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Article(id=1241023937115640556, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408179, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723219200000, receivedDateStr=2024-08-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812763718, onlineDateStr=2026-03-18, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812763718, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812763718, creator=13701087609, updateTime=1773812763718, updator=13701087609, issue=Issue{id=1241023927812682133, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812761500, creator=13701087609, updateTime=1773812858867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024336258200259, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024336258200260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=476, endPage=480, ext={EN=ArticleExt(id=1241023937887392571, articleId=1241023937115640556, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the mediating effect of physical activity on the relationship between sleep quality and depression among community-dwelling elderly in Shanghai, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between sleep quality and depression among elderly individuals in Shanghai’s communities, as well as the mediating role of physical activity.

Methods

A multi-stage cluster sampling method was employed to survey 2 500 elderly individuals aged 60 and above in Hongkou District, Shanghai. A self-developed demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Physical Activity Scale for the Elderly (PASE), and the Geriatric Depression Scale (GDS) were used for data collection. Pearson correlation analysis and linear regression analysis were conducted to investigate the relationships among sleep quality, physical activity, and depression, while the mediating effect of physical activity was tested using the PROCESS macro in SPSS 27.0.

Results

The average sleep quality score among community-dwelling elderly in Shanghai was 6.11±2.90, the physical activity level score was 156.23±96.67, and the depression score was 4.01±5.40. A positive correlation was identified between sleep quality and depression (r=0.488, P < 0.001), while a negative correlation existed between physical activity level and depressive symptoms (r=-0.414, P < 0.001). Physical activity partially mediated the relationship between sleep quality and depression, accounting for 8.79% of the total effect.

Conclusion

Sleep quality and depression are closely related among community-dwelling elderly in Shanghai, with physical activity playing a partial mediating role. Enhancing sleep quality and physical activity levels among the elderly may help prevent and alleviate depression.

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目的

探讨上海市社区老年人睡眠质量与抑郁之间的关系及体力活动在其中的中介作用。

方法

采用多阶段整群抽样，对上海市虹口区的2 500名60岁及以上老年人进行调查。采用自编一般人口学资料调查表、匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）、老年人体育活动量表（physical activity scale for the elderly, PASE）、老年抑郁量表（geriatric depression scale, GDS）进行问卷调查。运用Pearson相关分析、线性回归分析探讨睡眠质量，体力活动和抑郁之间的关系，运用SPSS 27.0的process宏程序检验体力活动的中介效应。

结果

研究结果显示，上海市社区老年人睡眠质量得分为（6.11±2.90）分，体力活动水平得分为（156.23±96.67）分，抑郁得分为（4.01±5.40）分，睡眠质量与抑郁之间存在正相关（r=0.488，P<0.001），体力活动水平与抑郁情绪之间则呈负相关（r=-0.414，P<0.001）。体力活动在睡眠质量与抑郁之间的关系中起到了部分中介作用，解释了总效应的8.79%。

结论

上海市社区老年人的睡眠质量与抑郁密切相关，体力活动在其中起到部分中介作用。提高老年人的睡眠质量和体力活动水平可能有助于预防和缓解抑郁。

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李秀秀，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=5ncu/HgiyVTbfZ+bpMktZQ==, magXml=LgS8XHsmCGi8kkEGOBiBUw==, pdfUrl=null, pdf=66oJDUP7tYRE4Kh/IXVYrA==, pdfFileSize=673935, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=YR4ICkSpbhjFEVh62Jz+sw==, mapNumber=null, authorCompany=null, fund=null, authors=

刘峥（1984—），女，硕士，副主任医师，研究方向：公共卫生

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刘峥（1984—），女，硕士，副主任医师，研究方向：公共卫生

