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Article(id=1241522858355127216, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308070, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1691337600000, receivedDateStr=2023-08-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931715810, onlineDateStr=2026-03-19, pubDate=1707494400000, pubDateStr=2024-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931715810, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931715810, creator=13701087609, updateTime=1773931715810, updator=13701087609, issue=Issue{id=1241522846384583426, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', 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=1773931712956, creator=13701087609, updateTime=1773931842201, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523388544504301, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523388544504302, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=500, endPage=506, ext={EN=ArticleExt(id=1241522861492465708, articleId=1241522858355127216, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The mediating effect of depression on the quality of life related to physical and mental health in the elderly with sleep disorders, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between sleep disorder, depression, and health-related quality of life in the elderly, and the mediating effect of depression on sleep disorder and health-related quality of life.

Methods

In total 3 612 elderly people over 60 years old in Hebei Province were selected by stratified random sampling, and the related data were collected with the use of Pittsburgh sleep quality index (PSQI), the simplified geriatric depression scale (GDS-15), and concise health quality of life scale (SF-36).

Results

There was a positive correlation between sleep disorder and depression in the elderly (r = 0.39, P < 0.001), and a negative correlation between sleep disorder, depression, and health-related quality of life (r = -0.43 and -0.40, P < 0.001). Sleep disorders and depression in the elderly had negative predictive effects on health-related quality of life (β =-0.26, -0.194,-0.43, and -0.520), and depression played a mediating role between sleep disorders and physical health-related quality of life in the elderly, accounting for 39.29% of the total effect. Depression played a mediating role between sleep disorders and mental health-related quality of life in the elderly, and the intermediary effect accounted for 51.57% of the total effect.

Conclusion

The health-related quality of life of the elderly with sleep disorder and depression is poor. Sleep disorder of the elderly not only directly affects the health-related quality of life, but also indirectly affects the physical and mental health-related quality of life of the elderly through depression.

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目的

探讨老年人睡眠障碍、抑郁与健康相关生命质量的关系，以及抑郁在睡眠障碍与健康相关生活质量的中介作用。

方法

采用分层随机抽样法对河北省3 612名>60岁老年人进行调查，采用匹兹堡睡眠质量指数量表（PSQI）、简版老年抑郁量表（GDS-15）、简明健康生活质量量表（SF-36）收集相关资料。

结果

老年人睡眠障碍与抑郁存在正相关关系（r=0.39，P<0.001），睡眠障碍、抑郁与健康相关生活质量存在负相关关系（r=-0.43，-0.40，P<0.001）。老年人睡眠障碍和抑郁对健康相关生活质量有负向预测作用（β=-0.26、-0.194、-0.43、-0.520）；抑郁在老年人睡眠障碍和躯体健康相关生命质量之间起部分中介作用，中介效应占总效应39.29%；抑郁在老年人睡眠障碍和心理健康相关生命质量之间起部分中介作用，中介效应占总效应51.57%。

结论

有睡眠障碍、抑郁的老年人健康相关生命质量较差，老年人睡眠障碍直接影响健康相关生命质量，也会通过抑郁对老年人躯体、心理健康相关生命质量产生间接影响。

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白江涛，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=+zXnHXBTmdCgbqBjEHZxPw==, magXml=qxrCiuyBAcgyC0mqYOIIyg==, pdfUrl=null, pdf=g7FjGi4LRqlEzp6KJLf1Xw==, pdfFileSize=678978, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=4fRwcJGZphvTqAy1v8j2SQ==, mapNumber=null, authorCompany=null, fund=null, authors=

孙秀娜（1991—），女，硕士，讲师，研究方向：老年健康促进

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孙秀娜（1991—），女，硕士，讲师，研究方向：老年健康促进

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孙秀娜（1991—），女，硕士，讲师，研究方向：老年健康促进

