健康生态学模型视域下慢性病共病对中老年人抑郁症状的影响

黄爱文; 雒敏

doi:10.16462/j.cnki.zhjbkz.2025.02.004

健康生态学模型视域下慢性病共病对中老年人抑郁症状的影响

doi: 10.16462/j.cnki.zhjbkz.2025.02.004

黄爱文¹,
雒敏^{1, 2, ,}

1.
南京医科大学医政学院, 南京 211166
2.
江苏省健康研究院, 南京 211166

基金项目:

教育部人文社会科学研究规划项目 22YJAZH078

江苏省社会科学基金 23SHB013

详细信息

通讯作者:
雒敏, E-mail: luominjs@163.com

中图分类号: R181.3;R195.4
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- HTML全文浏览量: 14
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-12
- 修回日期: 2024-10-17
- 网络出版日期: 2025-03-08
- 刊出日期: 2025-02-10

Study on the impact of chronic disease comorbidities on depression symptoms in middle-aged and elderly people based on health ecology models

HUANG Aiwen¹,
LUO Min^{1, 2
, ,}

1.
School of Medical Administration, Nanjing Medical University, Nanjing 211166, China
2.
Jiangsu Provincial Health Research Institute, Nanjing 211166, China

Funds:

The Ministry of Education of Humanities and Social Science Project 22YJAZH078

Jiangsu Provincial Social Science Fund Project 23SHB013

More Information

Corresponding author: LUO Min, E-mail: luominjs@163.com

摘要

摘要: 目的探索慢性病共病对中老年人抑郁症状的影响, 为优化我国中老年人慢性病共病患者的心理健康干预策略提供依据。方法利用2018年中国健康与养老追踪调查(China health and retirement longitudinal study, CHARLS)数据, 纳入9 583例＞45岁的中老年人作为研究对象, 采用SPSS 26.0软件进行χ²检验和二元logistic回归分析模型分析慢性病共病对中老年人抑郁症状的影响, 利用R 4.3.3软件构建中老年人慢性病共病患者抑郁症状发生风险的列线图模型。结果我国中老年人慢性病共病发生率为38.81%, 共病中老年人的抑郁症状发生率为61.98%。共病中老年人出现抑郁症状的风险是非共病中老年人的1.556倍(95% CI: 1.382~1.753), 抑郁症状的发生率随慢性病数量的增加而升高(P＜0.001);此外, 列线图模型表明中老年人抑郁症状与人口特质、行为特征、政策环境相关(均P＜0.05)。结论慢性病共病增加了我国中老年人出现抑郁症状的风险, 应加强对慢性病共病中老年人的健康管理, 关注中老年人的心理健康。
- 慢性病共病 /
- 中老年人 /
- 抑郁症状 /
- 健康生态学
Abstract: Objective To explore the impact of chronic disease comorbidities on depression symptoms in middle-aged and elderly people, providing a theoretical basis for optimizing psychological health interventions in this population in China. Methods Data from 9 583 middle-aged and elderly individuals in the 2018 China Health and Retirement Longitudinal Study (CHARLS)were analyzed. Chi-square testing and binary logistic regression were performed using SPSS 26.0, and a column chart model for the risk of depression symptoms in those with chronic disease comorbidities was created using R 4.3.3. Results The comorbidity rate of chronic diseases among middle-aged and elderly people in China was 38.81%, and the prevalence of depressive symptoms among those with comorbidities was 61.98%. The likelihood of developing depressive symptoms in those with comorbidities was 1.556 times higher than in those without (95% CI: 1.382-1.753). The prevalence of depressive symptoms increased with the number of chronic diseases (P < 0.001). Additionally, the column chart model showed that depressive symptoms in middle-aged and elderly people were associated with demographic traits, behavioral characteristics, and the policy environment (all P < 0.05). Conclusions Chronic comorbidities increased the risk of depression symptoms among middle-aged and elderly people in China. Therefore, it is necessary to strengthen the health management of middle-aged and elderly people with chronic comorbidities and pay attention to their mental health.
- Chronic comorbidities /
- Middle-aged and elderly people /
- Depressive symptoms /
- Health ecology