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Sleep quality and physical activity in the management of depression and anxiety[J].Preventive Medicine, 2023, 171: 107514., articleTitle=Sleep quality and physical activity in the management of depression and anxiety, refAbstract=null)], funds=[Fund(id=1241023946666070364, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, awardId=2017YFC13105 0004, language=CN, fundingSource=2017年国家重点研发计划重点专项项目(2017YFC13105 0004), fundOrder=null, country=null), Fund(id=1241023946754150752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, awardId=71673055, language=CN, fundingSource=2017年国家自然科学基金面上项目(71673055), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023941209280519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, xref=1., ext=[AuthorCompanyExt(id=1241023941217669129, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, companyId=1241023941209280519, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Dongming Community Health Service Center, Pudong New District, Shanghai 200123, China), AuthorCompanyExt(id=1241023941230252042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, companyId=1241023941209280519, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.上海市浦东新区东明社区卫生服务中心，上海 200123)]), AuthorCompany(id=1241023941456744472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, xref=2., ext=[AuthorCompanyExt(id=1241023941460938778, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, companyId=1241023941456744472, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.复旦大学公共卫生学院/国家卫生健康委员会卫生技术评估重点实验室/公共卫生安全教育部重点实验室，上海 200032)])], figs=[ArticleFig(id=1241023945739129117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=EN, label=Table 1, caption=

Basic information of GDS scores of the elderly with different characteristics

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变量人数（%）GDS得分
（）		t/F值P值
性别-3.43<0.001
男1209(48.36)3.63±5.26
女1291(51.64)4.37±5.51
年龄（岁）167.48<0.001
60～691473(58.92)2.75±4.04
70～79670(26.80)4.59±5.88
≥80357(14.28)8.13±6.96
教育程度55.13<0.001
文盲51(2.04)7.04±0.99
小学217(8.68)6.88±0.47
初中909(36.36)4.13±5.54
高中及以上1323(52.92)3.20±4.59
婚姻118.12<0.001
在婚2141(85.64)3.54±5.04
其他359(14.36)6.81±6.54
吸烟16.22<0.001
不吸烟2065(82.60)4.02±5.36
已戒烟74(2.96)7.19±7.98
吸烟361(14.44)3.29±4.76
饮酒状态17.47<0.001
不饮酒2188(87.52)4.01±5.44
已戒酒38(1.52)8.84±7.74
饮酒274(10.96)3.35±4.28
个人月收入（元）28.43<0.001
<200053(2.12)8.47±8.23
2000～50001691(67.64)4.23±5.42
>5000756(30.24)3.21±4.90
睡眠障碍-16.04<0.001
有862(34.48)6.70±7.08
无1638(65.52)2.59±3.52
体力活动水平189.53<0.001
低水平832(33.28)6.91±6.91
中水平836(33.44)3.50±4.42
高水平832(33.28)1.90±2.96
), ArticleFig(id=1241023945818820900, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=CN, label=表1, caption=

不同特征老年人GDS得分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数（%）GDS得分
（）		t/F值P值
性别-3.43<0.001
男1209(48.36)3.63±5.26
女1291(51.64)4.37±5.51
年龄（岁）167.48<0.001
60～691473(58.92)2.75±4.04
70～79670(26.80)4.59±5.88
≥80357(14.28)8.13±6.96
教育程度55.13<0.001
文盲51(2.04)7.04±0.99
小学217(8.68)6.88±0.47
初中909(36.36)4.13±5.54
高中及以上1323(52.92)3.20±4.59
婚姻118.12<0.001
在婚2141(85.64)3.54±5.04
其他359(14.36)6.81±6.54
吸烟16.22<0.001
不吸烟2065(82.60)4.02±5.36
已戒烟74(2.96)7.19±7.98
吸烟361(14.44)3.29±4.76
饮酒状态17.47<0.001
不饮酒2188(87.52)4.01±5.44
已戒酒38(1.52)8.84±7.74
饮酒274(10.96)3.35±4.28
个人月收入（元）28.43<0.001
<200053(2.12)8.47±8.23
2000～50001691(67.64)4.23±5.42
>5000756(30.24)3.21±4.90
睡眠障碍-16.04<0.001
有862(34.48)6.70±7.08
无1638(65.52)2.59±3.52
体力活动水平189.53<0.001
低水平832(33.28)6.91±6.91
中水平836(33.44)3.50±4.42
高水平832(33.28)1.90±2.96
), ArticleFig(id=1241023945944650030, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=EN, label=Table 2, caption=

