中年危机评分构建及其与认知、抑郁的关系

尹平; 谢今朝; 廖婧; 顾菁

doi:10.16462/j.cnki.zhjbkz.2023.05.012

中年危机评分构建及其与认知、抑郁的关系

doi: 10.16462/j.cnki.zhjbkz.2023.05.012

尹平¹,
谢今朝¹,
廖婧^{1, 2, 3},
顾菁^{1, 2, 3, ,}

1.
510080 广州，中山大学公共卫生学院医学统计学系
2.
510030 广州，中山大学全球卫生研究中心
3.
510030 广州，中山大学卫生信息研究中心

基金项目:

国家自然科学基金 72061137003

广州市科技计划项目 2060206

详细信息

通讯作者:
顾菁，E-mail：gujing5@mail.sysu.edu.cn

中图分类号: R749.4
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-30
- 修回日期: 2023-03-16
- 刊出日期: 2023-05-10

Construction of midlife crisis scores and its relationship with cognition and depression

YIN Ping¹,
XIE Jinzhao¹,
LIAO Jing^{1, 2, 3},
GU Jing^{1, 2, 3
, ,}

1.
Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
2.
Center of Global Health Research, Sun Yat-Sen University, Guangzhou 510300, China
3.
Center for Health Information Research, Sun Yat-sen University, Guangzhou 510300, China

Funds:

National Natural Science Foundation of China 72061137003

Science and Technology Program of Guangzhou 2060206

More Information

Corresponding author: GU Jing，E-mail：gujing5@mail.sysu.edu.cn

摘要

摘要: 目的初步构建中国人群中年危机的综合测量方法，比较不同年份人群中年危机的差异及其与社会人口特征的关系，并探究中年危机与认知、抑郁的关系。方法采用2011年和2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Survey, CHARLS)数据，基于文献和专家咨询，从经济、照护、工作、健康、社交5个维度构建中年危机的综合测量(总分10分，分数越高代表中年危机越严重)。采用多重线性回归比较了不同年份中年危机的差异和社会人口学影响因素，并探讨了中年危机与认知、抑郁的关系。结果共纳入8 554名45~60岁的中年人。校正了社会人口学变量后，与2011年相比，2018年中年危机总分更高。从各维度看，2018年中年人的经济危机与照护危机更大，而工作危机、健康危机和社会关系危机相对较小(均有P < 0.05)。年龄较大者、女性、农村居民的工作危机和健康危机更大，学历水平更高者经济危机更大，消费水平低、家庭规模大的中年人照护危机更重(均有P < 0.05)。中年危机与认知功能呈负相关，与抑郁呈正相关(均有P < 0.05)。结论不同时代人群面临的中年危机情况不同，中年危机与认知和抑郁有关，未来应关注中年危机的情况，加强对高危群体的干预。
- 中年危机 /
- 中老年人 /
- 中国健康与养老追踪调查 /
- 认知 /
- 抑郁
Abstract: Objective To construct a comprehensive measurement of midlife crisis in the Chinese population, compare the differences in midlife crisis across different years, examine its relationship with socio-demographic characteristics, and explore the association between midlife crisis and cognition and depression. Methods Using data from the China Health and Retirement Longitudinal Survey (CHARLS) in 2011 and 2018, based on the literature and expert consultations, a comprehensive assessment for midlife crisis was constructed from five dimensions: economic, caregiving, work status, health, and social relationship. A total score of 10 was assigned, with a higher score indicating a more severe midlife crisis. Multiple linear regressions were used to analyze the differences and sociodemographic factors influencing midlife crisis across different years, and to explore the association between midlife crisis and cognition and depression. Results A total of 8 554 middle-aged adults aged 45-60 years were included. After adjusting for sociodemographic variables, the total score for midlife crisis was higher in 2018 than in 2011. In terms of the five dimensions, the economic crisis and caregiving crisis in 2018 were higher, while the work crisis, health crisis, and social relationship crisis were relatively lower (all P < 0.05). Older individuals, women, and rural residents experienced greater work and health crises, while those with higher levels of education experienced greater economic crisis. Middle-aged individuals with lower consumption levels and larger family sizes experienced greater care crisis (all P < 0.05). The midlife crisis was negatively correlated with cognitive function and positively correlated with depression (all P < 0.05). Conclusions The midlife crisis situation differs among different generations, and it is related to cognitive function and depression. In the future, attention should be paid to midlife crisis and interventions should be strengthened for high-risk groups.
- Midlife crisis /
- Middle-aged and elderly /
- China Health and Retirement Longitudinal Survey /
- Cognition /
- Depression

