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Article(id=1322167997716869527, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167989802217791, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.04.013, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750176000000, receivedDateStr=2025-06-18, revisedDate=1769011200000, revisedDateStr=2026-01-22, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159015349, onlineDateStr=2026-10-28, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159015349, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159015349, creator=13701087609, updateTime=1793159015349, updator=13701087609, issue=Issue{id=1322167989802217791, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='4', pageStart='529', pageEnd='704', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159013461, creator='13701087609', updateTime=1793159013461, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=618, endPage=624, ext={EN=ArticleExt(id=1322167997976916376, articleId=1322167997716869527, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Network analysis of depression symptoms in disabled middle-aged and elderly people, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To reveal the core symptoms and subgroup heterogeneity of depression in disabled middle-aged and elderly people using network analysis methods,and to provide basis for formulating precise intervention plans.

Methods

Data from the 2018 China health and retirement longitudinal study(CHARLS) were selected.A total of 10 336 middle-aged and elderly people were included as the research subjects.The structural differences in depression symptoms between the disabled and healthy groups were compared using a symptom network model.The symptom intensity characteristics among subgroups of disabled middle-aged and elderly people were deeply analyzed.

Results

There was no significant difference in the overall strength of the depression network among disabled and healthy middle-aged and elderly people.The core symptoms were all "depressed mood","feeling troubled",and "unable to continue living".Among the symptom networks of the disabled middle-aged group,the intensity value of "unable to continue living" was the highest,while for the disabled elderly group,the most prominent symptom was "depression of mood".Compared with disabled men,the intensity value of "depression of mood" for disabled women was greater.For disabled middle-aged and elderly people with educational attainment below primary school,the intensity value of "depression of mood" was the highest,while for those with educational attainment at or above primary school,the most prominent symptoms were "feeling troubled" and "unable to continue living".For married and cohabiting disabled middle-aged and elderly people,the main symptoms were "depression of mood","feeling troubled" and "unable to continue living",while for other disabled elderly people,the main symptoms were "depression of mood", "feeling troubled" and "lack of happiness".

Conclusions

The core symptoms of depression in disabled elderly individuals exhibit heterogeneity characteristics related to age,gender,educational level,and marital status.It is suggested that in clinical practice,individual differences of disabled middle-aged and elderly individuals should be fully considered.Categorized interventions should be adopted to improve their mental health levels.

, authors=Shilei ZHANG1, 2, Jiayu TAO3, Yajing ZHANG4, Pan ZHANG4, authorsList=Shilei ZHANG, Jiayu TAO, Yajing ZHANG, Pan ZHANG, authorCompany=null, correspAuthors=Pan ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Pan， E-mail：
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322167998987743649, articleId=1322167997716869527, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=失能中老年人抑郁症状的网络分析, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

基于网络分析的方法揭示失能中老年人抑郁网络的核心症状及亚组异质性，为制定精准化干预方案提供依据。

方法

选取2018年中国健康与养老追踪调查（CHARLS）数据，纳入10 336名中老年人为研究对象，通过症状网络模型比较失能与健康群体抑郁症状的结构差异，并深入分析失能中老年人亚组间的症状强度特征。

结果

失能与健康中老年人抑郁网络整体强度无显著差异，核心症状均为“情绪低落”“感到烦恼”及“无法继续生活”。失能中年群体症状网络中“无法继续生活”的强度值最大，而失能老年群体的“情绪低落”症状最为突出；相对于男性，女性“情绪低落”症状的强度值更大；小学以下学历的中老年人“情绪低落”症状的强度值最大，而小学及以上学历的中老年人表现最为突出的症状是“感到烦恼”和“无法继续生活”；已婚同居者主要症状表现为“情绪低落”“感到烦恼”及“无法继续生活”，其他群体则以“情绪低落”“感到烦恼”和“缺少快乐”构成主要症状。