Correlation analysis of sleep quality, physical activity, and depression

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变量（）睡眠质量体力活动抑郁
睡眠质量6.11±2.901
体力活动156.23±96.67-0.11***1
抑郁4.01±5.400.49-0.41***1
), ArticleFig(id=1241023946066284854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=CN, label=表2, caption=

睡眠质量、体力活动、抑郁的相关分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量（）睡眠质量体力活动抑郁
睡眠质量6.11±2.901
体力活动156.23±96.67-0.11***1
抑郁4.01±5.400.49-0.41***1
), ArticleFig(id=1241023946150170939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=EN, label=Table 3, caption=

Regression analysis of the mediation model of physical activity in sleep quality and depression

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
Bt值Bt值Bt值
睡眠质量0.9127.95-0.02-22.760.8327.94
体力活动-0.02-22.75
R2值0.240.170.37
F值781.42518.06730.32
), ArticleFig(id=1241023946271805764, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=CN, label=表3, caption=

体力活动在睡眠质量与抑郁的中介模型的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
Bt值Bt值Bt值
睡眠质量0.9127.95-0.02-22.760.8327.94
体力活动-0.02-22.75
R2值0.240.170.37
F值781.42518.06730.32
), ArticleFig(id=1241023946393440585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=EN, label=Table 4, caption=

Analysis of the mediating role of physical activitybetween sleep quality and depression

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效应效应值
（Boot 95%CI）		Boot
标准误		P值相对效应值
（%）
总效应0.91（0.85～0.97）0.03<0.001100
直接效应0.83（0.78～0.89）0.03<0.00191.21
间接效应0.08（0.05～0.10）0.01<0.0018.79
), ArticleFig(id=1241023946498298193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023937115640556, language=CN, label=表4, caption=

体力活动在睡眠质量与抑郁之间的中介作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应效应值
（Boot 95%CI）		Boot
标准误		P值相对效应值
（%）
总效应0.91（0.85～0.97）0.03<0.001100
直接效应0.83（0.78～0.89）0.03<0.00191.21
间接效应0.08（0.05～0.10）0.01<0.0018.79
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上海市社区老年人体力活动在睡眠质量与抑郁之间的中介效应分析
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刘峥 1 , 张玉姝 2 , 井玉荣 2 , 王欣宁 2 , 李秀秀 2 , 王颖 2
现代预防医学 | 基层卫生服务 2025,52(3): 476-480
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现代预防医学 | 基层卫生服务 2025, 52(3): 476-480
上海市社区老年人体力活动在睡眠质量与抑郁之间的中介效应分析
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刘峥1, 张玉姝2, 井玉荣2, 王欣宁2, 李秀秀2 , 王颖2
作者信息
  • 1.上海市浦东新区东明社区卫生服务中心，上海 200123
  • 2.复旦大学公共卫生学院/国家卫生健康委员会卫生技术评估重点实验室/公共卫生安全教育部重点实验室，上海 200032

    • 刘峥（1984—），女，硕士，副主任医师，研究方向：公共卫生

通讯作者:

李秀秀，E-mail:
Analysis of the mediating effect of physical activity on the relationship between sleep quality and depression among community-dwelling elderly in Shanghai
Zheng LIU1, Yu-shu ZHANG2, Yu-rong JING2, Xin-ning WANG2, Xiu-xiu LI2 , Ying WANG2
Affiliations
  • Dongming Community Health Service Center, Pudong New District, Shanghai 200123, China
出版时间: 2025-02-10 doi: 10.20043/j.cnki.MPM.202408179
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摘要
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目的