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图 1 研究对象纳入、排除流程图

Figure 1. Flow chart for inclusion and exclusion of study subjects

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表 1 中年危机各维度的定义

Table 1. Definition of the each dimension of midlife crisis

中年危机维度	具体变量及赋值
经济	(1)为父母/子女提供经济帮助(0=不提供，0.5=提供一方，1=提供两方); (2)是否有负债(0=无，1=有)
照护	(1)照护孙子女(0=不照护，1=照护); (2)照护父母(0=不照护，1=照护)
工作	(1)目前是否从事不止一项工作(0=否，1=是); (2)工作稳定性(0=稳定，0.5=一般稳定，1=不稳定)
健康	(1)自评健康(0=健康状况良好，1=健康状况一般，2=健康状况不佳)
社会关系	(1)与子女关系的紧密度(0=紧密，0.5=一般紧密，1=不紧密); (2)与朋友交往的紧密度(0=紧密，1=不紧密)

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表 2 2011年与2018年调查对象基本情况及中年危机情况[n(%)]

Table 2. Basic characteristics and midlife crisis of respondents in 2011 and 2018 [n(%)]

变量	总体(N=8 554)	2011年(n=3 564)	2018年(n=4 990)	$\chi$²/t值	P值
年龄组(岁)				217.750	< 0.001
45~ < 51	2 848(33.3)	1 161(32.6)	1 687(33.8)
51~ < 56	3 019(35.3)	998(28.0)	2 021(40.5)
56~60	2 687(31.4)	1 405(39.4)	1 282(25.7)
性别				2.181	0.146
男	4 293(50.2)	1 755(49.2)	2 538(50.9)
女	4 261(49.8)	1 809(50.8)	2 452(49.1)
教育水平				28.658	< 0.001
初中及以下	6 957(81.3)	2 982(83.7)	3 975(79.7)
高中或职高	1 361(15.9)	514(14.4)	847(17.0)
大学及以上	236(2.76)	68(1.91)	168(3.37)
婚姻状况				112.920	< 0.001
已婚	7 253(84.8)	2 924(82.0)	4 329(86.8)
同居	681(7.96)	257(7.21)	424(8.50)
其他	620(7.25)	383(10.7)	237(4.75)
居住地区				0.137	0.728
城市	3 637(42.5)	1 507(42.3)	2 130(42.7)
农村	4 917(57.5)	2 057(57.7)	2 860(57.3)
家庭规模(人)				380.830	< 0.001
1~ < 3	3 348(39.1)	1 036(29.1)	2 312(46.3)
3~ < 5	3 488(40.8)	1 510(42.4)	1 978(39.6)
≥5	1 718(20.1)	1 018(28.6)	700(14.0)
家庭人均年消费[M(IQR)，元]				5.650	0.130
最低	2 959(12 632)	2 084(1 090)	5 035(2 598)
较低	8 275(6 138)	4 120(1 152)	10 140(2 872)
较高	13 840(10 227)	6 930(1 834)	16 956(2 656)
最高	27 500(25 430)	13 610(8 201)	35 565(26 979)
认知功能(x ±s)
认知总分	13.2±3.27	12.7±3.19	13.5±3.29	-11.117	< 0.001
情景记忆	4.57±1.81	3.98±1.63	5.00±1.82	-27.025	< 0.001
精神状态	8.58±2.22	8.72±2.26	8.49±2.18	4.631	< 0.001
抑郁分数(x ±s)	7.72±6.04	7.95±6.20	7.56±5.92	2.864	0.004
中年危机(x ±s)
总分	3.95±1.47	3.60±1.37	4.20±1.49	-19.086	< 0.001
经济	0.71±0.62	0.40±0.48	0.93±0.62	-44.121	< 0.001
照料	0.72±0.66	0.54±0.62	0.85±0.66	-21.910	< 0.001
工作	0.69±0.45	0.78±0.39	0.62±0.48	16.560	< 0.001
健康	0.91±0.69	0.97±0.70	0.87±0.68	6.653	< 0.001
社会关系	0.67±0.56	0.68±0.54	0.66±0.57	1.938	0.053

