Article(id=1241036337453781963, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241036327177744706, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503078, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741276800000, receivedDateStr=2025-03-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815720188, onlineDateStr=2026-03-18, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815720188, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815720188, creator=13701087609, updateTime=1773815720188, updator=13701087609, issue=Issue{id=1241036327177744706, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='17', pageStart='3073', pageEnd='3264', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815717738, creator=13701087609, updateTime=1773840080282, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241138511152206262, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241036327177744706, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241138511152206263, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241036327177744706, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3166, endPage=3171, ext={EN=ArticleExt(id=1241036339437687776, articleId=1241036337453781963, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of social participation on the life satisfaction of perimenopausal women: the longitudinal mediating role of depression, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the impact of social participation on life satisfaction in perimenopausal women and the mediating role of depression over time.

Methods

Using China Health and Retirement Longitudinal Study (2011—2018) data, a latent growth model analyzed trajectories of social participation, depression, and life satisfaction in 1 133 perimenopausal women and tested the longitudinal mediation of depressionin in the relationship between social participation and life satisfaction.

Results

Social participation, depression, and life satisfaction showed increasing trends. After controlling for education, the intercept of social participation negatively predicted the intercept of depression (β=-1.198, P<0.001), and the intercept of depression negatively predicted the intercept of life satisfaction (β=-0.058, P<0.001). The slope of social participation negatively predicted the slope of depression (β=-0.909, P<0.05), while the slope of depression negatively predicted the slope of life satisfaction (β=-0.101, P<0.001). The intercept and slope of depression showed longitudinal mediation between social participation and life satisfaction, with indirect effects of 0.069(95% CI: 0.037-0.112) and 0.092(95% CI: 0.024-0.215),respectively.

Conclusion

Social participation indirectly affects life satisfaction by influencing the level of depression. Providing flexible participation opportunities and emotional support may enhance psychological well-being and life satisfaction in perimenopausal women.

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目的

探讨社会参与对围绝经期女性生活满意度的影响及抑郁在其中的纵向中介作用。

方法

基于中国健康与养老追踪调查2011—2018年数据,采用潜增长模型描绘1 133例围绝经期女性的社会参与、抑郁和生活满意度的变化轨迹,检验抑郁在社会参与和生活满意度中的纵向中介作用机制。

结果

研究发现社会参与、抑郁和生活满意度随时间均呈上升趋势。在控制教育水平的条件下,社会参与的截距负向预测抑郁的截距(β=-1.198,P<0.001),抑郁的截距负向预测生活满意度的截距(β=-0.058,P<0.001);社会参与斜率负向预测抑郁斜率(β=-0.909,P<0.05),而抑郁斜率负向预测生活满意度斜率(β=-0.101,P<0.001)。抑郁的起始水平和发展速率在社会参与和生活满意度之间的发挥纵向中介作用,间接效应分别0.069(95% CI: 0.037~0.112)和0.092(95% CI: 0.024~0.215)。

结论

社会参与通过影响抑郁水平间接影响围绝经期女性的生活满意度。社会需要关注围绝经期女性多样化的个性和需求,提供灵活的社会参与机会和情感支持资源,以最大程度地促进她们的心理健康和生活满意度。

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姚秀钰,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=wBelFZNxua6c2wk6x52HwQ==, magXml=nfG4Za4SAKroJ3xJWU3ZjA==, pdfUrl=null, pdf=oAsUQipGzRMZa+h3MmBePw==, pdfFileSize=845993, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=xCupuBaPNDcLvUElT0BUyA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=ASr9GqjXhMfpfAAKx+/q5w==, mapNumber=null, authorCompany=null, fund=null, authors=