结论

失能中老年人抑郁网络的核心症状呈现年龄、性别、文化程度及婚姻状态的异质性特征，建议临床实践中充分考虑失能中老年人的个体差异，通过分类干预提升其心理健康水平。

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张石磊，讲师，博士研究生在读

, correspAuthorsNote=
张盼，E-mail：
ZHANG Pan， E-mail：
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（A为失能中老年人；B为健康中老年人。实线代表正相关，虚线代表负相关。1为“感到烦恼”，2为“难于集中精力”，3为“情绪低落”，4为“做事费劲”，5为“绝望”，6为“感到害怕”，7为“睡眠障碍”，8为“缺少快乐”，9为“感到孤独”，10为“无法继续生活”）

, figureFileSmall=LT76+G/kA9+bRwSutHENsQ==, figureFileBig=kQHr+ObRUwXnsYQrtR14uQ==, tableContent=null), ArticleFig(id=1322530062163890987, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=EN, label=Figure 2, caption=Centrality index of depression symptom network in the middle-aged and elderly people, figureFileSmall=45XJ9CGFczoV87v52/Od2g==, figureFileBig=JEs4nFuV9DqdzxPPqF5NNA==, tableContent=null), ArticleFig(id=1322530062226805548, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=CN, label=图2, caption=中老年人抑郁症状网络的中心性指数

（1为“感到烦恼”，2为“难于集中精力”，3为“情绪低落”，4为“做事费劲”，5为“绝望”，6为“感到害怕”，

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（A为健康中老年人；B为失能中老年人）

, figureFileSmall=GVG53jbLQ05TzwpLtcCXIQ==, figureFileBig=zRd6qT/v5ZEJKC0VawKKpA==, tableContent=null), ArticleFig(id=1322530062432326448, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=EN, label=Figure 4, caption=Stability coefficient of central indicators for depression symptoms in the middle-aged and elderly people, figureFileSmall=Ium/vgx8+zZL7Tv/rJV0Fg==, figureFileBig=o43ZdCpEt+VlVDzgiNnqwQ==, tableContent=null), ArticleFig(id=1322530062507823921, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=CN, label=图4, caption=中老年人抑郁症状的中心性指标稳定性系数

（A为健康中老年人；B为失能中老年人）

, figureFileSmall=Ium/vgx8+zZL7Tv/rJV0Fg==, figureFileBig=o43ZdCpEt+VlVDzgiNnqwQ==, tableContent=null), ArticleFig(id=1322530062570738482, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=EN, label=Table 1, caption=

Incidence and severity of depression symptoms in middle-aged and elderly people（n=10 336）

, figureFileSmall=null, figureFileBig=null, tableContent=
症状抑郁严重程度（x±s，分）
例数发生率（%）
感到烦恼5 64554.62.05±1.13
难以集中精力5 61554.32.04±1.13
情绪低落5 73655.52.05±1.12
做事费劲5 79356.02.14±1.19
绝望6 56263.52.41±1.27
感到害怕2 68726.01.48±0.91
睡眠障碍6 18659.82.29±1.24
缺少快乐5 84856.62.14±1.19
感到孤独3 62735.11.70±1.07
无法继续生活2 74226.51.51±0.95
), ArticleFig(id=1322530062650430259, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=CN, label=表1, caption=

中老年人抑郁症状发生率及严重程度（n=10 336）

, figureFileSmall=null, figureFileBig=null, tableContent=
症状抑郁严重程度（x±s，分）
例数发生率（%）
感到烦恼5 64554.62.05±1.13
难以集中精力5 61554.32.04±1.13
情绪低落5 73655.52.05±1.12
做事费劲5 79356.02.14±1.19
绝望6 56263.52.41±1.27
感到害怕2 68726.01.48±0.91
睡眠障碍6 18659.82.29±1.24
缺少快乐5 84856.62.14±1.19
感到孤独3 62735.11.70±1.07
无法继续生活2 74226.51.51±0.95
), ArticleFig(id=1322530062721733428, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=EN, label=Table 2, caption=

