Article(id=1311350492903596438, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601293, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1768838400000, receivedDateStr=2026-01-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579921222, onlineDateStr=2026-09-28, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579921222, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579921222, creator=13701087609, updateTime=1790579921222, updator=13701087609, issue=Issue{id=1311350193946194882, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579849945, creator='13701087609', updateTime=1790588319569, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385718195315029, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385718195315030, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350193946194882, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2833, endPage=2839, ext={EN=ArticleExt(id=1311350494480654743, articleId=1311350492903596438, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The relationship between hearing impairment and depression among middle-aged and older adults in China and the moderating role of sleep duration, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between hearing impairment and depressive symptoms among middle-aged and older adults, as well as the moderating role of sleep duration.

Methods

Data from four waves of the China Health and Retirement Longitudinal Study (2013—2020) were analyzed. Multivariable Cox regression was used to conduct interaction tests and stratified analyses to verify the association and moderating effect.

Results

In the overall population, hearing impairment was associated with a significantly higher risk of depression (HR=1.29, 95% CI: 1.08-1.55). Stratified analysis revealed that such association existed in the short sleep group (HR=1.35) and long sleep group (HR=1.78), whereas no significant association was observed in the normal sleep group. Interaction analysis indicated that only prolonged sleep significantly exacerbated the association between hearing impairment and depression (HR=1.69). Subgroup analysis showed that the association was more prominent in females with short sleep and males with long sleep, and the effect was significant among individuals aged 60 years and above.

Conclusion

Hearing impairment is a significant risk factor for depressive symptoms among older adults, and sleep duration plays a moderating role in this relationship. Maintaining a normal sleep duration may alleviate and offset the increased risk of depression attributable to hearing impairment, thereby providing a novel intervention target for the mental health protection of middle-aged and older adults with hearing impairment.

, authors=Jia-lin XU1, Yang LUO1, Long-yi HUANG1, Zhi LIU2, Peng-yu XU1, Ai-jun XU1, 3, authorsList=Jia-lin XU, Yang LUO, Long-yi HUANG, Zhi LIU, Peng-yu XU, Ai-jun XU, authorCompany=null, correspAuthors=Ai-jun XU, authorNote=null, correspAuthorsNote=null, 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=1311350496468754848, articleId=1311350492903596438, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=我国中老年人听力障碍与抑郁的关系及睡眠时间的调节作用, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探究中老年人听力障碍与抑郁的关联及睡眠时间的调节作用。

方法

采用中国健康与养老追踪调查2013—2020年四期数据,基于多变量Cox回归进行交互项检验与分层分析,以验证关联及调节效应。

结果

在全人群中,听力障碍者抑郁风险显著升高(HR=1.29,95%CI:1.08~1.55);分层分析表明,该关联存在于短睡眠组(HR=1.35)和长睡眠组(HR=1.78),正常睡眠组则无关联;交互项检验结果显示,仅长时间睡眠可显著放大听力障碍对抑郁的影响(HR=1.69)。亚组分析显示,女性短睡眠者和男性长睡眠者的关联更为突出,且在60岁及以上人群效应显著。

结论

听力障碍是老年人抑郁症状的重要危险因素,睡眠时间具有调节作用,维持正常睡眠时间可缓解、抵消听力障碍带来的抑郁风险,为听力障碍的中老年人心理健康防护提供了新的干预方向。

, authors=许家林1, 骆阳1, 黄龙毅1, 刘志2, 徐鹏宇1, 徐爱军1, 3, authorsList=许家林, 骆阳, 黄龙毅, 刘志, 徐鹏宇, 徐爱军, authorCompany=null, correspAuthors=徐爱军, authorNote=

许家林(2001—),男,硕士在读,研究方向:卫生政策与管理

, correspAuthorsNote=
徐爱军,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=79jAI1iaAMhDsqkz9m3Klw==, magXml=Qdn1Fa2wfRV15tP97wvFmQ==, pdfUrl=null, pdf=tWqXQhh133f404riHnAoAw==, pdfFileSize=905002, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=8NObSJWqbRQ20OH9lpASEQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=c+VBw9QP7giFvXmMAAWeSw==, mapNumber=null, fund=null)}, authors=[Author(id=1311350497215340969, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1311350498897256875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, authorId=1311350497215340969, language=EN, stringName=Jia-lin XU, firstName=Jia-lin, middleName=null, lastName=XU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1311350498960171436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, authorId=1311350497215340969, language=CN, stringName=许家林, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.南京中医药大学卫生经济管理学院,江苏 南京 210023, bio={"content":"

