Yeung T Y, Wong M M C
Department of Psychiatry, United Christian Hospital, Hong Kong SAR, China.
East Asian Arch Psychiatry. 2025 Mar;35(1):3-10. doi: 10.12809/eaap2513.
To investigate the relationships among loneliness, maladaptive coping, and depressive symptoms in Chinese older patients with major depressive disorder (MDD), and to compare differences in loneliness and coping between Chinese older individuals with and without depression.
Chinese patients aged ≥60 years who were diagnosed with MDD were approached in a randomised sequence during follow-up appointments at psychiatric outpatient clinics. Attendees of general outpatient clinics and elderly community centres matched for age, sex, and education level were recruited by convenience sampling as controls. Both groups completed a questionnaire that included the six-item De Jong Gierveld Loneliness Scale, the Brief Coping Orientation to Problem Experiences Inventory, the Social Readjustment Rating Scale, the Hamilton Depression Rating Scale, the Hong Kong version of the Montreal Cognitive Assessment, the Cumulative Illness Rating Scale-Geriatric, and the Lawton Instrumental Activities of Daily Living scale. Hierarchical multiple linear regression was performed to examine relationships among coping, loneliness, and depressive symptoms, followed by correlation and mediation analyses.
In total, 100 cases and 100 matched controls were included in the analysis. Cases reported significantly greater overall, emotional, and social loneliness relative to controls. Among patients with MDD, emotional loneliness and avoidant coping were associated with depressive symptoms. Among controls, only emotional loneliness was associated with depressive symptoms. Among all participants, avoidant coping partially mediated the relationship between emotional loneliness and depressive symptoms. Depressive symptoms were positively correlated with overall, emotional, and social loneliness, and avoidant coping and negatively correlated with problem-focused coping.
Loneliness and coping should be considered in comprehensive clinical assessments, psychiatric formulations, and individualised treatment plans for older patients with MDD. Targeted interventions addressing emotional loneliness and maladaptive coping strategies are warranted in MDD management.
探讨中国老年重度抑郁症（MDD）患者的孤独感、适应不良应对方式与抑郁症状之间的关系，并比较有抑郁和无抑郁的中国老年人在孤独感和应对方式上的差异。
在精神科门诊随访预约期间，以随机顺序接触年龄≥60岁且被诊断为MDD的中国患者。通过便利抽样招募年龄、性别和教育水平相匹配的普通门诊就诊者和老年社区中心参与者作为对照。两组均完成一份问卷，其中包括六项德容·吉尔维尔德孤独量表、问题体验应对取向简表、社会再适应评定量表、汉密尔顿抑郁评定量表、香港版蒙特利尔认知评估量表、累积疾病评定量表-老年版以及劳顿日常生活能力量表。进行分层多元线性回归以检验应对方式、孤独感和抑郁症状之间的关系，随后进行相关性和中介分析。
分析共纳入100例病例和100例匹配对照。病例组报告的总体、情感和社交孤独感明显高于对照组。在MDD患者中，情感孤独感和回避应对方式与抑郁症状相关。在对照组中，只有情感孤独感与抑郁症状相关。在所有参与者中，回避应对方式部分介导了情感孤独感与抑郁症状之间的关系。抑郁症状与总体、情感和社交孤独感以及回避应对方式呈正相关，与问题聚焦应对方式呈负相关。
在对老年MDD患者进行全面临床评估、精神科诊断和个体化治疗计划时，应考虑孤独感和应对方式。在MDD管理中，有必要针对情感孤独感和适应不良应对策略进行有针对性的干预。