The intensity and stability of depressive symptoms among disabled elderly people with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类强度稳健性
感到
烦恼		难以集
中精力		情绪
低落		做事
费劲		绝望感到
害怕		睡眠
障碍		缺少
快乐		感到
孤独		无法
继续生活
年龄45~<60岁1.000.871.100.720.610.670.630.810.731.200.280
≥60岁1.100.791.200.840.610.780.570.900.790.960.439
性别男0.980.881.100.800.610.760.610.810.870.960.283
女1.100.761.300.800.500.740.510.970.710.950.517
居住地农村1.000.851.100.730.470.750.500.810.800.920.516
城镇0.920.701.300.800.400.690.570.850.651.000.204
文化程度小学以下0.930.841.200.890.500.810.770.820.770.850.439
小学及以上1.200.841.100.820.710.850.550.970.801.200.518
婚姻状态已婚同居1.100.831.100.820.630.830.600.890.841.000.438
其他1.000.751.400.700.710.790.461.000.760.980.360
饮酒是1.000.771.000.820.600.700.570.890.970.790.204
否1.100.811.300.770.580.820.540.890.701.000.594
), ArticleFig(id=1322530062797230901, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167997716869527, language=CN, label=表2, caption=

不同特征失能中老年人抑郁症状的强度和稳健性

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类强度稳健性
感到
烦恼		难以集
中精力		情绪
低落		做事
费劲		绝望感到
害怕		睡眠
障碍		缺少
快乐		感到
孤独		无法
继续生活
年龄45~<60岁1.000.871.100.720.610.670.630.810.731.200.280
≥60岁1.100.791.200.840.610.780.570.900.790.960.439
性别男0.980.881.100.800.610.760.610.810.870.960.283
女1.100.761.300.800.500.740.510.970.710.950.517
居住地农村1.000.851.100.730.470.750.500.810.800.920.516
城镇0.920.701.300.800.400.690.570.850.651.000.204
文化程度小学以下0.930.841.200.890.500.810.770.820.770.850.439
小学及以上1.200.841.100.820.710.850.550.970.801.200.518
婚姻状态已婚同居1.100.831.100.820.630.830.600.890.841.000.438
其他1.000.751.400.700.710.790.461.000.760.980.360
饮酒是1.000.771.000.820.600.700.570.890.970.790.204
否1.100.811.300.770.580.820.540.890.701.000.594
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失能中老年人抑郁症状的网络分析
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张石磊 1, 2 , 陶佳雨 3 , 张亚静 4 , 张盼 4, *, *
护理研究 | 综合研究 2026,40(4): 618-624
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护理研究 |综合研究 2026 , 40 (4) : 618 -624
失能中老年人抑郁症状的网络分析
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张石磊1, 2, 陶佳雨3, 张亚静4, 张盼4, *, *
作者信息
  • 1河北师范大学教育学院，河北 050010
  • 2河北师范大学汇华学院
  • 3承德医学院
  • 4河北师范大学心理学系
通讯作者:
张盼，E-mail：
ZHANG Pan， E-mail：
作者简介:

张石磊，讲师，博士研究生在读

Network analysis of depression symptoms in disabled middle-aged and elderly people
Shilei ZHANG1, 2, Jiayu TAO3, Yajing ZHANG4, Pan ZHANG4
Affiliations
  • 1College of Education, Hebei Normal University, Hebei 050010 China
  • 2Huihua College of Hebei Normal University
  • 3Chengde Medical University
  • 4Department of Psychology，Hebei Normal University
    • Corresponding Author:
    ZHANG Pan， E-mail：
出版时间: 2026-02-25 doi: 10.12102/j.issn.1009-6493.2026.04.013
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摘要
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目的

基于网络分析的方法揭示失能中老年人抑郁网络的核心症状及亚组异质性，为制定精准化干预方案提供依据。

方法

选取2018年中国健康与养老追踪调查（CHARLS）数据，纳入10 336名中老年人为研究对象，通过症状网络模型比较失能与健康群体抑郁症状的结构差异，并深入分析失能中老年人亚组间的症状强度特征。