楼澜(2004—),女,本科在读,研究方向:护理学

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Front Public Health, 2024, 12:1446246., articleTitle=Impact of informal social support on the mental health of older adults, refAbstract=null), Reference(id=1241139384339198548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, doi=null, pmid=null, pmcid=null, year=2024, volume=34, issue=3, pageStart=443, pageEnd=463, url=null, language=null, rfNumber=[18], rfOrder=23, authorNames=Hayfield N, Moore H, Terry G, journalName=Feminism &Psychology, refType=null, unstructuredReference=Hayfield N, Moore H, Terry G. “Friends? Supported. Partner? Not So Much…”: women's experiences of friendships, family, and relationships during perimenopause and menopause[J]. Feminism &Psychology, 2024, 34(3): 443-463., articleTitle=“Friends? Supported. Partner? Not So Much…”: women's experiences of friendships, family, and relationships during perimenopause and menopause, refAbstract=null), Reference(id=1241139384448250458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, doi=null, pmid=null, pmcid=null, year=2024, volume=60, issue=8, pageStart=1189, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=24, authorNames=Lee S, Jang M, Kim D, journalName=Medicina (Kaunas, Lithuania), refType=null, unstructuredReference=Lee S, Jang M, Kim D, et al. Association between Menopausal Women's Quality of Life and Aging Anxiety: The Role of Life Satisfaction and Depression[J]. Medicina (Kaunas, Lithuania),2024, 60(8): 1189., articleTitle=Association between Menopausal Women's Quality of Life and Aging Anxiety: The Role of Life Satisfaction and Depression, refAbstract=null), Reference(id=1241139384553108063, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=26, pageStart=3601, pageEnd=3605, url=null, language=null, rfNumber=[20], rfOrder=25, authorNames=燕可书, 王红霞, journalName=全科护理, refType=null, unstructuredReference=燕可书, 王红霞.社会支持在社区围绝经期女性人格特征与主观幸福感间的中介效应[J].全科护理202220(26):3601-3605., articleTitle=社会支持在社区围绝经期女性人格特征与主观幸福感间的中介效应, refAbstract=null), Reference(id=1241139386075640419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=26, pageStart=3601, pageEnd=3605, url=null, language=null, rfNumber=[20], rfOrder=26, authorNames=Yan KS, Wang HX, journalName=Chinese General Practice Nursing, refType=null, unstructuredReference=Yan KS, Wang HX. The mediating effect of social support between personality traits and subj ective well-being among perimenopausal women in the community[J]. Chinese General Practice Nursing, 2022, 20(26):3601-3605.(In Chinese), articleTitle=The mediating effect of social support between personality traits and subj ective well-being among perimenopausal women in the community, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241139374771990630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, xref=null, ext=[AuthorCompanyExt(id=1241139374780379239, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, companyId=1241139374771990630, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Peking Union Medical College, Beijing 100144, China), AuthorCompanyExt(id=1241139374792962152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, companyId=1241139374771990630, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=北京协和医学院护理学院,北京 100144)])], figs=[ArticleFig(id=1241139378446201148, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Figure 1, caption=Effect of social participation on the trajectory of life satisfaction, figureFileSmall=e9996LPCHAnnpyflE3HfOA==, figureFileBig=kczcF7ZbhYAm91xuFYPWjg==, tableContent=null), ArticleFig(id=1241139378534281539, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=图1, caption=社会参与对生活满意度轨迹的影响, figureFileSmall=e9996LPCHAnnpyflE3HfOA==, figureFileBig=kczcF7ZbhYAm91xuFYPWjg==, tableContent=null), ArticleFig(id=1241139378651722059, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Figure 2, caption=Longitudinal mediation model of depression, figureFileSmall=yjBPprWO923/Covzp6w7wg==, figureFileBig=4BcQEd5+QMAYhcHJLx6jvg==, tableContent=null), ArticleFig(id=1241139378764968277, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=图2, caption=抑郁的纵向中介模型, figureFileSmall=yjBPprWO923/Covzp6w7wg==, figureFileBig=4BcQEd5+QMAYhcHJLx6jvg==, tableContent=null), ArticleFig(id=1241139378874020187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Table 1, caption=