探讨上海市社区老年人睡眠质量与抑郁之间的关系及体力活动在其中的中介作用。

方法

采用多阶段整群抽样，对上海市虹口区的2 500名60岁及以上老年人进行调查。采用自编一般人口学资料调查表、匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）、老年人体育活动量表（physical activity scale for the elderly, PASE）、老年抑郁量表（geriatric depression scale, GDS）进行问卷调查。运用Pearson相关分析、线性回归分析探讨睡眠质量，体力活动和抑郁之间的关系，运用SPSS 27.0的process宏程序检验体力活动的中介效应。

结果

研究结果显示，上海市社区老年人睡眠质量得分为（6.11±2.90）分，体力活动水平得分为（156.23±96.67）分，抑郁得分为（4.01±5.40）分，睡眠质量与抑郁之间存在正相关（r=0.488，P<0.001），体力活动水平与抑郁情绪之间则呈负相关（r=-0.414，P<0.001）。体力活动在睡眠质量与抑郁之间的关系中起到了部分中介作用，解释了总效应的8.79%。

结论

上海市社区老年人的睡眠质量与抑郁密切相关，体力活动在其中起到部分中介作用。提高老年人的睡眠质量和体力活动水平可能有助于预防和缓解抑郁。

老年人  /  睡眠质量  /  抑郁  /  体力活动
Objective

To explore the relationship between sleep quality and depression among elderly individuals in Shanghai’s communities, as well as the mediating role of physical activity.

Methods

A multi-stage cluster sampling method was employed to survey 2 500 elderly individuals aged 60 and above in Hongkou District, Shanghai. A self-developed demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Physical Activity Scale for the Elderly (PASE), and the Geriatric Depression Scale (GDS) were used for data collection. Pearson correlation analysis and linear regression analysis were conducted to investigate the relationships among sleep quality, physical activity, and depression, while the mediating effect of physical activity was tested using the PROCESS macro in SPSS 27.0.

Results

The average sleep quality score among community-dwelling elderly in Shanghai was 6.11±2.90, the physical activity level score was 156.23±96.67, and the depression score was 4.01±5.40. A positive correlation was identified between sleep quality and depression (r=0.488, P < 0.001), while a negative correlation existed between physical activity level and depressive symptoms (r=-0.414, P < 0.001). Physical activity partially mediated the relationship between sleep quality and depression, accounting for 8.79% of the total effect.

Conclusion

Sleep quality and depression are closely related among community-dwelling elderly in Shanghai, with physical activity playing a partial mediating role. Enhancing sleep quality and physical activity levels among the elderly may help prevent and alleviate depression.