许家林(2001—),男,硕士在读,研究方向:卫生政策与管理

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Modern Preventive Medicine, 2026, 53(6): 968-972, 980.(In Chinese), articleTitle=Study on the association between sleep duration and cardiovascular health in the elderly based on federated causal learning, refAbstract=null)], funds=[Fund(id=1311350504056250846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, awardId=24JZD043, language=CN, fundingSource=2024年度教育部哲学社会科学研究重大课题攻关项目(24JZD043), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350496833659297, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, xref=1., ext=[AuthorCompanyExt(id=1311350496846242210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, companyId=1311350496833659297, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1311350496854630819, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, companyId=1311350496833659297, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京中医药大学卫生经济管理学院,江苏 南京 210023)]), AuthorCompany(id=1311350496921739684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, xref=2., ext=[AuthorCompanyExt(id=1311350496930128293, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, companyId=1311350496921739684, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.国家卫生健康委卫生发展研究中心)]), AuthorCompany(id=1311350496997237158, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, xref=3., ext=[AuthorCompanyExt(id=1311350497005625767, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, companyId=1311350496997237158, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.江苏重大健康风险管理与中医药防控政策研究中心,江苏 南京 210023)])], figs=[ArticleFig(id=1311350501095072207, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Figure 1, caption=Flowchart of sample screening, figureFileSmall=APx78QdhePL1KR+fRDKJZQ==, figureFileBig=8NObSJWqbRQ20OH9lpASEQ==, tableContent=null), ArticleFig(id=1311350501149598160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=图1, caption=样本筛选流程图, figureFileSmall=APx78QdhePL1KR+fRDKJZQ==, figureFileBig=8NObSJWqbRQ20OH9lpASEQ==, tableContent=null), ArticleFig(id=1311350501418033617, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Figure 2, caption=Subgroup analysis, figureFileSmall=dsN6mX48OeKjy/+Xqk7vrQ==, figureFileBig=IrncQEeyy7bGUjswXmHeGQ==, tableContent=null), ArticleFig(id=1311350501606777298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=图2, caption=亚组分析

注:A为男性亚组;B为女性亚组;C为60岁以下人群亚组;D为60岁及以上亚组;以上模型均纳入所有协变量。

, figureFileSmall=dsN6mX48OeKjy/+Xqk7vrQ==, figureFileBig=IrncQEeyy7bGUjswXmHeGQ==, tableContent=null), ArticleFig(id=1311350501829075411, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Table 1, caption=

Baseline characteristics [(), n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数
(n=5 398)
出现抑郁症状F/χ2值P值
是(n=1 472)否(n=3 926)
年龄(岁)57.58±8.0758.06±8.1457.40±8.036.91<0.001
性别1.170.280
男2 945(54.56)711(24.14)2 234(75.86)
女2 453(45.44)761(31.02 )1 692(68.98)
婚姻状况13.57<0.001
已婚5 022(93.03)1 357(27.02)3 665(72.98)
分居或离婚376(6.97)115(30.59)261(69.41)
学历9.520.002
文盲889(16.47)305(34.31)584(65.69)
小学2 162(40.05)639(29.56)1 523(70.44)
初中1 477(27.36)349(23.63)1 128(76.37)
高中及以上870(16.12)179(20.57)691(79.43)
居住类型18.48<0.001
农村3 296(61.06)977(29.64)2 319(70.36)
城镇2 102(38.94)495(23.55)1 607(76.45)
社会参与11.260.001
否1 956(36.24)558(28.53)1 398(71.47)
是3 442(63.76)914(26.55)2 528(73.45)
抽烟3.780.052
否2 940(54.46)850(28.91)2 090(71.09)
是2 458(45.54)622(25.31)1 836(74.69)
喝酒1.440.231
否3 673(68.04)1 031(28.07)2 642(71.93)
是1 725(31.96)441(25.57)1 284(74.43)
失能14.88<0.001
否4 978(92.22)1 327(26.66)3 651(73.34)
是420(7.78)145(34.52)275(65.48)
身体疼痛14.67<0.001
否4 099(75.94)1 075(26.23)3 024(73.77)
是1 299(24.06)397(30.56)902(69.44)
慢病数量17.73<0.001
无2 138(39.61)552(25.82)1 586(74.18)
11 624(30.09)441(27.16)1 183(72.84)
≥21 636(30.31)479(29.28)1 157(70.72)
睡眠(h)2.670.263
<72 005(37.14)565(28.18)1 440(71.82)
7~92 885(53.45)756(26.20)2 129(73.80)
>9508(9.41)151(29.72)357(70.28)
), ArticleFig(id=1311350503313859029, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=表1, caption=