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Annals of Palliative Medicine, 2022, 11(6): 1865-1875., articleTitle=Association among sleep, depression, and health-related quality of Life in patients with non-dialysis chronic kidney disease during the coronavirus disease 2019 pandemic, refAbstract=null)], funds=[Fund(id=1241680462796607544, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, awardId=20230205059, language=CN, fundingSource=2023年河北省社会科学发展研究课题(20230205059), fundOrder=null, country=null), Fund(id=1241680462918242369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, awardId=20233281, language=CN, fundingSource=2023年度承德市社科联项目(20233281), fundOrder=null, country=null), Fund(id=1241680463027294279, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, awardId=202015, language=CN, fundingSource=承德医学院青年基金项目(202015), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241680454525440666, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, xref=null, ext=[AuthorCompanyExt(id=1241680454538023579, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, companyId=1241680454525440666, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Chengde Medical College, Chengde, Hebei 067000, China), AuthorCompanyExt(id=1241680454542217885, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, companyId=1241680454525440666, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=承德医学院，河北 承德 067000)])], figs=[ArticleFig(id=1241680459852207071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, language=EN, label=Table 1, caption=

Comparison of physical and mental health-related quality of life of the elderly with different characteristics (n=3 612,）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数躯体健康t/F值P值心理健康t/F值P值
性别3.89<0.0011.870.610
男1 69561.5±18.062.7±16.3
女1 91759.2±17.861.7±16.4
年龄（岁）78.98<0.00123.57<0.001
60～691 39364.0±16.963.9±16.2
70～791 15560.5±17.762.6±16.2
≥801 06455.0±18.459.4±16.3
教育程度36.84<0.00118.13<0.001
小学及以下91656.8±18.159.7±16.5
初中1 71660.1±17.862.2±16.2
高中以上98063.8±17.664.3±16.3
婚姻状态11.41<0.0018.50<0.001
在婚2 48262.6±17.663.7±16.4
不在婚1 13055.3±17.858.7±15.9
空巢3.310.0015.48<0.001
否1 65461.4±18.863.8±16.9
是1 95859.4±17.360.8±15.8
居住地3.450.0012.460.014
城市1 60861.4±18.262.9±16.8
农村2 00459.3±17.761.5±16.0
吸烟1.740.0801.270.202
否2 32860.5±18.262.4±16.6
是1 28459.6±17.661.7±16.0
饮酒3.430.0010.280.077
否1 43261.2±16.862.2±16.0
是2 18059.4±18.762.1±16.6
家庭月收入（元）46.88<0.00122.39<0.001
<3 0001 81357.5±17.860.6±16.3
3 000～6 00063961.7±17.762.0±15.8
≥6 0001 16063.8±17.764.7±16.5
慢性病种数（种）148.13<0.00188.80<0.001
070869.2±17.668.4±16.8
11 30660.9±17.162.8±15.8
≥2159855.8±17.358.8±15.7
睡眠障碍20.68<0.00120.05<0.001
无1 93265.78±17.3267.03±16.10
有1 68054.00±16.7356.65±14.92
抑郁症状25.22<0.00130.04<0.001
无2 73464.25±17.0866.35±14.24
有87847.99±15.1149.25±11.96
), ArticleFig(id=1241680460003202021, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522858355127216, language=CN, label=表1, caption=

不同特征老年人躯体、心理健康相关生命质量比较（n=3 612，）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例数躯体健康t/F值P值心理健康t/F值P值
性别3.89<0.0011.870.610
男1 69561.5±18.062.7±16.3
女1 91759.2±17.861.7±16.4
年龄（岁）78.98<0.00123.57<0.001
60～691 39364.0±16.963.9±16.2
70～791 15560.5±17.762.6±16.2
≥801 06455.0±18.459.4±16.3
教育程度36.84<0.00118.13<0.001
小学及以下91656.8±18.159.7±16.5
初中1 71660.1±17.862.2±16.2
高中以上98063.8±17.664.3±16.3
婚姻状态11.41<0.0018.50<0.001
在婚2 48262.6±17.663.7±16.4
不在婚1 13055.3±17.858.7±15.9
空巢3.310.0015.48<0.001
否1 65461.4±18.863.8±16.9
是1 95859.4±17.360.8±15.8
居住地3.450.0012.460.014
城市1 60861.4±18.262.9±16.8
农村2 00459.3±17.761.5±16.0
吸烟1.740.0801.270.202
否2 32860.5±18.262.4±16.6
是1 28459.6±17.661.7±16.0
饮酒3.430.0010.280.077
否1 43261.2±16.862.2±16.0
是2 18059.4±18.762.1±16.6
家庭月收入（元）46.88<0.00122.39<0.001
<3 0001 81357.5±17.860.6±16.3
3 000～6 00063961.7±17.762.0±15.8
≥6 0001 16063.8±17.764.7±16.5
慢性病种数（种）148.13<0.00188.80<0.001
070869.2±17.668.4±16.8
11 30660.9±17.162.8±15.8
≥2159855.8±17.358.8±15.7
睡眠障碍20.68<0.00120.05<0.001
无1 93265.78±17.3267.03±16.10
有1 68054.00±16.7356.65±14.92
抑郁症状25.22<0.00130.04<0.001
无2 73464.25±17.0866.35±14.24
有87847.99±15.1149.25±11.96
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Correlation analysis of sleep disorder, depression, and health-related quality of life (n=3 612, r)