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图 1 中老年人慢性病共病患者抑郁的列线图

Linear prediction：线性预测值; LOS：线性预测概率。

Figure 1. Column chart of depression in middle-aged and elderly patients with chronic comorbidities; estimates based on 9 583 samples which are divided into a modeling group (6 708 cases) and a validation group (2 875 cases)

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表 1 慢性病数量与抑郁症状关联情况

Table 1. The association of the number of chronic diseases and depressive symptoms: estimates based on 9 583 middle-aged and elderly samples from CHARLS 2018 database

慢性病数量	无抑郁症状^①	有抑郁症状^①	χ²值	P值
无慢性病	3 084(58.05)	2 229(41.95)	223.820	＜0.001
1种	1 262(48.30)	1 351(51.70)
2种	393(39.42)	604(60.58)
≥3种	237(35.91)	423(64.09)
合计	4 976(51.93)	4 607(48.07)
注：①以人数(占比/%)表示。

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表 2 慢性病共病与非共病组抑郁症状发生情况

Table 2. The occurrence of depressive symptoms in comorbid and non-comorbid groups of chronic diseases: estimates based on 9 583 middle-aged and elderly samples from CHARLS 2018 database

组别	无抑郁症状^①	有抑郁症状^①	χ²值	P值
慢性病共病(n=1 657)	630(38.02)	1 027(61.98)	155.168	＜0.001
慢性病非共病(n=7 926)	4 346(54.83)	3 580(45.17)
合计	4 976(51.93)	4 607(48.07)
注：①以人数(占比/%)表示。

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表 3 慢性病共病与中老年人抑郁症状的单因素分析

Table 3. The univariate analysis of comorbidity of chronic diseases and depressive symptoms in middle-aged and elderly adults according to the health ecology model: estimates based on 9 583 samples from CHARLS 2018 database

项目	无抑郁症状组(n=4 976)	有抑郁症状组(n=4 607)	抑郁症状发生率/%	合计(n=9 583)	χ²值	P值
是否共病					155.168	＜0.001
否	4 346	3 580	45.17	7 926
是	630	1 027	61.98	1 657
个人特质层
年龄组/岁					3.821	0.281
45~＜60	2 482	2 353	48.67	4 835
60~＜70	1 610	1 481	47.91	3 091
70~＜80	713	643	47.42	1 356
≥80	171	130	43.19	301
性别					180.416	＜0.001
男	1 532	730	35.06	2 082
女	3 624	3 877	51.69	7 501
居住地					103.476	＜0.001
农村	3 147	3 360	51.64	6 507
城(镇)、乡结合区	490	343	41.18	833
城(镇)中心区	1 308	886	40.38	2 194
特殊区域	31	18	36.73	49
行为特征层
体力活动水平					29.163	＜0.001
低强度	1 822	1 561	46.14	3 383
中强度	1 775	1 536	46.39	3 311
高强度	1 379	1 510	52.27	2 889
吸烟					10.480	0.001
否	4 764	4 468	48.40	9 232
是	212	139	39.60	351
行为特征层
饮酒					59.960	＜0.001
否	3 676	3 710	50.23	7 386
是	1 300	897	40.83	2 197
夜间睡眠时长/h					474.004	＜0.001
＜6	1 173	2 055	63.66	3 228
6~8	3 322	2 218	40.04	5 540
＞8	481	334	40.98	815
午睡时长					17.515	0.001
不午睡	1 919	1 951	50.41	3 870
短时间午睡	944	867	47.87	1 811
中等时间午睡	1 496	1 237	45.26	2 733
长时间午睡	617	552	47.22	1 169
自评健康					751.203	＜0.001
很不好	130	404	75.66	534
不好	611	1 231	66.83	1 842
一般	2 530	2 217	46.70	4 747
好	818	456	36.57	1 274
很好	887	299	25.21	1 186
慢性病数量					223.820	＜0.001
无慢性病	3 084	2 229	41.94	5 313
1种	1 262	1 351	51.70	2 613
2种	393	604	60.58	997
≥3种	237	423	64.09	660
人际网络层
婚姻状况					0.001	0.981
未婚	12	11	47.82	23
已婚	4 964	4 596	48.06	9 560
社交状况					3.162	0.075
无社交	2 146	2 070	49.10	4 216
有社交	2 830	2 537	42.27	5 367
生活和工作条件层
受教育程度					117.612	＜0.001
小学及以下	3 609	3 226	51.24	6 295
初中	1 091	936	46.18	2 027
高中或中专	646	380	37.04	1 026
本科或大专及以上	170	65	27.66	235
政策环境层
医疗保险					0.176	0.674
无医疗保险	125	122	49.39	247
有医疗保险	4 851	4 485	48.04	9 336
养老保险					121.910	＜0.001
无养老保险	3 713	3 861	50.98	7 574
有养老保险	1 263	746	37.13	2 009