基线特征 [(),n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数
(n=5 398)
出现抑郁症状F/χ2值P值
是(n=1 472)否(n=3 926)
年龄(岁)57.58±8.0758.06±8.1457.40±8.036.91<0.001
性别1.170.280
男2 945(54.56)711(24.14)2 234(75.86)
女2 453(45.44)761(31.02 )1 692(68.98)
婚姻状况13.57<0.001
已婚5 022(93.03)1 357(27.02)3 665(72.98)
分居或离婚376(6.97)115(30.59)261(69.41)
学历9.520.002
文盲889(16.47)305(34.31)584(65.69)
小学2 162(40.05)639(29.56)1 523(70.44)
初中1 477(27.36)349(23.63)1 128(76.37)
高中及以上870(16.12)179(20.57)691(79.43)
居住类型18.48<0.001
农村3 296(61.06)977(29.64)2 319(70.36)
城镇2 102(38.94)495(23.55)1 607(76.45)
社会参与11.260.001
否1 956(36.24)558(28.53)1 398(71.47)
是3 442(63.76)914(26.55)2 528(73.45)
抽烟3.780.052
否2 940(54.46)850(28.91)2 090(71.09)
是2 458(45.54)622(25.31)1 836(74.69)
喝酒1.440.231
否3 673(68.04)1 031(28.07)2 642(71.93)
是1 725(31.96)441(25.57)1 284(74.43)
失能14.88<0.001
否4 978(92.22)1 327(26.66)3 651(73.34)
是420(7.78)145(34.52)275(65.48)
身体疼痛14.67<0.001
否4 099(75.94)1 075(26.23)3 024(73.77)
是1 299(24.06)397(30.56)902(69.44)
慢病数量17.73<0.001
无2 138(39.61)552(25.82)1 586(74.18)
11 624(30.09)441(27.16)1 183(72.84)
≥21 636(30.31)479(29.28)1 157(70.72)
睡眠(h)2.670.263
<72 005(37.14)565(28.18)1 440(71.82)
7~92 885(53.45)756(26.20)2 129(73.80)
>9508(9.41)151(29.72)357(70.28)
), ArticleFig(id=1311350503389356502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Table 2, caption=

Association between hearing impairment and risk of depressive symptoms

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变量模型1模型2模型3
HR (95%CI)P值HR (95%CI)P值HR (95%CI)P值
全样本
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.44(1.20~1.72)<0.0011.43(1.20~1.72)<0.0011.29(1.08~1.55)0.006
短时间睡眠组 (<7h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.48(1.12~1.97)0.0071.49(1.12~1.99)0.0071.35(1.01~1.81)0.042
长时间睡眠组(>9h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.92(1.17~3.14)0.0101.88(1.14~3.10)0.0131.78(1.01~2.99)0.027
正常睡眠组(7~9h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.29(0.99~1.69)0.0591.29(0.99~1.69)0.0621.15(0.88~1.51)0.304
), ArticleFig(id=1311350503473242583, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=表2, caption=

听力障碍与抑郁症状风险的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
HR (95%CI)P值HR (95%CI)P值HR (95%CI)P值
全样本
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.44(1.20~1.72)<0.0011.43(1.20~1.72)<0.0011.29(1.08~1.55)0.006
短时间睡眠组 (<7h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.48(1.12~1.97)0.0071.49(1.12~1.99)0.0071.35(1.01~1.81)0.042
长时间睡眠组(>9h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.92(1.17~3.14)0.0101.88(1.14~3.10)0.0131.78(1.01~2.99)0.027
正常睡眠组(7~9h)
听力正常组1.00(ref)1.00(ref)1.00(ref)
听力障碍组1.29(0.99~1.69)0.0591.29(0.99~1.69)0.0621.15(0.88~1.51)0.304
), ArticleFig(id=1311350503557128664, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Table 3, caption=

