Zhang Yuwen, Kuang Jiawen, Xin Zhaohua, Fang Jialie, Song Rui, Yang Yuting, Song Peige, Wang Ying, Wang Jingyi
Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
School of Public Health; NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
Arch Gerontol Geriatr. 2023 Jul;110:104980. doi: 10.1016/j.archger.2023.104980. Epub 2023 Feb 26.
To investigate the longitudinal associations between loneliness, social isolation, depression and anxiety in the elderly.
A longitudinal cohort study was conducted among 634 older adults from three districts of Shanghai. Data were collected at baseline and 6-month follow-up. Loneliness and social isolation were measured using the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale respectively. Depressive and anxiety symptoms were assessed using the subscales of Depression Anxiety Stress Scales. Logistic regression and negative binomial regression models were used to examine the associations.
We found that moderate to severe loneliness at baseline predicted higher depression scores 6 months later (incidence rate ratio (IRR)=1.99, 95% confidence interval (CI) [1.12, 3.53], p=0.019), while higher depression scores at baseline predicted social isolation at follow-up (odds ratio (OR)=1.14, 95% CI [1.03, 1.27], p=0.012). We also observed that higher anxiety scores predicted lower risk of social isolation (OR=0.87, 95% CI [0.77, 0.98], p=0.021). Additionally, persistent loneliness at both timepoints was significantly associated with higher depression scores at follow-up, and persistent social isolation was associated with a greater likelihood of having moderate to severe loneliness and higher depression scores at follow-up.
Loneliness was found to be a robust predictor of changes in depressive symptoms. Both persistent loneliness and social isolation were closely associated with depression. We should develop effective and feasible interventions for older adults who have depressive symptoms or who are at risk of long-term social relationship problems to avoid the vicious circle among depression, social isolation and loneliness.
探讨老年人孤独感、社会隔离、抑郁和焦虑之间的纵向关联。
对来自上海三个区的634名老年人进行了一项纵向队列研究。在基线和6个月随访时收集数据。分别使用德容吉尔维尔德孤独感量表和鲁本社会网络量表测量孤独感和社会隔离。使用抑郁焦虑压力量表的子量表评估抑郁和焦虑症状。采用逻辑回归和负二项回归模型检验关联。
我们发现，基线时中度至重度孤独感预测6个月后抑郁得分更高（发病率比（IRR）=1.99，95%置信区间（CI）[1.12，3.53]，p=0.019），而基线时较高的抑郁得分预测随访时的社会隔离（优势比（OR）=1.14，95%CI[1.03，1.27]，p=0.012）。我们还观察到，较高的焦虑得分预测社会隔离风险较低（OR=0.87，95%CI[0.77，0.98]，p=0.021）。此外，两个时间点持续存在的孤独感与随访时较高的抑郁得分显著相关，持续的社会隔离与随访时出现中度至重度孤独感和较高抑郁得分的可能性更大相关。
孤独感被发现是抑郁症状变化的有力预测因素。持续的孤独感和社会隔离都与抑郁密切相关。我们应该为有抑郁症状或有长期社会关系问题风险的老年人制定有效可行的干预措施，以避免抑郁、社会隔离和孤独之间的恶性循环。