结果

失能与健康中老年人抑郁网络整体强度无显著差异，核心症状均为“情绪低落”“感到烦恼”及“无法继续生活”。失能中年群体症状网络中“无法继续生活”的强度值最大，而失能老年群体的“情绪低落”症状最为突出；相对于男性，女性“情绪低落”症状的强度值更大；小学以下学历的中老年人“情绪低落”症状的强度值最大，而小学及以上学历的中老年人表现最为突出的症状是“感到烦恼”和“无法继续生活”；已婚同居者主要症状表现为“情绪低落”“感到烦恼”及“无法继续生活”，其他群体则以“情绪低落”“感到烦恼”和“缺少快乐”构成主要症状。

结论

失能中老年人抑郁网络的核心症状呈现年龄、性别、文化程度及婚姻状态的异质性特征，建议临床实践中充分考虑失能中老年人的个体差异，通过分类干预提升其心理健康水平。

中老年人  /  失能  /  抑郁症状  /  网络分析
Objective

To reveal the core symptoms and subgroup heterogeneity of depression in disabled middle-aged and elderly people using network analysis methods,and to provide basis for formulating precise intervention plans.

Methods

Data from the 2018 China health and retirement longitudinal study(CHARLS) were selected.A total of 10 336 middle-aged and elderly people were included as the research subjects.The structural differences in depression symptoms between the disabled and healthy groups were compared using a symptom network model.The symptom intensity characteristics among subgroups of disabled middle-aged and elderly people were deeply analyzed.

Results

There was no significant difference in the overall strength of the depression network among disabled and healthy middle-aged and elderly people.The core symptoms were all "depressed mood","feeling troubled",and "unable to continue living".Among the symptom networks of the disabled middle-aged group,the intensity value of "unable to continue living" was the highest,while for the disabled elderly group,the most prominent symptom was "depression of mood".Compared with disabled men,the intensity value of "depression of mood" for disabled women was greater.For disabled middle-aged and elderly people with educational attainment below primary school,the intensity value of "depression of mood" was the highest,while for those with educational attainment at or above primary school,the most prominent symptoms were "feeling troubled" and "unable to continue living".For married and cohabiting disabled middle-aged and elderly people,the main symptoms were "depression of mood","feeling troubled" and "unable to continue living",while for other disabled elderly people,the main symptoms were "depression of mood", "feeling troubled" and "lack of happiness".

Conclusions

The core symptoms of depression in disabled elderly individuals exhibit heterogeneity characteristics related to age,gender,educational level,and marital status.It is suggested that in clinical practice,individual differences of disabled middle-aged and elderly individuals should be fully considered.Categorized interventions should be adopted to improve their mental health levels.

