Yang Juxiang, Song Gang, Zhang Minheng, Liu Hongwei, Hou Miaomiao
Southwest University, Chongqing, China.
Department of Gerontology, The First People's Hospital of Jinzhong, Shanxi Medical University, Taiyuan, Shanxi, China.
BMJ Ment Health. 2025 Sep 12;28(1):e301749. doi: 10.1136/bmjment-2025-301749.
With rapid population ageing, depressive symptoms in older adults have become a pressing public health concern. While functional dependency is a known risk factor, the impact of changes in dependency over time remains unclear.
To examine the association between changes in daily living dependency and incident depressive symptoms in older adults across international cohorts.
We used data from 46 327 adults aged ≥50 years across four longitudinal ageing studies: China Health and Retirement Longitudinal Study (China), Health and Retirement Study (USA), English Longitudinal Study of Ageing (England) and Survey of Health, Ageing and Retirement in Europe (Europe). Daily living dependency was classified into three levels based on difficulties in activities of daily living (ADLs) and instrumental ADLs (IADLs). Change in dependency was assessed using baseline and 2-year follow-up data. Depressive symptoms were measured using the Center for Epidemiologic Studies depressive symptoms Scale or the European Depression Scales (EURO-D). Cox proportional hazard models estimated HRs and 95% CIs for incident depressive symptoms over a median follow-up of 4.2-5.1 years.
A total of 12 902 new depressive symptom cases occurred during follow-up. Compared with participants whose dependency status remained unchanged, those who recovered to independency had a significantly reduced risk of depressive symptoms. Functional deterioration, including transitions from independency to ADL or IADL dependency, was associated with increased risk of depressive symptoms (both pooled HRs 1.55), while functional improvement, from ADL or IADL dependency to independency, was linked to reduced risk (HRs 0.83 and 0.80, respectively).
Improvement in ADL dependency is linked to a lower risk of depressive symptoms, while worsening dependency significantly increases depressive symptoms risk.
Routine assessment of functional status and early interventions to maintain or restore daily living independency may help prevent depressive symptoms in older adults. Targeted rehabilitation and support services could play a key role in reducing the mental health burden of ageing populations.
随着人口老龄化的迅速发展，老年人的抑郁症状已成为一个紧迫的公共卫生问题。虽然功能依赖是一个已知的风险因素，但依赖程度随时间的变化所产生的影响仍不清楚。
研究国际队列中老年人日常生活依赖程度的变化与新发抑郁症状之间的关联。
我们使用了来自四项纵向老龄化研究的46327名年龄≥50岁成年人的数据：中国健康与养老追踪调查（中国）、健康与退休研究（美国）、英国老龄化纵向研究（英国）以及欧洲健康、老龄化和退休调查（欧洲）。根据日常生活活动（ADL）和工具性日常生活活动（IADL）的困难程度，将日常生活依赖分为三个等级。使用基线数据和2年随访数据评估依赖程度的变化。使用流行病学研究中心抑郁症状量表或欧洲抑郁量表（EURO-D）测量抑郁症状。Cox比例风险模型估计了在4.2 - 5.1年的中位随访期内新发抑郁症状的风险比（HR）和95%置信区间（CI）。
随访期间共出现12902例新发抑郁症状病例。与依赖状态保持不变的参与者相比，恢复到独立状态的参与者出现抑郁症状的风险显著降低。功能恶化，包括从独立状态转变为ADL或IADL依赖状态，与抑郁症状风险增加相关（合并HR均为1.55），而功能改善，即从ADL或IADL依赖状态转变为独立状态，则与风险降低相关（HR分别为0.83和0.80）。
ADL依赖程度的改善与抑郁症状风险降低相关，而依赖程度恶化则显著增加抑郁症状风险。
对功能状态进行常规评估以及采取早期干预措施以维持或恢复日常生活独立性，可能有助于预防老年人出现抑郁症状。有针对性的康复和支持服务在减轻老年人群心理健康负担方面可能发挥关键作用。