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表 3 2011年与2018年中年危机总分及各维度得分的校正分析

Table 3. Adjusted analysis for the total and dimensional scores of midlife crisis in 2011 and 2018

变量	中年危机总分	中年危机各维度得分值(95% CI)
变量	中年危机总分	经济	照护	工作	健康	社会关系
年份(年)
2011	1.00	1.00	1.00	1.00	1.00	1.00
2018	0.66(0.59~0.72) ^a	0.49(0.46~0.52) ^a	0.37(0.34~0.40) ^a	-0.14(-0.16~-0.12) ^a	-0.08(-0.11~-0.05) ^a	-0.03(-0.05~0.00) ^b
年龄组(岁)
45~ < 51	1.00	1.00	1.00	1.00	1.00	1.00
51~ < 56	0.23(0.15~0.31) ^a	-0.13(-0.16~-0.10) ^a	0.13(0.10~0.17) ^a	0.10(0.07~0.12) ^a	0.07(0.03~0.11) ^a	0.05(0.02~0.08) ^c
56~60	0.24(0.16~0.32) ^a	-0.25(-0.28~-0.22) ^a	0.12(0.08~0.15) ^a	0.17(0.15~0.20) ^a	0.13(0.09~0.17) ^a	0.08(0.05~0.12) ^a
性别
男	1.00	1.00	1.00	1.00	1.00	1.00
女	0.30(0.24~0.37) ^a	-0.04(-0.06~-0.01) ^c	0.05(0.02~0.07) ^c	0.15(0.13~0.17) ^a	0.12(0.09~0.15) ^a	0.00(-0.03~0.02)
婚姻
已婚	1.00	1.00	1.00	1.00	1.00	1.00
同居	-0.03(-0.15~0.09)	0.02(-0.02~0.07)	0.01(-0.04~0.06)	-0.08(-0.12~-0.05) ^a	0.02(-0.03~0.08)	0.02(-0.03~0.07)
其他	-0.22(-0.35~-0.09) ^a	-0.20(-0.25~-0.15) ^a	-0.11(-0.17~-0.06) ^a	-0.01(-0.04~0.03)	0.10(0.04~0.16) ^c	0.02(-0.03~0.07)
居住地
城市	1.00	1.00	1.00	1.00	1.00	1.00
农村	0.31(0.24~0.38) ^a	0.08(0.06~0.11) ^a	0.01(-0.02~0.04)	0.10(0.08~0.12) ^a	0.11(0.08~0.15) ^a	0.01(-0.02~0.03)
教育水平
初中及以下	1.00	1.00	1.00	1.00	1.00	1.00
高中或职高	-0.33(-0.42~-0.24) ^a	0.02(-0.02~0.05)	0.02(-0.02~0.06)	-0.13(-0.16~-0.10) ^a	-0.16(-0.20~-0.12) ^a	-0.06(-0.10~-0.03) ^a
大学及以上	-0.70(-0.90~-0.50) ^a	0.16(0.08~0.24) ^a	0.01(-0.08~0.10)	-0.40(-0.46~-0.34) ^a	-0.31(-0.41~-0.22) ^a	-0.15(-0.23~-0.07) ^a
家庭规模(人)
1~ < 3	1.00	1.00	1.00	1.00	1.00	1.00
3~ < 5	-0.10(-0.17~-0.03) ^c	-0.04(-0.07~-0.01) ^b	0.13(0.09~0.16) ^a	-0.03(-0.05~0.00) ^b	-0.03(-0.06~0.01)	-0.12(-0.15~-0.09) ^a
≥5	0.24(0.15~0.33) ^a	-0.03(-0.06~0.01)	0.45(0.41~0.49) ^a	0.00(-0.03~0.03)	-0.01(-0.06~0.04)	-0.17(-0.20~-0.13) ^a
家庭人均年消费水平
最低	1.00	1.00	1.00	1.00	1.00	1.00
较低	-0.08(-0.17~0.01)	0.02(-0.02~0.05)	0.03(-0.01~0.07)	-0.05(-0.08~-0.03) ^a	-0.05(-0.09~0.00)^b	-0.02(-0.06~0.02)
较高	-0.08(-0.17~0.01)	0.09(0.05~0.12) ^a	0.06(0.01~0.10) ^c	-0.08(-0.11~-0.06) ^a	-0.07(-0.11~-0.02) ^c	-0.06(-0.10~-0.03) ^a
最高	-0.12(-0.22~-0.02)^b	0.15(0.11~0.19) ^a	0.03(-0.01~0.07)	-0.08(-0.11~-0.05) ^a	-0.09(-0.13~-0.04) ^a	-0.12(-0.16~-0.09) ^a
注：^a P < 0.001; ^b P < 0.05; ^c P < 0.01。