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变量 s1234
1.睡眠障碍6.463.421
2.抑郁4.853.550.39**1
3.躯体健康60.3018.03-0.43**-0.53**1
4.心理健康62.1916.40-0.40**-0.60**0.737**1
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睡眠障碍、抑郁、健康相关生命质量状况的相关分析（n=3 612，r值）

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变量 s1234
1.睡眠障碍6.463.421
2.抑郁4.853.550.39**1
3.躯体健康60.3018.03-0.43**-0.53**1
4.心理健康62.1916.40-0.40**-0.60**0.737**1
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Regression analysis of depression in the intermediary model between sleep disorder and health-related quality of life in the elderly

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模型变量抑郁躯体健康心理健康
βt值R2值βt值R2值βt值R2值
模型1睡眠障碍0.3925.67**0.15-0.43-28.28**0.18-0.40-26.23**0.16
模型2抑郁-0.72-37.19**0.28-0.60-45.21**0.36
模型3睡眠质量-0.26-17.54**0.33-0.19-13.74**0.39
抑郁-0.43-28.74**-0.52-37.25**
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抑郁在老年人睡眠障碍与健康相关生命质量的中介模型的回归分析

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模型变量抑郁躯体健康心理健康
βt值R2值βt值R2值βt值R2值
模型1睡眠障碍0.3925.67**0.15-0.43-28.28**0.18-0.40-26.23**0.16
模型2抑郁-0.72-37.19**0.28-0.60-45.21**0.36
模型3睡眠质量-0.26-17.54**0.33-0.19-13.74**0.39
抑郁-0.43-28.74**-0.52-37.25**
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Analysis of the mediating role of depression between sleep disorder and physical health-related quality of life

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效应EffectBoott值P值相对效应值（95%CI）
总效应-2.240.07-28.28<0.001
直接效应-1.360.07-17.53<0.00160.71（-1.52～-1.21）
间接效应-0.880.04-28.73<0.00139.29（-0.18～-0.15）
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抑郁在睡眠障碍与躯体健康相关生命质量之间的中介作用分析

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效应EffectBoott值P值相对效应值（95%CI）
总效应-2.240.07-28.28<0.001
直接效应-1.360.07-17.53<0.00160.71（-1.52～-1.21）
间接效应-0.880.04-28.73<0.00139.29（-0.18～-0.15）
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Analysis of the mediating role of depression between sleep disorder and mental health-related quality of life

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效应EffectBoott值P值相对效应值（95%CI）
总效应-1.920.07-26.22<0.001
直接效应-0.930.06-13.73<0.00148.43（-1.06～-0.79）
间接效应-0.990.04-37.25<0.00151.57（-1.08～-0.90）
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抑郁在睡眠障碍与心理健康相关生命质量之间的中介作用分析

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效应EffectBoott值P值相对效应值（95%CI）
总效应-1.920.07-26.22<0.001
直接效应-0.930.06-13.73<0.00148.43（-1.06～-0.79）
间接效应-0.990.04-37.25<0.00151.57（-1.08～-0.90）
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抑郁在老年人睡眠障碍与躯体、心理健康相关生命质量的中介作用
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孙秀娜 , 梅佳 , 徐静 , 秦殿菊 , 徐萌泽 , 白江涛
现代预防医学 | 健康与社会行为 2024,51(3): 500-506
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现代预防医学 | 健康与社会行为 2024, 51(3): 500-506
抑郁在老年人睡眠障碍与躯体、心理健康相关生命质量的中介作用
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孙秀娜, 梅佳, 徐静, 秦殿菊, 徐萌泽, 白江涛
作者信息
  • 承德医学院，河北 承德 067000

