中老年人日常活动能力变化与抑郁症状关系的研究

Association between the change of daily living activities and symptoms of depression in Chinese middle-aged and elderly people

目的 研究中老年人日常活动能力变化与抑郁症状发生风险的关系。方法 选取＂2011、2013年中国健康与养老追踪调查＂中基线无抑郁症状、情感及精神方面问题和记忆相关疾病的≥ 45岁中老年人为研究对象，通过入户问卷调查和健康体检，收集人口学变量及健康状况功能等，采用简版流调中心抑郁水平评定量表评定抑郁症状，躯体生活自理量表和工具性日常生活活动能力量表测评日常活动能力。利用log-rank检验比较不同抑郁症状组躯体生活自理能力/工具性日常生活活动能力的变化差异。以是否为抑郁症状作因变量，利用Cox回归模型，分析日常活动能力变化与抑郁症状发生风险关系。结果 log-rank检验表明，不同躯体生活自理能力和工具性日常生活活动能力变化下，抑郁症状发生风险有差异，且差异具有统计学意义。Cox回归分析表明，躯体生活自理能力/工具性日常生活活动能力变差与抑郁症状发生风险显著相关（P〈0.01），相对于不变组，躯体生活自理能力和工具性日常生活活动能力变差组抑郁症状发生风险的HR值（95%CI）分别为1.45（1.20-1.76）和1.64（1.36-1.98）。农村中老年人躯体生活自理能力变差组其抑郁症状发生风险的差异有统计学意义（P〈0.01），而工具性日常生活活动能力在城乡间的差异均有统计学意义（P〈0.01）。结论 中老年人日常活动能力变差与抑郁症状发生风险相关，躯体生活自理能力/工具性日常生活活动能力表现不同，且具有城乡差异。

Objective To explore the association between the change of daily living activities and the suymtoms of depression in Chinese middle-age and elderly people. Methods People without symptoms on depression, emotional or spiritual diseases or memories related diseases in baseline survey （2011）, those who were aged ≥ 45 years in the China Health and Retirement Longitudinal Survey （CHARLS） with two waves from 2011 to 2013 were invited to participate in this CHARLS study. Information related to demographic characteristics and health status of the subjects were collected through household-interview. Depression symptom was assessed with the Center for Epidemiological Studies of Depression （CES-D10） scale. Activities of daily living function was assessed by both Basic Activities of Daily Living （BADL） and Instrument Activities of Daily Living （IADL） scales. Symptoms of depression was compared and the differences in various BADL/IADL changing groups were analyzed with Log-rank test. Association between the changes of daily living activities and depression symptom was analyzed by Cox regression model. Results Results from the log-rank test showed that the differences of depression symptom hazard ratio were statistically significant in different BADL/IADL changing groups. Results from the Cox regression analysis showed that the BADL/IADL in the deteriorating groups was associated with the higher hazard ratio of depression symptom （P〈0.01）, with the HR value （95%CI） for BADL and IADL deteriorate groups as 1.45 （1.20-1.76） and 1.64 （1.36-1.98）, respectively, when comparing to the ‘stablized’ group. This phenomenon appeared an urban-rural difference. Statistical significances on IADL also happened in both urban and rural areas while BADL only occurred in rurals. Conclusion There appeared an association between the change of daily living activities and depression symptom in Chinese middle-age and elderly people. Difference between IADL and BADL was also noticed between urban and rural areas.