Correlation analysis among key variables

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变量12345678910111213
1社会参与T10.770±0.9121
2社会参与T21.020±1.1400.394**1
3社会参与T31.060±1.2710.359**0.506**1
4社会参与T40.980±1.1720.246**0.386**0.403**1
5抑郁T18.140±6.014-0.115**-0.090**-0.087**-0.081**1
6抑郁T28.140±5.781-0.102**-0.090**-0.070*-0.128**0.488**1
7抑郁T38.510±6.367-0.129**-0.110**-0.118**-0.154**0.491**0.550**1
8抑郁T49.500±6.535-0.101**-0.117**-0.135**-0.129**0.411**0.494**0.535**1
9生活满意度T11.000±0.6210.082**0.02-0.008-0.014-0.321**-0.234**-0.233**-0.137**1
10生活满意度T21.030±0.6140.0290.0220.0550.067*-0.262**-0.328**-0.255**-0.172**0.368**1
11生活满意度T31.310±0.6280.053-0.0010.0060.021-0.216**-0.218**-0.325**-0.222**0.253**0.330**1
12生活满意度T41.140±0.6390.0480.0320.0420.044-0.212**-0.308**-0.281**-0.419**0.240**0.317**0.339**1
13教育水平——0.068*0.206**0.204**0.259**-0.153**-0.146**-0.171**-0.153**-0.0340.065*-0.059*0.0071
), ArticleFig(id=1241139379008237923, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=表1, caption=

各变量间的相关系数

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变量12345678910111213
1社会参与T10.770±0.9121
2社会参与T21.020±1.1400.394**1
3社会参与T31.060±1.2710.359**0.506**1
4社会参与T40.980±1.1720.246**0.386**0.403**1
5抑郁T18.140±6.014-0.115**-0.090**-0.087**-0.081**1
6抑郁T28.140±5.781-0.102**-0.090**-0.070*-0.128**0.488**1
7抑郁T38.510±6.367-0.129**-0.110**-0.118**-0.154**0.491**0.550**1
8抑郁T49.500±6.535-0.101**-0.117**-0.135**-0.129**0.411**0.494**0.535**1
9生活满意度T11.000±0.6210.082**0.02-0.008-0.014-0.321**-0.234**-0.233**-0.137**1
10生活满意度T21.030±0.6140.0290.0220.0550.067*-0.262**-0.328**-0.255**-0.172**0.368**1
11生活满意度T31.310±0.6280.053-0.0010.0060.021-0.216**-0.218**-0.325**-0.222**0.253**0.330**1
12生活满意度T41.140±0.6390.0480.0320.0420.044-0.212**-0.308**-0.281**-0.419**0.240**0.317**0.339**1
13教育水平——0.068*0.206**0.204**0.259**-0.153**-0.146**-0.171**-0.153**-0.0340.065*-0.059*0.0071
), ArticleFig(id=1241139379134067053, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Table 2, caption=

Model fit indices and coefficients of the linear unconditional latent growth models for main variables

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变量χ2/vPCFITLISRMR平均数协相关
截距斜率
社会参与4.6130.0100.9860.9580.0220.791***0.150***0.010
抑郁3.9880.0010.9850.9820.0387.880***0.458***-0.054
生活满意度1.0510.37910.9990.0190.988***0.050***-0.022**
), ArticleFig(id=1241139379226341747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=表2, caption=

主要研究变量线性无条件潜在增长模型拟合指数和系数

, figureFileSmall=null, figureFileBig=null, tableContent=
变量χ2/vPCFITLISRMR平均数协相关
截距斜率
社会参与4.6130.0100.9860.9580.0220.791***0.150***0.010
抑郁3.9880.0010.9850.9820.0387.880***0.458***-0.054
生活满意度1.0510.37910.9990.0190.988***0.050***-0.022**
), ArticleFig(id=1241139379331199355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Table 3, caption=