    • 孙秀娜（1991—），女，硕士，讲师，研究方向：老年健康促进

通讯作者:

白江涛，E-mail：
The mediating effect of depression on the quality of life related to physical and mental health in the elderly with sleep disorders
Xiu-na SUN, Jia MEI, Jing XU, Dian-ju QIN, Meng-ze XU, Jiang-tao BAI
Affiliations
  • Chengde Medical College, Chengde, Hebei 067000, China
出版时间: 2024-02-10 doi: 10.20043/j.cnki.MPM.202308070
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摘要
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目的

探讨老年人睡眠障碍、抑郁与健康相关生命质量的关系，以及抑郁在睡眠障碍与健康相关生活质量的中介作用。

方法

采用分层随机抽样法对河北省3 612名>60岁老年人进行调查，采用匹兹堡睡眠质量指数量表（PSQI）、简版老年抑郁量表（GDS-15）、简明健康生活质量量表（SF-36）收集相关资料。

结果

老年人睡眠障碍与抑郁存在正相关关系（r=0.39，P<0.001），睡眠障碍、抑郁与健康相关生活质量存在负相关关系（r=-0.43，-0.40，P<0.001）。老年人睡眠障碍和抑郁对健康相关生活质量有负向预测作用（β=-0.26、-0.194、-0.43、-0.520）；抑郁在老年人睡眠障碍和躯体健康相关生命质量之间起部分中介作用，中介效应占总效应39.29%；抑郁在老年人睡眠障碍和心理健康相关生命质量之间起部分中介作用，中介效应占总效应51.57%。

结论

有睡眠障碍、抑郁的老年人健康相关生命质量较差，老年人睡眠障碍直接影响健康相关生命质量，也会通过抑郁对老年人躯体、心理健康相关生命质量产生间接影响。

老年人  /  睡眠障碍  /  抑郁  /  健康相关生命质量  /  中介作用
Objective

To explore the relationship between sleep disorder, depression, and health-related quality of life in the elderly, and the mediating effect of depression on sleep disorder and health-related quality of life.

Methods

In total 3 612 elderly people over 60 years old in Hebei Province were selected by stratified random sampling, and the related data were collected with the use of Pittsburgh sleep quality index (PSQI), the simplified geriatric depression scale (GDS-15), and concise health quality of life scale (SF-36).

Results

There was a positive correlation between sleep disorder and depression in the elderly (r = 0.39, P < 0.001), and a negative correlation between sleep disorder, depression, and health-related quality of life (r = -0.43 and -0.40, P < 0.001). Sleep disorders and depression in the elderly had negative predictive effects on health-related quality of life (β =-0.26, -0.194,-0.43, and -0.520), and depression played a mediating role between sleep disorders and physical health-related quality of life in the elderly, accounting for 39.29% of the total effect. Depression played a mediating role between sleep disorders and mental health-related quality of life in the elderly, and the intermediary effect accounted for 51.57% of the total effect.

Conclusion

The health-related quality of life of the elderly with sleep disorder and depression is poor. Sleep disorder of the elderly not only directly affects the health-related quality of life, but also indirectly affects the physical and mental health-related quality of life of the elderly through depression.