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表 4 慢性病共病与中老年人抑郁症状的二元logistic回归分析模型

Table 4. Binary logistic regression analysis of chronic disease comorbidity and depressive symptoms in middle-aged and elderly people according to the health ecology model: estimates based on 9 583 samples from the CHARLS 2018 database

变量	β值	s_x	Wald χ²值	P值	OR值(95% CI)
是否共病
否					1.000
是	0.442	0.061	53.452	＜0.001	1.556(1.382~1.753)
个人特质层
性别
女					1.000
男	-0.569	0.062	83.013	＜0.001	0.566(0.501~0.640)
居住地
农村					1.000
城(镇)中心区	-0.166	0.064	6.669	0.010	0.847(0.747~0.961)
城(镇)、乡结合区	-0.230	0.083	7.698	0.006	0.794(0.675~0.935)
特殊区域	-0.251	0.313	0.644	0.422	0.778(0.421~1.437)
行为特征层
体力活动水平
低强度					1.000
中强度	0.096	0.053	3.236	0.072	1.100(0.991~1.221)
高强度	0.299	0.056	28.430	＜0.001	1.349(1.208~1.506)
吸烟
否					1.000
是	0.138	0.127	1.184	0.277	1.148(0.895~1.471)
饮酒
否					1.000
是	-0.001	0.058	0	0.993	0.999(0.892~1.120)
夜间睡眠时长/h
< 6					1.000
6~8	-0.729	0.049	224.873	＜0.001	0.483(0.439~0.531)
＞8	-0.782	0.085	85.190	＜0.001	0.458(0.388~0.540)
午睡时长
不午睡					1.000
短时间午睡	0.030	0.062	0.228	0.633	1.030(0.913~1.163)
中等时间午睡	-0.017	0.054	0.102	0.750	0.983(0.884~1.093)
长时间午睡	0	0.072	0	0.998	1.000(0.869~1.151)
自评健康
很不好					1.000
不好	-0.417	0.116	13.048	＜0.001	0.659(0.525~0.826)
一般	-1.074	0.109	96.856	＜0.001	0.342(0.276~0.423)
好	-1.378	0.122	127.664	＜0.001	0.252(0.199~0.32)
很好	-1.878	0.126	221.929	＜0.001	0.153(0.119~0.196)
慢性病数量
无慢性病					1.000
1种	0.393	0.048	66.932	＜0.001	1.481(1.348~1.627)
2种	0.754	0.071	114.453	＜0.001	2.126(1.852~2.442)
≥3种	0.904	0.086	111.086	＜0.001	2.469(2.087~2.921)
生活和工作条件层
受教育程度
小学及以下					1.000
初中	0.068	0.055	1.549	0.213	1.071(0.961~1.193)
高中/中专	-0.096	0.080	1.432	0.232	0.909(0.777~1.063)
本科/大专及以上	-0.176	0.164	1.143	0.285	0.839(0.608~1.158)
政策环境层
养老保险
无养老保险					1.000
有养老保险	-0.231	0.069	11.060	0.001	0.794(0.693~0.910)

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