Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, China; Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Jinan Municipal Center for Disease Control and Prevention, Jinan, China.
J Am Med Dir Assoc. 2021 Mar;22(3):570-576.e1. doi: 10.1016/j.jamda.2020.08.026. Epub 2020 Sep 30.
This study aimed to examine the relationship between frailty markers and socioeconomic status (SES) to incidence of depressive symptoms using a nationally representative sample of middle-age and older adults.
Cohort study with a 4-year follow-up; 89.1% of the participants were followed for 2 years and 73.4% for 4 years.
A total of 6641 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included in the analyses.
The outcome was incident depressive symptoms. Educational level and occupational status were used to assess SES. Physical frailty status was evaluated using 2 frailty markers, namely weakness and slowness. Two-item questionnaire was used to assess social frailty. Cox regression models were used to examine the relationship between frailty markers and SES to incidence of depressive symptoms, with sociodemographic characteristics, lifestyle information, self-rated health status, medical histories, and depressive symptoms score at baseline adjusted.
Infrequent social activity [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.00‒1.19], weakness (HR 1.15, 95% CI 1.03‒1.28), and slowness (HR 1.19, 95% CI 1.01‒1.41) were associated with incidence of depressive symptoms. SES was associated with depressive symptoms not only through social frailty (β = 0.01, 95% CI 0.002‒0.011) and physical frailty (β = 0.01, 95% CI 0.001‒0.012) separately but also through social frailty and physical frailty sequentially. Furthermore, the effect of weakness and slowness on depressive symptoms occurred in participants with lower educational level and doing agricultural work, while the effect of infrequent social activity occurred in participants with higher educational level and doing nonagricultural work.
CONCLUSIONS/IMPLICATIONS: SES is associated with depressive symptoms, in which frailty partly mediates the association. The effect of frailty on depressive symptoms varied across SES. Integrated and comprehensive intervention strategies, including assessing socioeconomic circumstances as well as improving frailty, are suggested in prevention of depressive symptoms.
本研究旨在使用具有全国代表性的中年和老年人样本，检查衰弱标志物与社会经济地位（SES）与抑郁症状发生之间的关系。
具有 4 年随访的队列研究；91.1%的参与者随访 2 年，73.4%的参与者随访 4 年。
共纳入中国健康与退休纵向研究（CHARLS）的 6641 名参与者进行分析。
结局是新发抑郁症状。教育程度和职业状况用于评估 SES。使用 2 种衰弱标志物（即虚弱和缓慢）评估身体衰弱状况。使用两项问卷评估社会衰弱。Cox 回归模型用于检查衰弱标志物和 SES 与抑郁症状发生之间的关系，调整了人口统计学特征、生活方式信息、自我报告的健康状况、病史和基线时的抑郁症状评分。
不频繁的社会活动[危险比（HR）1.09，95%置信区间（CI）1.00-1.19]、虚弱（HR 1.15，95%CI 1.03-1.28）和缓慢（HR 1.19，95%CI 1.01-1.41）与抑郁症状的发生相关。SES 不仅通过社会衰弱（β=0.01，95%CI 0.002-0.011）和身体衰弱（β=0.01，95%CI 0.001-0.012）分别与抑郁症状相关，而且还通过社会衰弱和身体衰弱的顺序与抑郁症状相关。此外，虚弱和缓慢对抑郁症状的影响发生在教育程度较低和从事农业工作的参与者中，而不频繁的社会活动的影响发生在教育程度较高和从事非农业工作的参与者中。
结论/意义：SES 与抑郁症状相关，衰弱部分介导了这种关联。衰弱对抑郁症状的影响因 SES 而异。建议在预防抑郁症状时采用综合全面的干预策略，包括评估社会经济状况以及改善衰弱。