Elderly  /  Sleep disorder  /  Depression  /  Health-related quality of life  /  Mediating effect
孙秀娜, 梅佳, 徐静, 秦殿菊, 徐萌泽, 白江涛. 抑郁在老年人睡眠障碍与躯体、心理健康相关生命质量的中介作用. 现代预防医学, 2024 , 51 (3) : 500 -506 . DOI: 10.20043/j.cnki.MPM.202308070
Xiu-na SUN, Jia MEI, Jing XU, Dian-ju QIN, Meng-ze XU, Jiang-tao BAI. The mediating effect of depression on the quality of life related to physical and mental health in the elderly with sleep disorders[J]. Modern Preventive Medicine, 2024 , 51 (3) : 500 -506 . DOI: 10.20043/j.cnki.MPM.202308070
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全国第七次人口普查数据显示，我国60岁以上人口数占总人口比多达18.7%，老龄化程度进一步加深。随着经济社会的快速发展，生活方式的转变、社会环境和家庭环境的改变，老年人更容易出现入睡困难、夜间易醒或早醒、失眠、白天嗜睡等睡眠质量问题[1-3]。老年人睡眠时间短、早醒、入睡困难发生比率比年轻人高[4]；一项meta分析，结果显示中国老年人睡眠障碍患病率为46.0%，老年人睡眠障碍发病率较高[5]。
睡眠是维持生理健康、心理健康的重要生理过程，良好的睡眠质量有利于机体恢复和调整、增强新陈代谢、提高免疫力、集中注意力、改善记忆力以及缓解焦虑、紧张、不安、抑郁等情绪[6-11]。研究发现中老年人失眠与慢性疼痛、心脏病及记忆力减退密切相关[11]，还可能导致肥胖、高血压、糖尿病、高尿酸血症、血脂异常等生理健康问题[11-14]。除此之外，睡眠障碍还会引起疲劳、焦虑、抑郁等心理健康问题[7,15-17]。多项研究显示老年人睡眠时间过短或过长、失眠与抑郁发生密切相关[15-17]，老年抑郁还可能导致情绪低落、衰弱、认知功能减退、甚至自杀行为等[17-21]，与心血管疾病、炎症、胰岛素抵抗等[22]也有密切关系，严重危害老年人生活质量。
随着物质生活改善、医疗水平提高，老年人对于健康定义不局限于躯体健康层面，而是生理健康、心理健康以及良好社会适应整体性健康。健康相关生命质量反映个体健康状况对其造成的躯体功能、心理和社会功能等方面的影响[6,21]。相比于传统健康评价质变的患病率、死亡率、病死率，更能准确、客观、全面的反映健康状况对个体生理、心理以及社会关系之间的影响。
目前，已以往研究中较多关于单一维度的躯体健康，较少关注对老年人心理健康的影响[6,23-24]，抑郁在睡眠质量与健康相关生命质量的中介效应研究更甚少。健康不仅仅是躯体健康，还应该包括良好的心理健康。本研究采用国际上公认比较成熟的简明健康量表（SF-36）从生理功能、生理职能、躯体疼痛、一般健康状况、生命活力、社交功能、情感角色、精神健康共8个维度，生理健康、心理健康2个领域（其中心理健康领域包括社交功能及情感角色社会功能指标）评价老年人健康相关生命质量，能够较为全面反映睡眠质量对老年健康相关生命质量的影响，以抑郁作为中介变量，深入探讨三者之间的关系及机制，为提高老年人健康相关生命质量，实现健康老龄化提供理论依据。
1　对象与方法
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1.1　对象
样本量估算：本研究为横断面研究，本研究中最大维度数为15个，通过估算公式：最大维度数×（15～20）×[1+（15%-20%）]，以变量维度的最大倍数20倍进行估算，考虑样本无效率和数据偏倚，扩大样本量20%，样本量约为460个，按城、乡老年人1:1计算，则样本量为920人。
2023年1—7月，本研究采用分层随机抽样方法，按照河北省社会发展水平综合评价指标，将其11个区市划分为高、中、低三个层级（石家庄市、邯郸市、承德市），采用随机数字表法，每个层级按城、乡老年人1:1计算，抽取样本量为920人，最终确定最少样本量为2 760人。本次共发放问卷3 700份，回收问卷3 612份，有效回收率为97.6%。本研究纳入标准：年龄≥60周岁；无认知及沟通障碍；知情同意，自愿参与调查，本研究项目经承德医学院伦理委员会审核批准（审批编号：202216）。最终确定河北省3 612名老年人参与本研究，年龄60～99周岁，平均年龄（68.91±6.98）周岁，其中男性1 695人（46.9%），女性1 917人（53.1%）。
1.2　工具
1.2.1　睡眠质量