middle-aged and elderly people  /  disability  /  depression symptoms  /  network analysis
张石磊, 陶佳雨, 张亚静, 张盼. 失能中老年人抑郁症状的网络分析. 护理研究, 2026 , 40 (4) : 618 -624 . DOI: 10.12102/j.issn.1009-6493.2026.04.013
Shilei ZHANG, Jiayu TAO, Yajing ZHANG, Pan ZHANG. Network analysis of depression symptoms in disabled middle-aged and elderly people[J]. Chinese Nursing Research, 2026 , 40 (4) : 618 -624 . DOI: 10.12102/j.issn.1009-6493.2026.04.013
正文
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随着年龄增长，抑郁症的患病风险明显增大，尤其在中老年人群中抑郁症更为普遍，全球数亿人受其影响。我国中老年人口持续增加，相应的抑郁等心理健康问题受到广泛关注[1]。同时，程明梅等[2]研究发现，失能人口预期比例随着我国人口老龄化不断上升。失能明显降低中老年人的生活质量[3]，更是导致抑郁发生的潜在重要因素[4]。目前，学界对于失能中老年人抑郁症状的研究多是基于潜变量视角，各症状之间彼此独立且同等重要，从而忽视了症状之间复杂的相互作用关系。精神疾病网络理论也指出，对精神疾病核心症状的干预往往能起到更佳的治疗效果。了解不同人口学亚组的抑郁症状表现、风险因素及干预需求的差异性，对制定个性化的干预策略至关重要。因此，本研究旨在通过最新的网络分析探究失能中老年人抑郁网络的核心症状和群体差异，进而提出更为精准化的护理干预措施，促进中老年人的身心健康。
1　资料与方法
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1.1　资料
本研究数据来源于2018年中国健康与养老追踪调查（China health and retirement longitudinal study,CHARLS）的数据，研究对象均为45岁及以上的中老年人，最终纳入10 336名中老年人。CHARLS属于公开数据库，数据来自其官方网站。纳入标准：年龄数据完整；居住地数据明确；日常活动和抑郁调查数据没有缺失。
1.2　研究工具
1.2.1　失能标准
采用主要社会生物学功能测量方法[5]研究中老年人的日常生活自理能力，如需要帮助才能完成说明存在失能情况。CHARLS中基本日常生活自理能力的调查涉及穿衣、洗澡、吃饭、上下床、如厕及控制大小便6个方面。本研究参照以往研究，如其中一个方面的回答为“有困难，需要帮助”或“无法完成”则认为研究对象存在失能[6]。
1.2.2　抑郁症状
采用简版流调中心抑郁水平评定量表（CESD-10），共10个题目，其中希望和快乐的题目反向计分。每个题目的选项均为“很少或根本没有（<1 d）”“不太多（1~2 d）”“有时或者说有一半的时间（3~4 d）”“大多数时间（5~7 d）”，依次计0分、1分、2分、3分，得分越高说明症状越严重。症状得分为0分表示无此症状。经检验，该量表的Cronbach's α系数为0.80，具有良好的信效度。
1.3　统计学方法
采用R语言中的qgraph软件包进行网络分析。已有研究表明接近度的估计不够稳定[7]，因此，本研究只关注中心性差异中的节点强度和期望度，用于描述节点在网络结构中的重要性。中心性指标均以Z分数的形式报告，数值越高表示越重要。通过自助抽样的方法评估中心性指标的稳定性（CS），一般而言，CS值>0.25表示稳健性可以接受，CS值>0.50表示稳健性较好。
2　结果
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2.1　中老年人的一般资料
10 336名中老年人中，男4 351人，女5 985人；年龄45~<60岁4 443人，≥60岁5 893人；文化程度：小学以下4 658人，小学及以上5 678人；居住地：城镇2 851人，农村7 485人；婚姻状况：已婚同居者8 211人，其他2 125人；饮酒3 140人，不饮酒7 196人；失能729人（7.05%）。
2.2　中老年人抑郁症状的发生率和严重程度
