School of Nursing, Peking University, Beijing, China.
School of Nursing, Weifang Medical University, Weifang, China.
J Clin Nurs. 2023 Jun;32(11-12):2592-2602. doi: 10.1111/jocn.16313. Epub 2022 Apr 8.
To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms.
Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear.
A cross-sectional study was conducted with 667 older inpatients aged 60-90 years in the internal medicine wards of a hospital in China.
Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5-item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline.
The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms.
Unlike robust older adults who have the age-related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms.
Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well-being.
探讨执行功能和注意偏向在衰弱与抑郁症状关系中的序列中介作用。
尽管衰弱与预测抑郁的关系已得到充分证实，但潜在机制尚不清楚。
采用横断面研究方法，对中国某医院内科病房 667 名 60-90 岁的老年住院患者进行研究。
采用正性和负性注意信息量表、身体虚弱表型和 5 项老年抑郁量表评估注意偏向、衰弱和抑郁症状。采用数字倒背、类别流畅性测验和连线测验 3 种测试评估执行功能。研究遵循 STROBE 指南。
潜在剖面分析（LPA）确定了 4 种注意偏向模式，即“无正性偏向且无负性偏向”（第 1 类，9.3%）、“轻度正性偏向且无负性偏向”（第 2 类，48.0%）、“重度正性偏向且轻度负性偏向”（第 3 类，25.6%）和“重度正性偏向且无负性偏向”（第 4 类，17.1%）。回归分析发现，衰弱与抑郁症状相关。衰弱与执行功能呈负相关，执行功能是注意偏向第 1、2 和 3 类的保护因素，而第 4 类则无保护作用。与第 4 类相比，第 1 类和第 2 类但不是第 3 类的注意偏向与抑郁症状相关。联合显著性检验证实，执行功能和注意偏向是连接衰弱与抑郁症状的序列中介。
与稳健的老年人相比，衰弱的老年人由于执行功能障碍而存在注意偏向缺陷，因此会出现临床相关的抑郁症状。
临床医生应考虑执行功能训练和注意偏向调节，以减轻衰弱对情绪健康的不利影响。
