Wu Haichen, Dong Pengxin, Chai Yidan, Huang Ping, Lai Lichong, Peng Jie, Cao Xiaoying, Feng Xiaoling, Huang Dongmei, Huang Huiqiao
Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Rehabilitation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Clin Interv Aging. 2025 Sep 1;20:1429-1438. doi: 10.2147/CIA.S536619. eCollection 2025.
Living alone is becoming increasingly common among the elderly population, and there is a close relationship between living alone and chronic diseases in relation to depression. However, the interplay between them has not been fully investigated. This study aims to explore the role of the number of chronic diseases in the relationship between living alone and depressive symptoms among older adults in China.
A population-based cross-sectional study was conducted in Guangxi, China, involving 10,370 older adults (aged ≥ 65 years) living in the community. Using the four-way decomposition analysis, we evaluated: (1) The direct impact of living alone on depression; (2) The mediating role of the number of chronic diseases when controlling for potential confounding factors.
The risk of depressive symptoms in older adults living alone was significantly higher than that in older adults cohabiting (adjusted OR = 1.66, 95% CI: 1.57, 1.76). Mediation analysis showed that 71.64% of the total effect was a controllable direct effect (CDE: β = 0.384, 95% CI: 0.058, 0.709), and 11.91% of the total effect was mediated by the number of chronic diseases (pure indirect effect: β = 0.046, 95% CI: 0.005, 0.086). The effects of reference interaction (INTref) and mediating interaction (INTmed) did not reach statistical significance.
The number of chronic diseases plays a partial mediating role between living alone and depression. Although chronic diseases do mediate the relationship between living alone and depression to some extent, the majority of the effect is directly attributable to the state of living alone. These findings highlight the significant impact of living alone on depression in older adults and suggest that mental health interventions targeting older adults living alone should focus on enhancing social support and emotional care to effectively reduce the risk of depression.
独居在老年人群中越来越普遍，独居与抑郁症相关的慢性病之间存在密切关系。然而，它们之间的相互作用尚未得到充分研究。本研究旨在探讨慢性病数量在中国老年人独居与抑郁症状关系中的作用。
在中国广西进行了一项基于人群的横断面研究，纳入了10370名居住在社区的老年人（年龄≥65岁）。使用四向分解分析，我们评估了：（1）独居对抑郁的直接影响；（2）在控制潜在混杂因素时慢性病数量的中介作用。
独居老年人出现抑郁症状的风险显著高于同居老年人（调整后的OR = 1.66，95% CI：1.57，1.76）。中介分析表明，总效应的71.64%是可控直接效应（CDE：β = 0.384，95% CI：0.058，0.709），总效应的11.91%由慢性病数量介导（纯间接效应：β = 0.046，95% CI：0.005，0.086）。参考交互作用（INTref）和中介交互作用（INTmed）的效应未达到统计学显著性。
慢性病数量在独居与抑郁之间起部分中介作用。虽然慢性病确实在一定程度上介导了独居与抑郁之间的关系，但大部分效应直接归因于独居状态。这些发现突出了独居对老年人抑郁的重大影响，并表明针对独居老年人的心理健康干预应侧重于加强社会支持和情感关怀，以有效降低抑郁风险。