中老年人抑郁症状发生率为26.0%~63.5%，常见的症状为绝望（63.5%）、睡眠障碍（59.8%）、缺少快乐（56.6%）、做事费劲（56.0%）；症状得分较高的是绝望、睡眠障碍、缺少快乐、做事费劲。中老年人抑郁症状发生率及严重程度见表1。
2.3　中老年人抑郁症状的网络分析
2.3.1　中老年人抑郁症状的网络可视图
根据症状网络中边的粗细可知，失能中老年人与健康中老年人群体症状中相关性较强的症状均为“情绪低落”“感到烦恼”和“无法继续生活”，较弱的是“睡眠障碍”，见图1。
2.3.2　中老年人抑郁的核心症状
健康组强度值前3位的症状为“情绪低落”“感到烦恼”和“无法继续生活”，边缘症状为“睡眠障碍”；失能组强度值前3位的症状为“情绪低落”“感到烦恼”和“无法继续生活”，边缘症状为“绝望”。健康组期望影响前3位的症状为“情绪低落”“感到害怕”和“无法继续生活”，边缘症状为“缺少快乐”；失能组期望影响前3位的症状为“情绪低落”“感到烦恼”和“无法继续生活”，边缘症状为“缺少快乐”。“情绪低落”在健康组和失能组中的强度值和期望影响均最大，由此可知“情绪低落”处于抑郁症状网络的核心位置。见图2。
2.3.3　中心性指标稳定性及差异性检验
网络估计的准确性结果见图3、图4。从图3展示的边权重（edge-weights）自助法置信区间（bootstrapped CIs）结果来看，大多数自助法置信区间都很窄，表明基于单点估计计算的边权排序非常稳定。同时，图4展示的中心性指标稳定性结果表明，随着重抽样样本比例的减少，健康组的强度和期望影响都非常稳定，CS值分别为0.750和0.750；而失能组的强度和期望影响相对稳定，CS值分别为0.594和0.750。
2.4　不同特征失能中老年人抑郁症状的强度和稳健性
失能中年人“无法继续生活”的强度值最大，而失能老年人“情绪低落”的强度值最大；失能中老年人群中，女性“情绪低落”的强度值比男性大；居住农村和城镇的中老年人的“情绪低落”强度值均最大，但农村的中老年人强度次之的是“感到烦恼”，而城镇的中老年人是“无法继续生活”；文化程度为小学以下的失能中老年人“情绪低落”的强度值最大，而小学及以上的失能中老年人“感到烦恼”和“无法继续生活”的强度值相同且最大；已婚同居的失能中老年人“情绪低落”和“感到烦恼”的强度值相同且最大，“无法继续生活”的强度值次之，而其他婚姻状态的失能中老年人“情绪低落”的强度值最大，“感到烦恼”和“缺少快乐”次之；饮酒的失能中老年人“情绪低落”和“感到烦恼”的强度值相同且最大，“感到孤独”的强度值次之，不饮酒的失能中老年人“情绪低落”的强度值最大，其次是“感到烦恼”和“无法继续生活”。但从稳健性指标分析可知，年龄、性别、文化程度和婚姻状态的影响具有稳定性。见表2。
3　讨论
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3.1　情绪低落症状处于整个网络的核心
本研究结果发现，情绪低落是抑郁症状中强度最大的症状，在整个网络中起着重要作用。这与抑郁症作为常见的情绪障碍，主要症状是情绪持续低落的研究结果[8]相同。临床实践进一步证实，调节机体情绪能有效治疗抑郁症[9]。针对“情绪低落”这一核心症状进行干预，对抑郁症的整体治疗具有重要意义。研究发现，绘画等干预活动能显著缓解抑郁情绪[10]。通过营造支持性互动环境，设计符合失能中老年人身心特点的休闲娱乐活动等，对改善其情绪状态具有积极的现实意义。
3.2　感到烦恼和无法继续生活是中老年人抑郁的主要症状
本研究结果表明，感到烦恼是中老年人抑郁的主要症状之一，与以往的研究结果[11]相似。抑郁症个体通常在加工负性信息方面存在困难[12]，同时对模糊信息往往进行负性解读[13]。根据理性情绪疗法理论，非理性的认知是导致个体消极情绪的主要原因[14]。个体对现实信息的非理性加工会致使出现烦恼等负性情绪。尤其是失能中老年人面临较多的困难，需要更多的支持和帮助。研究发现，提供社区养老服务能有效提高失能老年人的心理健康水平[15]。通过提供更为便利的生活环境，能够有效降低失能中老年人在日常生活中遇到的障碍，从而减轻其因行动或自理困难所引起的“感到烦恼”的情绪强度。