Elderly  /  Sleep quality  /  Depression  /  Physical activity
刘峥, 张玉姝, 井玉荣, 王欣宁, 李秀秀, 王颖. 上海市社区老年人体力活动在睡眠质量与抑郁之间的中介效应分析. 现代预防医学, 2025 , 52 (3) : 476 -480 . DOI: 10.20043/j.cnki.MPM.202408179
Zheng LIU, Yu-shu ZHANG, Yu-rong JING, Xin-ning WANG, Xiu-xiu LI, Ying WANG. Analysis of the mediating effect of physical activity on the relationship between sleep quality and depression among community-dwelling elderly in Shanghai[J]. Modern Preventive Medicine, 2025 , 52 (3) : 476 -480 . DOI: 10.20043/j.cnki.MPM.202408179
正文
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抑郁症是一种常见的精神障碍，在老年人群中普遍存在[1]。据报告，中国60岁及以上老年人的抑郁症患病率为43.5%[2]。老年抑郁症已成为中国日益受关注且亟待解决的问题，给医疗保健系统带来沉重负担[3]。然而，老年人的抑郁症往往诊断不足或治疗不足，更好地了解其风险因素有助于识别高危人群，以实施早期有效的干预措施[4]。
睡眠质量通常会随着年龄的增长而逐渐下降，我国60岁以上老年人睡眠障碍的发病率为30%～40%之间[5]。睡眠质量不仅直接影响其生理功能的维持与恢复，还与心理健康状态密切相关[6]。研究表明，睡眠质量与抑郁患病率之间存在负相关关系[7-8]。例如，与健康睡眠者相比，失眠症患者患抑郁症的风险大约高出两倍[9]。因此，改善老年人睡眠质量对降低抑郁发生率至关重要。
体力活动可以改善人体的生理、心理和精神功能，引起人体器官的微观和宏观变化，达到预防和治疗疾病的目的[10]。研究发现，睡眠和体力活动在短期和长期内都可能相互影响。高质量的睡眠能够通过降低皮质醇水平、减轻炎症，以及提高睾酮和生长激素水平来促进体力活动[11]。良好的睡眠有助于老年人在日常活动中保持更充沛的精力，如更有意愿参与散步、健身操等轻度到中度的运动，或者在进行家务劳动等日常体力活动时表现出更高的效率和耐力。反之，睡眠质量不佳可能导致老年人在体力活动时感到疲倦、乏力，从而降低其参与体力活动的积极性，不利于其整体健康水平的维持和提升[12]。近年来，体力活动与抑郁症之间的关系受到了广泛关注[13-14]。有研究表明，体力活动已被证明可以控制抑郁和焦虑，提高大脑中的血清素水平以及增强免疫力，体力活动被广泛作为抑郁症有效的非药物干预措施[15]。
目前，国内多研究老年人睡眠质量、体力活动和抑郁症状之间的两两关系[16-17]，对三者关系的研究相对较少。基于此，本研究旨在通过调查上海市虹口区老年人睡眠质量、体力活动和抑郁症状情况，探究三者之间潜在的影响机制，并探讨体力活动在睡眠质量和抑郁症状之间是否存在中介作用，以期为制定有效的健康促进措施和相关政策提供有力的参考依据，帮助老年人降低抑郁症状发生率，提高晚年健康水平，为制定相应的干预措施提供政策支撑。
1　资料与方法
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1.1　资料来源
本研究采用横断面调查，地点为上海市虹口区江湾镇，采用多阶段随机整群抽样的方法抽选60岁及以上的常住社区老人，开展面对面问卷调查。调查均由受过统一培训的调查员对抽选的社区老人进行。在调查过程中，所调查的老人需满足纳入排除标准。纳入标准：（1）60岁及以上的虹口区江湾镇地区的常住老年人（居住时间≥6个月）；（2）对调查知情并同意；（3）神志清醒、言语表达清楚，有足够能力配合调查。排除标准：（1）调查期间不在社区居住或人户分离的老人；（2）失明、失语，严重听力障碍者；（3）严重或不稳定的其他内科疾病可影响脑功能或影响对认知功能评价；（4）有严重感知觉障碍者；（5）处于生命终末期者或存在其他无法完成问卷的情况。该研究方案已获得复旦大学伦理审查委员会的批准（IRB#TYSQ，2019-2-03）。数据收集之前，受试者均签署知情同意书。
1.2　方法
1.2.1　抽样方法
