 4 131 (55.80) 23.14±4.20 无 4 753(64.20) 21.93±4.70 女 3 272 (44.20) 21.42±4.89 有 2 650(35.80) 23.19±4.29 年龄(岁) 7.189 < 0.001 吸烟状况 -3.882 < 0.001 ≤70 4 430 (59.84) 22.69±4.49 无 5 034(68.00) 22.24±4.70 > 70 2 973 (40.16) 21.91±4.72 有 2 369(32.00) 22.68±4.35 居住地 343.421 < 0.001 收入状况 -6.576 < 0.001 城市 1 739 (23.49) 24.49±3.97 无 6 287(84.93) 22.23±4.65 城镇 543 (7.33) 24.05±4.03 有 1 116(15.07) 23.21±4.22 农村 5 121 (69.17) 21.49±4.58 养老金 -1.036 0.300 教育程度 516.378 < 0.001 无 2 249(30.38) 22.30±4.46 小学以下 3 058 (41.31) 19.79±4.49 有 5 154(69.62) 22.42±4.66 小学 1 923 (25.98) 23.05±3.93 退休 -7.680 < 0.001 初中 1 491 (20.14) 24.64±3.39 否 4 022(54.33) 22.01±4.52 高中 795 (10.74) 25.81±2.89 是 3 381(45.67) 22.83±4.65 大专及以上 136 (1.84) 26.33±2.80 抑郁 18.893 < 0.001 婚姻状况 44.022 < 0.001 否 4 766(64.37) 23.11±4.42 已婚 5 875 (79.36) 22.65±4.52 是 2 637(35.62) 21.05±4.62 离异或分居 359 (4.85) 22.50±4.41 社会参与 -7.814 < 0.001 丧偶 1 133 (15.30) 21.00±4.79 无 3 498(47.25) 21.94±4.64 未婚 36 (0.49) 20.39±4.98 有 3 905(52.75) 22.77±4.53 
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表 2 老年人社会参与、抑郁与认知功能相关性分析
Table 2. Correlation analysis of social engagement, depression and cognitive function in older persons
变量 认知功能 社会参与 抑郁 认知功能 1.000 社会参与 0.103 a 1.000 抑郁 -0.242 a -0.050 a 1.000 注：a P < 0.001。
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表 3 抑郁在老年人社会参与和认知功能之间中介效应的Bootstrap分析
Table 3. Bootstrap analysis of mediating effect of depression on social engagement and cognitive function in older persons
效应 效应值 Boot标准误 Boot 95% CI值 相对效应占比(%) 总效应 0.430 0.048 0.335~0.525 直接效应 0.380 0.045 0.292~0.467 88.37 间接效应 0.050 0.116 0.027~0.073 11.63
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