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表 4 2011年和2018年中年危机与认知、抑郁的关联

Table 4. Association of midlife crisis with cognition and depression in 2011 and 2018

变量	认知功能β值(95% CI)			抑郁β值(95% CI)
变量	总体认知分数	精神状态	情景记忆	抑郁β值(95% CI)
2011年
中年危机总分	-0.24(-0.32~-0.16) ^a	-0.15(-0.21~-0.10) ^a	-0.09(-0.13~-0.05) ^a	1.32(1.16~1.47) ^a
经济	0.11(-0.11~0.33)	0.11(-0.05~0.27)	0.00(-0.12~0.12)	0.39(-0.03~0.81)
照护	0.01(-0.17~0.19)	-0.03(-0.16~0.10)	0.04(-0.06~0.13)	0.06(-0.28~0.40)
工作	-0.51(-0.79~-0.22) ^a	-0.34(-0.54~-0.13) ^b	-0.17(-0.32~-0.02) ^c	1.22(0.68~1.77) ^a
健康	-0.46(-0.61~-0.31) ^a	-0.29(-0.40~-0.18) ^a	-0.17(-0.25~-0.09) ^a	3.29(3.01~3.58) ^a
社会关系	-0.39(-0.58~-0.20) ^a	-0.22(-0.36~-0.08) ^b	-0.17(-0.27~-0.07) ^b	0.51(0.14~0.87) ^b
2018年
中年危机总分	-0.20(-0.27~-0.14) ^a	-0.11(-0.15~-0.07) ^a	-0.10(-0.13~-0.06) ^a	0.95(0.84~1.07) ^a
经济	0.08(-0.07~0.23)	0.01(-0.09~0.12)	0.07(-0.02~0.15)	0.49(0.22~0.76) ^a
照护	-0.03(-0.17~0.11)	0.00(-0.10~0.09)	-0.03(-0.11~0.05)	0.05(-0.21~0.30)
工作	-0.41(-0.61~-0.21) ^a	-0.30(-0.44~-0.17) ^a	-0.11(-0.22~0.00)	0.57(0.22~0.92) ^b
健康	-0.47(-0.60~-0.33) ^a	-0.24(-0.33~-0.15) ^a	-0.22(-0.30~-0.15) ^a	2.95(2.71~3.19) ^a
社会关系	-0.34(-0.50~0.17) ^a	-0.12(-0.23~-0.01) ^c	-0.22(-0.31~-0.13) ^a	0.18(-0.11~0.47)
注：^a P < 0.001; ^b P < 0.01; ^c P < 0.05; 校正了年龄、性别、婚姻状况、居住地、教育水平、家庭规模、家庭人均年消费水平。

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