采用多阶段整群随机抽样。第一阶段：在上海市随机抽取一个区；第二阶段：在所随机抽取的虹口区中，再随机抽取一个镇或街道；第三阶段：在所抽取的江湾镇中，将60岁及以上所有老年人口，按照年龄组（5岁/组）和性别组（男/女）分层，计算不同组人数与占比，确定2 500人样本中各年龄组与性别组的人数；第四阶段：在江湾镇30个居委中，随机抽取“纪念”和“场中”二个社区。纪念社区采取随机抽样，符合标准的人数不足时，另随机抽取场中社区老人，直至满足样本量要求。采用问卷调查法，面对面入户调查。样本量计算公式：
公式中N为所需样本量；a为显著性检验水平，α= 0.05；uα/2为正态分布中累积概率等于α/2时的μ值，α=0.05时，uα/2=1.96；δ为精准度，δ=0.015；p为患病率估计值，中国60岁及以上老年人MCI的患病率为15.5%；；考虑10%的失访率，将样本量增加至2 500人。
1.2.2　调查方法
采用自制问卷及标准化量表进行调查，调查内容：（1）社会人口学信息：性别、年龄、教育水平、婚姻状态、个人月收入；（2）生活方式：吸烟状况、饮酒习惯、体力活动水平、睡眠质量等。
1.3　主要分析指标与判定标准
1.3.1　睡眠质量
匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI），该量表由7个维度组成，各维度0～3分进行评分，汇总后得分的范围界定在0～21分之间，其中，得分越高说明睡眠质量越差[18]。
1.3.2　体力活动
采用老年人体育活动量表（physical activity scale for the elderly, PASE)。通过调查前一周活动的频率，持续时间和强度水平来计算分数，分数越高表示体力活动水平越高，并使用三分位数划分为低、中、高水平[19]。
1.3.3　抑郁
采用老年抑郁量表(geriatric depression scale, GDS)，共计30个条目，得分范围在0～30分，得分越高说明抑郁越严重[20]。
1.4　质量控制
为确保研究数据的准确性和一致性，本研究采取了以下质量控制策略：所有参与调查的人员均接受了专业培训，内容包括统一的提问方式、调查流程及问卷填写规范；每位受访者均由调查员进行了面对面的询问；在数据处理阶段，采用双重录入，随后对录入的数据进行比对，以确保信息的准确无误，并及时纠正偏差。
1.5　统计学分析
采用SPSS 27.0软件对数据进行统计分析。计量资料以（）表示，计数资料用［n（%）］表示，分类变量的比较采用χ2检验；使用皮尔逊相关性分析确定睡眠质量、体力活动、抑郁之间的关系。在控制了协变量后，构建中介模型，通过Process插件model 4模型检验中介效应，检验水准α=0.05。
2　结果
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2.1　研究对象基本特征
结果显示，女性略多于男性，60～69岁老年人占比居多，为58.92%。教育程度方面，高中及以上占比最高，为52.92%，文盲及小学文化程度的老年人占比较低。婚姻状态以在婚为主，占85.64%，吸烟和饮酒的老年人占比较低。从个人收入来看，大部分老年人的月收入在2 000～5 000元之间，占67.64%。
2.2　老年人睡眠质量、体力活动、抑郁的相关分析
以主要人口学变量为控制变量做皮尔逊相关分析，结果显示，睡眠质量与抑郁呈正相关（r=0.488, P<0.001）。体力活动水平与抑郁呈负相关（r=-0.414, P<0.001）。见表2。
2.3　体力活动在睡眠质量与抑郁的中介作用分析
在调整控制变量后，模型1仅纳入睡眠质量作为自变量，模型2在此基础上增加了体力活动作为中介变量，模型3则同时纳入睡眠质量和体力活动作为自变量，抑郁作为因变量。结果显示，在模型2中，体力活动的加入改善了模型对抑郁的预测效果（R2从0.17增加到0.37）。体力活动在睡眠质量与抑郁之间的中介效应显著0.08（95%CI: 0.05～0.10），占总效应的8.79%。见表3、表4。
3　讨论
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本研究结果显示，调查对象中睡眠障碍检出率为34.48%，高于曹光海[21]等人(29.3%)以及王建芳[22]等人(28.04%)对老年人睡眠质量的调查结果。低于王昕晔[23]等人（41.4%）和何令[24]等(40.0%)的研究结果。这可能与研究设计和数据纳入排除标准不同有关。从生理机制层面来看，随着年龄增长，老年人身体机能逐渐衰退，免疫力降低，多种慢性疾病并发的情况较为常见。例如，夜尿频繁以及褪黑素分泌减少等因素，易导致老年人多次夜醒，进而使得夜间深度睡眠时长不足[24]，这或许是本研究中睡眠障碍检出率处于特定水平的原因之一。