Direct effects in the longitudinal mediation model

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直接路径βBP
社会参与截距→生活满意度截距0.0080.0130.030.801
抑郁截距→生活满意度截距-0.058-0.5910.005<0.001
社会参与截距→生活满意度斜率-0.013-0.0740.0160.429
社会参与斜率→生活满意度斜率-0.050-0.1130.0500.321
抑郁截距→生活满意度斜率0.0040.1330.0020.127
抑郁斜率→生活满意度斜率-0.101-0.8750.026<0.001
社会参与截距→抑郁截距-1.198-0.1980.309<0.001
社会参与截距→抑郁斜率-0.118-0.080.1230.338
社会参与斜率→抑郁斜率-0.909-0.2360.3730.015
), ArticleFig(id=1241139379503165826, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=表3, caption=

纵向中介模型中的直接路径

, figureFileSmall=null, figureFileBig=null, tableContent=
直接路径βBP
社会参与截距→生活满意度截距0.0080.0130.030.801
抑郁截距→生活满意度截距-0.058-0.5910.005<0.001
社会参与截距→生活满意度斜率-0.013-0.0740.0160.429
社会参与斜率→生活满意度斜率-0.050-0.1130.0500.321
抑郁截距→生活满意度斜率0.0040.1330.0020.127
抑郁斜率→生活满意度斜率-0.101-0.8750.026<0.001
社会参与截距→抑郁截距-1.198-0.1980.309<0.001
社会参与截距→抑郁斜率-0.118-0.080.1230.338
社会参与斜率→抑郁斜率-0.909-0.2360.3730.015
), ArticleFig(id=1241139379616412037, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=EN, label=Table 4, caption=

Indirect effects in the longitudinal mediation model

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间接路径效应值(95%CI
社会参与截距→抑郁截距→生活满意度截距0.069(0.037~0.112)0.019
社会参与斜率→抑郁斜率→生活满意度斜率0.092(0.024~0.215)0.050
), ArticleFig(id=1241139379763212687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241036337453781963, language=CN, label=表4, caption=

纵向中介模型中的间接路径

, figureFileSmall=null, figureFileBig=null, tableContent=
间接路径效应值(95%CI
社会参与截距→抑郁截距→生活满意度截距0.069(0.037~0.112)0.019
社会参与斜率→抑郁斜率→生活满意度斜率0.092(0.024~0.215)0.050
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社会参与对围绝经期女性生活满意度的影响——抑郁的纵向中介作用
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楼澜 , 姚秀钰
现代预防医学 | 儿少卫生与妇幼保健 2025,52(17): 3166-3171
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(17): 3166-3171
社会参与对围绝经期女性生活满意度的影响——抑郁的纵向中介作用
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楼澜, 姚秀钰
作者信息
  • 北京协和医学院护理学院,北京 100144
  • 楼澜(2004—),女,本科在读,研究方向:护理学

通讯作者:

姚秀钰,E-mail:
The impact of social participation on the life satisfaction of perimenopausal women: the longitudinal mediating role of depression
Lan LOU, Xiu-yu YAO
Affiliations
  • School of Nursing, Peking Union Medical College, Beijing 100144, China
出版时间: 2025-09-10 doi: 10.20043/j.cnki.MPM.202503078
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目的

探讨社会参与对围绝经期女性生活满意度的影响及抑郁在其中的纵向中介作用。

方法

基于中国健康与养老追踪调查2011—2018年数据,采用潜增长模型描绘1 133例围绝经期女性的社会参与、抑郁和生活满意度的变化轨迹,检验抑郁在社会参与和生活满意度中的纵向中介作用机制。

结果

研究发现社会参与、抑郁和生活满意度随时间均呈上升趋势。在控制教育水平的条件下,社会参与的截距负向预测抑郁的截距(β=-1.198,P<0.001),抑郁的截距负向预测生活满意度的截距(β=-0.058,P<0.001);社会参与斜率负向预测抑郁斜率(β=-0.909,P<0.05),而抑郁斜率负向预测生活满意度斜率(β=-0.101,P<0.001)。抑郁的起始水平和发展速率在社会参与和生活满意度之间的发挥纵向中介作用,间接效应分别0.069(95% CI: 0.037~0.112)和0.092(95% CI: 0.024~0.215)。

结论

社会参与通过影响抑郁水平间接影响围绝经期女性的生活满意度。社会需要关注围绝经期女性多样化的个性和需求,提供灵活的社会参与机会和情感支持资源,以最大程度地促进她们的心理健康和生活满意度。

围绝经期  /  社会参与  /  抑郁  /  生活满意度  /  CHARLS
Objective

To examine the impact of social participation on life satisfaction in perimenopausal women and the mediating role of depression over time.

