老年慢性病患者的社会隔离在日常生活活动能力与抑郁症状间的中介作用

Mediating role of social isolation in the relationship between activities of daily living and depressive symptoms among elderly patients with chronic diseases:A longitudinal study

目的:研究老年慢性病患者的日常生活活动能力(Activities of daily living,ADLs)、社会隔离和抑郁症状的纵向变化,并分析社会隔离在ADLs与抑郁症状间的中介作用。方法:于2022年7月至2023年7月,对430名老年慢性病患者进行了前瞻性队列研究,采用路径分析径检验ADLs通过社会隔离影响抑郁症状的中介作用。结果:从基线到随访,低ADLs,高社会隔离和有抑郁症状的受访者分别从8.6%、33.7%、24.4%上升至10.5%、47.2%、35.3%,P<0.05;中介模型显示,与低ADLs相比,社会隔离在中ADLs(a_1b=-0.45,占比39.1%)和高ADLs(a_2b=-0.73,占比33.3%)与抑郁症状间均起部分中介作用。结论:随时间的变化,老年慢性病患者的ADLs下降,社会隔离和抑郁症状上升,且社会隔离在ADLs与抑郁症状间起部分中介作用。提示未来针对老年慢性疾病患者抑郁症状的干预,不仅应着力于提高ADLs,同时也应重点关注减轻社会隔离。

Objective:To explore the longitudinal changes in activities of daily living(ADLs),social isolation,and depressive symptoms among elderly patients with chronic diseases,and to assess the mediating role of social isolation in the relationship between ADLs and depressive symptoms.Methods:From July 2022 to July 2023,a prospective cohort study was conducted on 430 elderly patients with chronic diseases.Path analysis was used to examine the mediating role of social isolation in the effect of Activities of Daily Living(ADLs)on depressive symptoms.Results:Between baseline and follow-up,the proportions of respondents with low ADLs,high social isolation,and depressive symptoms increased from 8.6%,33.7%,and 24.4%to 10.5%,47.2%,and 35.3%,respectively(all P<0.05).Mediation analysis revealed that social isolation served as a partial mediator in the relationship between both moderate(a 1b=-0.45,39.1%)and high(a 2b=-0.73,33.3%)ADLs and depressive symptoms,compared with low ADLs.Conclusion:Social isolation partially mediates the relationship between activities of daily living(ADLs)and depressive symptoms.The findings indicate that interventions targeting depressive symptoms in elderly patients with chronic diseases should not only focus on enhancing ADLs but also prioritize reducing social isolation.