采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)，由刘贤臣等[25]于翻译成中文，量表包含18个条目，用以评价最近一个月的睡眠质量情况，可分为主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物和日间功能障碍7个成份。每个成份按0～3分等级记分，总分范围为0～21分，得分越高，说明睡眠质量越差。以PSQI总分>7为有睡眠障碍，PSQI总分≤7分为无睡眠障碍，该量表的Cronbach α系数0.846[26]。
1.2.2　抑郁
采用简版老年抑郁量表（geriatric depression scale，GDS-15）评价，由Sheikh和Savage于1986年在GDS-30的基础上设计简化出来，唐丹等[27]人翻译为中文。表含15个条目，被试者以“是”或“否”做答，分数越高，表示抑郁症状越明显，该量表的Cronbach α系数0.763[27]。
1.2.3　健康相关生命质量
采用简明健康状况量表(the MOS item short from health survey, SF-36)由美国波士顿健康研究所研制[28]，该量表包含躯体健康与心理健康2个分量表，共36个条目。其中躯体健康量表包括生理功能、生理职能、躯体疼痛、一般健康状况共4个维度，心理健康量表包括生命活力、社交功能、情感角色、精神健康共4个维度。计分方法：原始分转化为标准分=[（实际得分-该方面可能最低得分）]/[(该方面可能最高得分-最低得分）]×100%。评分越高，表示老年人健康相关生命质量状况越好，该量表的Cronbach α系数0.892[28]。
1.3　统计分析
采用SPSS 23.0统计软件建立数据库及统计分析，采用描述性分析（），单因素描分析t检验、F检验比较不同特征老年人躯体、心理健康相关生命质量的差异性，采用Pearson相关性分析睡眠障碍、抑郁与躯体、心理健康相关生命质量关系，然后采用线性回归分析、Process插件model 4模型检验抑郁在睡眠质量与老年人躯体、心理健康相关生命质量状况之间的中介作用，检验水准α=0.05。
2　结果
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2.1　不同人口学特征老年人健康相关生命质量比较
不同年龄、受教育程度、婚姻状态、是否空巢、居住地、家庭经济收入、慢性病情况老年人躯体、心理健康相关生命质量差异均具有统计学意义（P<0.01），不同性别、是否饮酒老年人躯体健康相关生命质量，差异具有统计学意义（P<0.01）。
有睡眠障碍的老年人健康相关生命质量得分均低于无睡眠障碍的老年人，有抑郁症状的老年人健康相关生命质量得分均低于无抑郁症状的老年人，差异具有统计学意义（P<0.01）。见表1。
2.2　老年人睡眠障碍、抑郁、健康相关生命质量状况的相关分析
相关分析结果显示：老年人睡眠障碍与抑郁存在正相关关系（r=0.39，P<0.001）；睡眠障碍与躯体健康相关生命质量存在负相关关系（r=-0.43，P<0.001），与心理健康相关生命质量存在负相关关系（r=-0.40，P<0.001）；抑郁与躯体健康相关生命质量存在负相关关系（r=-0.53，P<.001），与心理健康相关生命质量存在负相关关系（r=-0.60，P<0.001），见表2。
2.3　抑郁在睡眠障碍与健康相关生活质量的中介作用
采用线性回归分析，分别以躯体健康相关生活质量、躯体健康相关生活质量为因变量，睡眠障碍为自变量、抑郁为中介变量。根据Hayes提出的宏程序Process插件模型4，检验抑郁在睡眠障碍与健康相关生命质量状况之间的中介作用。
回归分析结果表明：模型1，睡眠障碍能负向预测老年人躯体健康、心理健康（β=-0.43、-0.40，P<0.001）；模型2，抑郁亦能负向预测老年人躯体健康、心理健康健康相关生命质量（β=-0.72、-0.60，P<0.001），模型2的R2大于模型1；模型3，睡眠障碍、抑郁同时进入回归分析时，两者均能负向预测老年人躯体健康、心理健康相关生命质量（β=-0.26、-0.19、-0.43、-0.52，P<0.001）,见表3。路径睡眠障碍→抑郁→躯体健康相关生命质量总效应为-2.24，直接效应为-1.36，直接效应占效应总量为60.71%；中介效应为-0.88，中介效应占效应总量为39.29%，见表4。路径睡眠障碍→抑郁→心理健康健康相关生命质量总效应值为-1.92，直接效应为-0.93，直接效应占效应总量为48.43%；中介效应为-0.99，中介效应占效应总量为51.57%，见表5。两条路径Bootstrap95%CI均不包含0，说明抑郁在睡眠障碍与躯体、心理健康相关生命质量之间均为部分中介作用。
3　讨论