与以往研究结论一致，睡眠质量与抑郁呈正相关关系（r=0.488，P<0.001）[25-26]。尽管当前睡眠质量差与抑郁症状关联的内在机制尚未完全明晰，但已有多种解释被提出。一方面，睡眠质量不佳可能引发机体炎症反应增强，而炎症水平的上升可能进一步促使抑郁症状的加剧[27]。另一方面，抑郁症的发生与睡眠期间快速眼动期（REM）的改变密切相关[28]，并且常伴随单胺类物质如血清素、去甲肾上腺素和多巴胺的减少[29]。依据“单胺假说”，单胺类物质的减少可能在抑郁症的发病进程中起到促进作用[30]。已有研究提供的证据表明，抑郁症与睡眠质量之间存在双向交互影响的关系。具体而言，患有抑郁症的老年人通常表现出睡眠质量较差的状况，而睡眠障碍又可能进一步加重抑郁症的程度[31]。同时，睡眠障碍作为抑郁症的一项固有症状，在绝大多数抑郁患者中普遍存在[32]。这种双向联系可通过炎症反应以及下丘脑-垂体-肾上腺（HPA）轴失调等共同机制予以阐释，上述机制不仅可能诱发抑郁，且与睡眠问题高度相关[33]。
本研究结果显示，体力活动低的老年人抑郁得分更高，体力活动水平与抑郁之间存在负相关，与以往的研究结果一致[34]。研究表明，体力活动通过多种神经生物学、心理社会和行为机制对心理健康产生积极影响。神经生物学机制假说认为，体力活动会导致大脑结构和功能的变化，增强心理健康[35-36]。心理社会机制假说提出，体力活动提供了社会互动、自我效能感和身体形象改善的机会，进而促进更好的心理健康[37]。行为机制假说认为，参与剧烈的体力活动可能会增加对睡眠的需求，这有助于能量保存和身体恢复，对心理健康产生积极贡献[38]。
中介分析结果显示，体力活动在睡眠质量与抑郁之间的关系起部分中介作用。睡眠质量下降可以直接对老年人的抑郁症状产生影响，也可能通过降低老年人的体力活动水平而导致抑郁情绪产生。体力活动反映了个体调动身体能量和增强心理韧性的能力[39]。其作用机制可能是当老年人睡眠质量下降后，白天疲劳感加剧，降低参加体力活动可能性，进而降低日常活动能力和社会角色适应能力，增加抑郁症状发生可能性[12]。但本研究的中介分析结果表明，体力活动在两者关系中解释了总效应的8.79%，相较于体力活动对抑郁症状的中介作用，睡眠质量对抑郁症状具有更大的直接影响，这意味着睡眠质量在老年人抑郁症状的发展过程中更为关键。
鉴于睡眠质量和体力活动对老年人抑郁症状的显著影响，提出以下建议：医护及社区工作者应在提高老年人睡眠质量的同时关注其体力活动水平，实施动态评估和早期干预，以发挥体力活动在提高老年人心理健康水平中的积极作用。可以设置多样化的运动，增加老年人运动机会，如散步、太极拳、健身操等，增加老年人运动机会，预防老年人抑郁症的发生。社区和医疗机构应定期开展健康教育活动，提高老年人对睡眠和体力活动重要性的认识，提供科学指导和支持，如举办睡眠健康讲座、体力活动指导课程等。
本研究数据为自我报告，可能存在信息偏倚。研究设计为横断面，无法确认睡眠和抑郁之间的因果关系。未来的研究可能需要纵向数据来进一步探索这种关系。尽管如此，本研究的结果仍可为后续开展纵向研究提供参考，具有一定的理论和现实意义。
基金
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  • 2017年国家重点研发计划重点专项项目(2017YFC13105 0004)
  • 2017年国家自然科学基金面上项目(71673055)
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doi: 10.20043/j.cnki.MPM.202408179
  • 接收时间：2024-08-10
  • 首发时间：2026-03-18
  • 出版时间：2025-02-10
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  • 收稿日期：2024-08-10
基金
2017年国家重点研发计划重点专项项目(2017YFC13105 0004)
2017年国家自然科学基金面上项目(71673055)
作者信息
    1.上海市浦东新区东明社区卫生服务中心，上海 200123
    2.复旦大学公共卫生学院/国家卫生健康委员会卫生技术评估重点实验室/公共卫生安全教育部重点实验室，上海 200032

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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