Zhao Yongze, Mai Huaxin, Bian Ying
Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau, China.
Unit of Psychiatry, Department of Public Health and Medicinal Administration & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China.
Healthcare (Basel). 2024 Sep 26;12(19):1928. doi: 10.3390/healthcare12191928.
: China's rapidly aging population presents challenges for cognitive health and mental well-being among the older adults. This study examines how the number of children affects cognitive function in middle-aged and older adults and whether depressive symptoms mediate this relationship. : This study analyzed data from waves 1 to 5 (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS), involving 5932 participants aged 45 and older. Participants were grouped by the number of children: childless, only child and multiple children. We used Logarithmic Generalized Linear Models (LGLMs) to explore the relationships among the number of children, depressive symptoms, and cognitive function. Indirect effect coefficients and 95% bias-corrected and accelerated confidence intervals (BCaCI) were estimated using Simultaneous Equation Models (SEM) with three-stage least squares (3SLS) and the bootstrap method to assess the mediating effect of depressive symptoms. : In middle-aged and older adults, a negative association was observed between the number of children and overall cognitive functioning (all < 0.01). This association remained significant even after adjusting for covariates in groups with three ( = -0.023, < 0.05) and four or more children ( = -0.043, < 0.001). Conversely, the positive association between the number of children and depression also persisted after adjusting for covariates, although it weakened as the number of children increased (all < 0.01). Depressive symptoms consistently correlated negatively with overall cognitive function ( < 0.001) and partially mediated the relationship between the number of children and cognitive function (pMe = 20.36%, < 0.05). The proportion of the mediating effect attributed to depression was more pronounced in middle-aged and older adults who had experienced the loss of children (pMe = 24.31%) or had two children (pMe = 25.39%), with stronger mediating effects observed in males (pMe = 48.84%) and urban residents (pMe = 64.58%). : The findings indicate that depressive symptoms partially mediate the relationship between the number of children and cognitive function in middle-aged and older adults in China. These results highlight the significance of considering mental health factors when studying cognitive function in this demographic. Notably, in families without children and those with two children, depressive symptoms play a crucial role in explaining the decline in cognitive function.
中国人口的迅速老龄化给老年人的认知健康和心理健康带来了挑战。本研究探讨了子女数量如何影响中老年人的认知功能，以及抑郁症状是否介导了这种关系。本研究分析了中国健康与养老追踪调查（CHARLS）第1至5轮（2011 - 2020年）的数据，涉及5932名45岁及以上的参与者。参与者按子女数量分组：无子女、独生子女和多个子女。我们使用对数广义线性模型（LGLMs）来探讨子女数量、抑郁症状和认知功能之间的关系。使用具有三阶段最小二乘法（3SLS）的联立方程模型（SEM）和自助法估计间接效应系数以及95%偏差校正和加速置信区间（BCaCI），以评估抑郁症状的中介效应。在中老年人中，观察到子女数量与总体认知功能之间存在负相关（所有p < 0.01）。即使在对有三个子女（β = -0.023，p < 0.05）和四个及以上子女（β = -0.043，p < 0.001）的组进行协变量调整后，这种关联仍然显著。相反，在对协变量进行调整后，子女数量与抑郁之间的正相关也依然存在，尽管它随着子女数量的增加而减弱（所有p < 0.01）。抑郁症状始终与总体认知功能呈负相关（p < 0.001），并部分介导了子女数量与认知功能之间的关系（中介效应比例pMe = 20.36%，p < 0.05）。在经历过子女离世的中老年人（pMe = 24.31%）或有两个子女的中老年人（pMe = 25.39%）中，归因于抑郁的中介效应比例更为明显，在男性（pMe = 48.84%）和城市居民（pMe = 64.58%）中观察到更强的中介效应。研究结果表明，抑郁症状在中国中老年人中部分介导了子女数量与认知功能之间的关系。这些结果凸显了在研究这一人群的认知功能时考虑心理健康因素的重要性。值得注意的是，在无子女家庭和有两个子女的家庭中，抑郁症状在解释认知功能下降方面起着关键作用。