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本研究发现，有睡眠障碍的老年人健康相关生命质量较低，睡眠障碍与躯体健康、心理健康存在显著负相关关系，与已有研究结果一致[6-7,23,28]。睡眠时间短、睡眠质量差与高血压、糖尿病、血脂异常等慢性病相关，严重可能还会有心脏疾病、脑血管疾病、癌症等，老年人还容易出现跌倒、骨折等危险事件，严重影响老年人躯体健康状况；睡眠时间过短、多梦、夜间易醒等睡眠质量问题，使人出现不同程度的消极情绪，比如自卑、焦虑、烦躁、抑郁等问题，影响老年人心理健康状况[29]。研究也显示：睡眠障碍与抑郁存在显著正向关系，睡眠障碍往往伴随抑郁的出现，睡眠质量差老年人常常会出现易疲劳、食欲减退、忧思多虑、烦躁、焦虑，甚至发展为抑郁[30]。
有抑郁症状老年人健康相关生活质量较低，抑郁与老年人健康相关生活质量中躯体健康领域、心理健康领域均为显著负相关，与Han Ke等[31]研究结果一致。随着身体机能衰退及疾病相关风险因素，抑郁成为老年人常见的心理疾病。一项横断面研究[32]对上海2 525名≥60岁社区老年人调查发现，与非抑郁、非认知障碍老年人相比，患有抑郁的老年人健康相关生活质量生理领域、心理领域得分最低，其次为认知障碍老年人。此外，在多发性骨髓瘤、类风湿关节炎、糖尿病以及肌少症一些疾病患者中，抑郁与健康相关生活质量呈负相关。抑郁为老年人健康相关生活质量有独立负向预测因素，一项对老年人焦虑、抑郁对健康相关生活质量影响的纵向研究发现[33]，年龄增长与生活质量差存在关联，在其他因素中，焦虑、抑郁对老年人健康相关生活质量影响最大。因此改善老年人抑郁症状，是积极实现健康老龄化的重要干预领域。
本研究中，抑郁在老年人睡眠障碍与健康相关生命质量之间的部分中介作用，即睡眠质量不仅可以直接影响老年人健康相关生活质量，还可以通过抑郁间接影响，抑郁在睡眠障碍与心理健康领域中介效应高于躯体健康领域。李莎等[34]采用匹兹堡睡眠质量指数量表及老年抑郁症状自评量表，发现社区老年人主观睡眠质量、睡眠紊乱、日间功能障碍灯与抑郁症状存在统计学关联关系相关。一项对社区515名18～70岁成年人横断面研究[35]，睡眠质量差与抑郁相关，睡眠质量差，则健康相关生活质量平均得分低于睡眠质量好的受试者。睡眠障碍与抑郁往往存在共病性，抑郁调节睡眠与健康相关生活质量的之间的关系，可能是一种生理-心理-生理循环的工作机制，睡眠障碍与抑郁具有双向关系、双向强化，导致老年人健康相关生活质量降低。
与Chen Y等[36]研究结果不同，其在COVID-19大流行期间非透析慢性肾脏病睡眠、抑郁和健康相关生活质量之间的关系的研究发现，抑郁能解释睡眠状态与躯体健康关系的51%的显著中介变量，而在睡眠与心理健康领域的关联中起完全中介作用。本研究中抑郁在睡眠与心理健康领域的关联中起部分中介作用，抑郁在睡眠障碍与心理领域中介效应明显。考虑可能研究对象、使用的评估工具不同，本研究中老年人有抑郁症状的较低为24.3%（878/3 612），而Chen Y为COVID-19大流行期间慢性肾脏病患者其抑郁发生率为49.4%，因此抑郁对心理领域健康生命质量影响较大。
睡眠障碍、抑郁与健康相关生活质量存在密切的关系，有睡眠障碍的老年人较多，有抑郁症状的老年人检出率较低，但抑郁在老年人睡眠及健康相关生活存在显著的中介作用。提示我们不仅要关注老年人睡眠质量，还要关注抑郁的发生，以提高老年人躯体、心理健康相关生活质量。
基金
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  • 2023年河北省社会科学发展研究课题(20230205059)
  • 2023年度承德市社科联项目(20233281)
  • 承德医学院青年基金项目(202015)
文献
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2024年第51卷第3期
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doi: 10.20043/j.cnki.MPM.202308070
  • 接收时间：2023-08-07
  • 首发时间：2026-03-19
  • 出版时间：2024-02-10
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  • 收稿日期：2023-08-07
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2023年河北省社会科学发展研究课题(20230205059)
2023年度承德市社科联项目(20233281)
承德医学院青年基金项目(202015)
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    承德医学院，河北 承德 067000

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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