本研究结果还表明，无法继续生活也是中老年人抑郁的主要症状之一，无法继续生活往往使个体出现一些过激行为。已有研究发现，抑郁症与个体的过激行为如自杀存在密切关系[16]，抑郁症个体通常存在活动、欲望和兴趣等方面的下降[17]。抑郁症状与更低的生活满意度之间密切相关[18],这与本研究中无法继续生活均为健康与失能人群抑郁的主要症状相一致。此外，压力与抑郁症常互为风险因素[19]，进一步加剧了个体的无助感和生存意愿下降。已有研究指出，幸福感能有效降低自杀等行为[20]，而和谐的人际关系是促进老年人幸福的重要因素[21]。为缓解失能中老年人无法继续生活的症状，可以建立结对陪伴关系，通过定期交流等增强社会支持；通过组织经验分享活动，帮助其重塑人生价值；设计渐进式目标计划，逐步重建生活希望。
3.3　睡眠障碍属于抑郁症的伴随症状
研究发现，失眠个体患抑郁症的风险更高[22]，抑郁常伴有失眠。本研究结果表明，睡眠障碍属于抑郁症状中强度较弱的症状，这与失眠属于常见临床表现，但并非所有抑郁症病人都有失眠的研究结果[23]相一致。临床治疗表明，能有效治疗抑郁症状的药物往往对失眠症状作用不明显[24]。在临床实践中，建议采用匹兹堡睡眠质量指数量表等对失能中老年病人进行系统评估，通过定量分析睡眠障碍与抑郁症状的共病关系，据此制定差异化干预方案。对于无共病的单纯抑郁症状，可采用认知行为疗法进行干预；对于共病的情况应及时启动药物治疗方案。
3.4　抑郁症状的亚组差异分析
本研究结果表明，中老年人年龄、性别、文化程度和婚姻状态对抑郁网络的核心症状有影响。中年人抑郁症状强度较大的是“无法继续生活”，相对老年人，中年人需要面对来自各方的压力，较易出现“无法继续生活”的症状。这可能与多方压力下的中年人容易出现中年危机有关，已有研究发现，中年危机与抑郁症状呈正相关[25]。与老年人群体相比，失能中年人所获得的社会支持显著不足。应建立健全针对该群体的物质保障与服务体系，同时，护理人员应运用专业的心理疏导技术，通过认知重构和情绪管理等干预手段，协助其重新建立生活希望，逐步恢复社会适应能力。相对于男性，女性中老年人“情绪低落”表现得更为严重，与抑郁症存在性别差异且女性的患病率比男性高的研究结果[26]相一致，这可能与女性中老年群体在面对压力时更容易激活强烈的应激反应有关。针对该人群的特点，应建立系统化的沟通与支持机制，通过定期情感疏导和倾听干预，帮助构建稳固的社会支持网络，从而有效提升其生活满意度，缓解情绪低落症状。小学及以上的中老年人感到烦恼和无法继续生活两个症状的强度最高。这与石智雷等[27]研究结果相一致，其研究发现抑郁水平随着文化程度出现先降后升的情况，而拐点是高等教育，在高等教育之前，抑郁的情绪表现随着教育水平的提高而降低。依据理性情绪疗法的理论框架，应重点干预该类中老年人因失能状况所产生的非理性认知。可借助临床成功案例发挥示范效应，引导其建立积极的应对策略，从而有效增强生活信心与面对困难的勇气。与其他人群相比，已婚且共同居住的中老年人在“感到烦恼”与“情绪低落”两个症状上的强度值相当。这一现象可能与夫妻日常生活中更频繁的互动所引发的摩擦有关。已有研究指出，夫妻关系影响中国老年慢性病病人的幸福感[28]。针对这一类失能中老年人，在护理过程中需注重协助其维护和谐的夫妻关系，从而提升整体干预效果。
4　小结
收起
在失能中老年抑郁症病人的护理过程中，应注意抑郁症病人的情绪并采取有效措施防止病人出现过激行为，改善病人抑郁情绪，提高病人的生活质量；同时，注意观察病人的睡眠情况，改善失眠病人的睡眠质量。在整个护理过程中，要充分考虑病人的年龄、性别、文化程度和婚姻状态等因素，提供更为个性化的护理方案，强化干预的科学性及效果。

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doi: 10.12102/j.issn.1009-6493.2026.04.013
  • 接收时间：2025-06-18
  • 首发时间：2026-10-28
  • 出版时间：2026-02-25
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  • 收稿日期：2025-06-18
  • 修回日期：2026-01-22
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    1河北师范大学教育学院，河北 050010
    2河北师范大学汇华学院
    3承德医学院
    4河北师范大学心理学系

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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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