Methods

Using China Health and Retirement Longitudinal Study (2011—2018) data, a latent growth model analyzed trajectories of social participation, depression, and life satisfaction in 1 133 perimenopausal women and tested the longitudinal mediation of depressionin in the relationship between social participation and life satisfaction.

Results

Social participation, depression, and life satisfaction showed increasing trends. After controlling for education, the intercept of social participation negatively predicted the intercept of depression (β=-1.198, P<0.001), and the intercept of depression negatively predicted the intercept of life satisfaction (β=-0.058, P<0.001). The slope of social participation negatively predicted the slope of depression (β=-0.909, P<0.05), while the slope of depression negatively predicted the slope of life satisfaction (β=-0.101, P<0.001). The intercept and slope of depression showed longitudinal mediation between social participation and life satisfaction, with indirect effects of 0.069(95% CI: 0.037-0.112) and 0.092(95% CI: 0.024-0.215),respectively.

Conclusion

Social participation indirectly affects life satisfaction by influencing the level of depression. Providing flexible participation opportunities and emotional support may enhance psychological well-being and life satisfaction in perimenopausal women.

Perimenopause  /  Social participation  /  Depression  /  Life satisfaction  /  CHARLS
楼澜, 姚秀钰. 社会参与对围绝经期女性生活满意度的影响——抑郁的纵向中介作用. 现代预防医学, 2025 , 52 (17) : 3166 -3171 . DOI: 10.20043/j.cnki.MPM.202503078
Lan LOU, Xiu-yu YAO. The impact of social participation on the life satisfaction of perimenopausal women: the longitudinal mediating role of depression[J]. Modern Preventive Medicine, 2025 , 52 (17) : 3166 -3171 . DOI: 10.20043/j.cnki.MPM.202503078
生活满意度是个体对自身生活状态的评估,受认知和评价驱动,能够影响心理状态并预测未来行为[1]。其下降与抑郁、焦虑、认知退化及慢性病风险增加有关[2],对中年女性群体构成威胁。该阶段女性受激素水平波动、社会角色转变等因素影响,生活满意度普遍下降,部分个体还可能出现社会网络收缩与认同感弱化[3]
在众多影响因素中,社会参与作为一种积极的社会资源,与生活满意度密切相关[4]。高水平的社会参与有助于增强活动能力、改善心理状态并提高生活质量。围绝经期女性因社会角色转变,其社会参与模式与频率随之调整[5],可能影响生活满意度。研究表明[4],社会参与不仅会影响社会支持的获取方式,还可能改变其心理适应过程,从而对生活满意度产生间接影响。外向性、开放性等人格特质也与生活满意度和领悟社会支持水平成正相关[6]
抑郁是围绝经期女性常见的心理健康问题,常发生在绝经前后的45~55岁之间,发生率达33.9%[7]。生理变化与社会压力使其更易产生抑郁情绪,降低生活满意度。已有研究指出,社会参与与抑郁呈负相关,参与度每增加1分,抑郁程度可降低1.806分[8]。因此,提升社会参与可能是改善该群体生活满意度和心理健康的重要路径。
现有关围绝经期女性抑郁的研究多聚焦发生机制与干预[7,9],虽有研究指出社会参与、抑郁、生活满意度三者相关,但多聚焦于广义中老年群体,对围绝经期女性这一特定群体的研究仍显不足。相关横断面研究显示,社会参与可通过增强情感支持提升围绝经期女性的生活满意度[4],并对抑郁情绪有缓冲作用[10]。而抑郁情绪是影响生活满意度的重要机制[2],这提示其可能在其中发挥中介作用。已有研究证实老年人的积极社会参与可以提升其心理健康水平和生活满意度[11]。虽然围绝经期女性与老年人同样面对角色转变和心理适应,但前者还受限于激素波动、经期紊乱等生理因素,心理状态更易波动[3]。因此,有必要针对其特性开展,探索更契合围绝经期特征的动态变化规律。
基于此,本研究拟以45~55岁围绝经期女性为研究对象,通过2011—2018年四次追踪测查检验以下基本假设:(1)围绝经期女性的社会参与能够正向预测生活满意度;(2)抑郁在围绝经期女性社会参与和生活满意度的纵向关系中起中介作用。
本研究利用“中国健康与养老追踪调查(CHARLS)”2011—2018年的四次追踪数据进行分析,该调查是一项具有全国代表性的中国中老年人口纵向调查[12]。本研究采用潜增长模型,描绘围绝经期女性社会参与、生活满意度与抑郁的动态轨迹,探讨社会参与对生活满意度的影响,检验抑郁在社会参与和生活满意度中的纵向中介作用机制。纳入标准:(1)年龄在45~55岁之间的女性;(2)完成四次追踪随访。排除标准:(1)重要数据缺失,如社会参与、抑郁和生活满意度;(2)患有严重影响生活质量的躯体或精神疾病,如晚期肿瘤、严重心力衰竭、肾功能衰竭或精神发育迟滞等。最终纳入符合条件样本1 133例。对于纵向数据中个别缺失值,采用Mplus默认的FIML方法(full information maximum likelihood)进行处理,在保留样本规模的同时准确估计参数,避免均值填补带来的偏差。
CHARLS调查中,受访者对问题“总体来说,您对自己的生活是否感到满意?”进行回答,回答“不太满意”或“一点也不满意”赋值为0;“比较满意”赋值为1;“极其满意”或“非常满意”赋值为2,得分越高说明生活满意度越高。
本研究采用CHARLS调查中的11项社会活动来反映围绝经期女性的社会参与水平,信效度较好[10]。11项活动为:(1)串门、跟朋友交往;(2)棋牌、去社区活动室;(3)向亲友或邻居提供帮助;(4)跳舞、健身、练气功等;(5)社团活动;(6)志愿或慈善活动;(7)照顾非同住的病人或残疾人;(8)上学或参加培训课程;(9)炒股;(10)上网;(11)其他。每项回答“不参加”或“不经常”赋值为0,“差不多每周”或“差不多每天”赋值为1。11项活动相加总得分为社会参与最终得分,得分介于0~11分,0~3分说明社会参与水平低,4~7分说明社会参与水平中等,8~11分为高社会参与水平。
CHARLS调查使用10项流行病学研究中心抑郁量表(CES-D-10)[13]对围绝经期女性过去一周的抑郁情绪和行为进行评估。该量表信效度较好[14],每个问题有4个答案,分别为“很少或根本没有(<1 d)”“不太多(1~2 d)”“有时或有一半时间(3~4 d)”“大多数时间(5~7 d)”,评分范围为0~30分,得分越高,抑郁程度越高。
对数据的描述性统计和相关性分析使用SPSS 26.0进行,探索主要变量与年龄、教育水平、居住地、婚姻状况、生活自理能力、自评健康状况、慢性病状况、吸烟情况、经济支持、家庭情感支持及个人收入之间的关联。利用Mplus 8.3构建无条件潜在增长模型,通过截距和斜率分别反应变量的起始状态与变化速率,考察各变量的发展趋势。基于四次测量的社会参与和生活满意度数据,建立条件增长模型,评估社会参与是否对生活满意度的变化轨迹产生直接影响。最后,利用结构方程模型探讨社会参与、抑郁和生活满意度的截距及斜率之间的关联,并通过bootstrap法对纵向中介效应进行显著性验证。本研究采用双侧检验,检验水准α=0.05。
本研究采用四个时间点的纵向数据(T1:2011年,T2:2013年,T3:2015年,T4:2018年)进行分析。如表1所示,从T1到T4,社会参与、抑郁和生活满意度随时间变化呈上升趋势。社会参与和生活满意度之间呈正相关(P<0.01),与抑郁呈负相关(P<0.01),抑郁与生活满意度之间呈负相关(P<0.01)。在初步相关性分析中,教育水平与主要变量之间的相关性具有统计学意义(P<0.01)。考虑模型拟合与结构简约性,本研究从多项候选变量中仅纳入教育水平作为控制变量。
利用无条件潜增长模型分析各变量的变化轨迹如表2所示,社会参与模型、抑郁模型和生活满意度模型的拟合指标良好且变量的斜率均值为正,说明社会参与、抑郁和生活满意度的发展均呈上升趋势。此外,生活满意度的截距和斜率呈负相关,说明生活满意度初始值越高,其增长幅度越小。
为检验社会参与对生活满意度发展变化趋势的影响,在控制教育水平的基础上,构建条件增长模型,结果如图1,该条件模型拟合良好(χ2/v=3.441, CFI=0.952, TLI=0.931, RMSEA=0.046, SRMR =0.032)。社会参与的截距正向预测生活满意度的截距(β=0.074,P<0.05),社会参与的截距和斜率对生活满意度的斜率没有预测作用。说明社会参与起始水平越高的围绝经期女性生活满意度起始水平也越高。
通过结构方程模型分析抑郁在社会参与和生活满意度间的纵向中介作用,结果如表3图2所示,模型拟合良好(χ2/v= 4.801,CFI=0.927, TLI=0.906, RMSEA=0.058, SRMR=0.053)控制教育水平后,社会参与的截距负向预测抑郁的截距(β=-1.198, P<0.001),社会参与的斜率负向预测抑郁的斜率(β=-0.909, P<0.05),这表明社会参与起始水平越高的女性,抑郁的起始水平越低,社会参与增长速度越快的女性,抑郁增长速度越慢。抑郁的截距负向预测生活满意度的截距(β=-0.058, P<0.001),抑郁的斜率负向预测生活满意度的斜率(β=-0.101, P<0.001),这表明抑郁起始水平越高的女性起始时的生活满意度更低,抑郁水平下降越快的女性生活满意度的提升幅度越大。
使用重复抽样2 000次的bootstrap法进一步验证抑郁的纵向中介作用,结果见表4。抑郁的起始水平和发展速率在社会参与和生活满意度之间的二条间接路径均显著,其间接效应分别为0.069(95% CI:0.037~0.112)和0.092(95% CI: 0.024~0.215),说明围绝经期女性社会参与能间接影响生活满意度的发展,抑郁的起始水平和发展速率在两者间发挥了纵向中介作用。
本研究基于CHARLS调查45~55岁围绝经期女性,纵向探索了社会参与对生活满意度的影响机制及抑郁的中介作用。结果表明,社会参与、抑郁和生活满意度均呈总体上升趋势,社会参与不仅直接影响生活满意度,还通过缓解抑郁间接提高生活满意度。社会参与的起始水平和变化速率分别预测了抑郁的起始水平和变化速率,而抑郁又进一步影响生活满意度的发展,构成了动态中介路径。
在四次追踪调查期间,社会参与、抑郁和生活满意度均增长。社会参与水平提升,变化趋势与抑郁、生活满意度的变化关系密切。这反映围绝经期女性在经历角色转换等挑战时,对社会支持的需求增加。更多的社会参与有助于她们纾解来自家庭和伴侣关系的压力,建立更紧密的社会网络,提高社会参与水平[9]
抑郁的上升趋势可能与围绝经期女性在生理心理转折期面临的多重挑战有关。尽管社会参与水平提升,但社会参与的缓冲作用可能未能完全抵消其他因素的负面影响,以往研究也指出[3],雌激素变化、家庭责任压力和社会转型的发生会加剧抑郁情绪。同时,生活满意度的提升也反映出女性正在逐渐打破“家庭主妇”的角色固化,建立更广泛的社会支持系统加强自我角色的认同。
条件潜变量增长模型分析发现,社会参与的起始水平正向预测生活满意度的起始水平。这表明更高的社会参与有助于增强围绝经期女性的社会支持感和归属感,从而提升其生活满意度,这与既有研究结果一致[4]。在社会支持理论框架下,积极的社会参与和高质量关系能够积累更多社会资本,提升幸福感[15]
然而,社会参与增长速率对生活满意度增长速率的影响未达到显著水平。这可能表明,生活满意度作为较为稳定的主观指标,受社会参与变化的直接影响较弱,更多通过情绪变量间接体现。此外,社会参与的质量可能比频率更关键,浅层社交不仅难以提升满意度,甚至导致情感耗竭[16]
抑郁在社会参与和生活满意度间起纵向中介作用,是社会支持和生活满意度的缓冲因素。社会参与有助于维持心理平衡,对抑郁的负向预测作用与既往老年群体研究一致[10]。围绝经期女性在经历角色转变时社会归属感尤为重要。高水平的社会参与如拜访朋友、跳广场舞等能够为个体提供情感支持、增加社会联系,从而缓解负面情绪[17]。研究显示[18],围绝经期的女性更倾向与有相似经历的朋友分享负向情绪,而非家庭,这有助于构建高质量的社会关系。抑郁对生活满意度的负向预测作用与已有研究一致[2],其症状不仅表现为加剧情绪波动与衰老焦虑,还会削弱女性社会参与意愿,降低生活满意度[19]。尽管bootstrap结果支持“社会参与斜率→抑郁斜率→生活满意度斜率”的间接路径(0.092, 95% CI: 0.024~0.215),但其置信区间下限接近于零,提示该路径效应较弱,统计效力有限,可能反映其影响是渐进的。建议未来扩大样本量或延长追踪周期以提升稳定性。
健全的社会支持系统对围绝经期女性健康干预至关重要。社会参与通过扩展社会网络、提升社会资本和情感支持缓解抑郁症状[15]。不同人格特质的女性对社会互动的需求存在差异[20],外向者更容易从社交中获益,而内向者则更需个性化支持。这启示健康干预计划的制定需兼顾个性化参与方式与情感资源供给。同时,文化水平影响围绝经期女性的社会参与模式及心理弹性[20],本研究通过控制教育水平,减少文化背景的干扰,更准确地评估社会参与的作用机制。
综上,社会参与通过缓解抑郁间接提升生活满意度。这提示未来干预可以从增强社会参与和情绪调节能力两方面入手,结合兴趣活动、情绪支持小组等形式,同时倡导家庭、社区和社会形成多层次联动支持体系,共同促进围绝经期女性心理健康与生活质量的提升。
本研究虽然揭示了社会参与对生活满意度的影响机制,但仍存在以下不足:(1)社会参与水平和生活满意度的测量均依赖单条目自评,未区分不同类型活动(如生产性、娱乐性参与)及职业参与等关键维度的差异化影响,可能影响测量精度与结果稳定性。(2)样本为中国中老年女性,文化背景可能影响其社会参与动机与生活满意度评估,限制研究结论的跨文化适用性。(3)仅控制教育水平,未纳入婚姻状态、收入、自评健康等混杂变量,可能对主要变量关系产生一定干扰。未来研究建议采用标准化多维度量表,在多元文化环境中开展跨文化比较,并纳入更多混杂变量以提升研究精度。
本研究基于2011—2018年中国健康与养老追踪调查的数据,运用潜增长模型,动态分析了抑郁、社会参与及生活满意度的关联,验证了抑郁的中介作用。研究提示应加强对围绝经期女性情绪和社会活动监测,构建个性化、多元化的社会支持体系,帮助其度过人生转折期,提升整体生活满意度。
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2025年第52卷第17期
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doi: 10.20043/j.cnki.MPM.202503078
  • 接收时间:2025-03-07
  • 首发时间:2026-03-18
  • 出版时间:2025-09-10
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    北京协和医学院护理学院,北京 100144

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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
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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