Interaction analysis

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交互项HR (95%CI)P值
模型a听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.27(0.93~1.74)0.137
听力障碍*长时间睡眠1.69(1.08~2.64)0.022
模型b(敏感性分析)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.33(0.94~1.87)0.103
听力障碍*长时间睡眠1.65(1.02~2.67)0.043
), ArticleFig(id=1311350503624237529, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=表3, caption=

交互作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
交互项HR (95%CI)P值
模型a听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.27(0.93~1.74)0.137
听力障碍*长时间睡眠1.69(1.08~2.64)0.022
模型b(敏感性分析)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.33(0.94~1.87)0.103
听力障碍*长时间睡眠1.65(1.02~2.67)0.043
), ArticleFig(id=1311350503695540698, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Table 4, caption=

Sensitivity analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型4
HR (95%CI)P值
全样本
听力正常组1.00(ref)
听力障碍组1.36(1.11~1.66)0.003
短时间睡眠组 (<7h)
听力正常组1.00(ref)
听力障碍组1.43(1.04~1.97)0.030
长时间睡眠组(>9h)
听力正常组1.00(ref)
听力障碍组1.74(1.01~3.00)0.048
正常睡眠组(7~9h)
听力正常组1.00(ref)
听力障碍组1.21(0.91~1.62)0.198
), ArticleFig(id=1311350503766843867, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=表4, caption=

敏感性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型4
HR (95%CI)P值
全样本
听力正常组1.00(ref)
听力障碍组1.36(1.11~1.66)0.003
短时间睡眠组 (<7h)
听力正常组1.00(ref)
听力障碍组1.43(1.04~1.97)0.030
长时间睡眠组(>9h)
听力正常组1.00(ref)
听力障碍组1.74(1.01~3.00)0.048
正常睡眠组(7~9h)
听力正常组1.00(ref)
听力障碍组1.21(0.91~1.62)0.198
), ArticleFig(id=1311350503846535644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=EN, label=Table 5, caption=

Interaction tests in subgroup analyses

, figureFileSmall=null, figureFileBig=null, tableContent=
交互项HR (95%CI)P值
模型c(男性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.08(0.67~1.74)0.767
听力障碍*长时间睡眠1.87(1.08~3.25)0.025
模型d(女性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.45(0.95~2.20)0.083
听力障碍*长时间睡眠1.29(0.57~2.90)0.536
模型e(60岁以上人群亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.61(1.05~2.49)0.030
听力障碍*长时间睡眠2.73(1.59~4.70)<0.001
模型f(60岁以下人群亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠0.86(0.50~1.47)0.577
听力障碍*长时间睡眠0.89(0.39~2.06)0.793
模型g(60岁以上男性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.10(0.62~1.95)0.735
听力障碍*长时间睡眠2.18(1.22~3.91)0.009
模型h(60岁以上女性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠2.97(1.39~6.33)0.005
听力障碍*长时间睡眠3.92(1.01~15.31)0.049
), ArticleFig(id=1311350503913644509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350492903596438, language=CN, label=表5, caption=

亚组分析交互作用检验

, figureFileSmall=null, figureFileBig=null, tableContent=
交互项HR (95%CI)P值
模型c(男性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.08(0.67~1.74)0.767
听力障碍*长时间睡眠1.87(1.08~3.25)0.025
模型d(女性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.45(0.95~2.20)0.083
听力障碍*长时间睡眠1.29(0.57~2.90)0.536
模型e(60岁以上人群亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.61(1.05~2.49)0.030
听力障碍*长时间睡眠2.73(1.59~4.70)<0.001
模型f(60岁以下人群亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠0.86(0.50~1.47)0.577
听力障碍*长时间睡眠0.89(0.39~2.06)0.793
模型g(60岁以上男性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠1.10(0.62~1.95)0.735
听力障碍*长时间睡眠2.18(1.22~3.91)0.009
模型h(60岁以上女性亚组)听力障碍*正常时间睡眠1.00(ref)
听力障碍*短时间睡眠2.97(1.39~6.33)0.005
听力障碍*长时间睡眠3.92(1.01~15.31)0.049
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我国中老年人听力障碍与抑郁的关系及睡眠时间的调节作用
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许家林 1 , 骆阳 1 , 黄龙毅 1 , 刘志 2 , 徐鹏宇 1 , 徐爱军 1, 3
现代预防医学 | 健康与社会行为 2026,53(15): 2833-2839
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现代预防医学 |健康与社会行为 2026 , 53 (15) : 2833 -2839
我国中老年人听力障碍与抑郁的关系及睡眠时间的调节作用
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许家林1, 骆阳1, 黄龙毅1, 刘志2, 徐鹏宇1, 徐爱军1, 3
作者信息
  • 1.南京中医药大学卫生经济管理学院,江苏 南京 210023
  • 2.国家卫生健康委卫生发展研究中心
  • 3.江苏重大健康风险管理与中医药防控政策研究中心,江苏 南京 210023
通讯作者:
徐爱军,E-mail:
作者简介:

许家林(2001—),男,硕士在读,研究方向:卫生政策与管理

The relationship between hearing impairment and depression among middle-aged and older adults in China and the moderating role of sleep duration
Jia-lin XU1, Yang LUO1, Long-yi HUANG1, Zhi LIU2, Peng-yu XU1, Ai-jun XU1, 3
Affiliations
  • School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
出版时间: 2026-08-10 doi: 10.20043/j.cnki.MPM.202601293
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目的

探究中老年人听力障碍与抑郁的关联及睡眠时间的调节作用。

方法

采用中国健康与养老追踪调查2013—2020年四期数据,基于多变量Cox回归进行交互项检验与分层分析,以验证关联及调节效应。

结果

在全人群中,听力障碍者抑郁风险显著升高(HR=1.29,95%CI:1.08~1.55);分层分析表明,该关联存在于短睡眠组(HR=1.35)和长睡眠组(HR=1.78),正常睡眠组则无关联;交互项检验结果显示,仅长时间睡眠可显著放大听力障碍对抑郁的影响(HR=1.69)。亚组分析显示,女性短睡眠者和男性长睡眠者的关联更为突出,且在60岁及以上人群效应显著。

结论

听力障碍是老年人抑郁症状的重要危险因素,睡眠时间具有调节作用,维持正常睡眠时间可缓解、抵消听力障碍带来的抑郁风险,为听力障碍的中老年人心理健康防护提供了新的干预方向。

听力障碍  /  抑郁  /  睡眠时间  /  中老年人
Objective

To explore the association between hearing impairment and depressive symptoms among middle-aged and older adults, as well as the moderating role of sleep duration.

Methods

Data from four waves of the China Health and Retirement Longitudinal Study (2013—2020) were analyzed. Multivariable Cox regression was used to conduct interaction tests and stratified analyses to verify the association and moderating effect.

Results

In the overall population, hearing impairment was associated with a significantly higher risk of depression (HR=1.29, 95% CI: 1.08-1.55). Stratified analysis revealed that such association existed in the short sleep group (HR=1.35) and long sleep group (HR=1.78), whereas no significant association was observed in the normal sleep group. Interaction analysis indicated that only prolonged sleep significantly exacerbated the association between hearing impairment and depression (HR=1.69). Subgroup analysis showed that the association was more prominent in females with short sleep and males with long sleep, and the effect was significant among individuals aged 60 years and above.

Conclusion

Hearing impairment is a significant risk factor for depressive symptoms among older adults, and sleep duration plays a moderating role in this relationship. Maintaining a normal sleep duration may alleviate and offset the increased risk of depression attributable to hearing impairment, thereby providing a novel intervention target for the mental health protection of middle-aged and older adults with hearing impairment.

Hearing impairment  /  Depression  /  Sleep duration  /  Middle-aged and older adults
许家林, 骆阳, 黄龙毅, 刘志, 徐鹏宇, 徐爱军. 我国中老年人听力障碍与抑郁的关系及睡眠时间的调节作用. 现代预防医学, 2026 , 53 (15) : 2833 -2839 . DOI: 10.20043/j.cnki.MPM.202601293
Jia-lin XU, Yang LUO, Long-yi HUANG, Zhi LIU, Peng-yu XU, Ai-jun XU. The relationship between hearing impairment and depression among middle-aged and older adults in China and the moderating role of sleep duration[J]. Modern Preventive Medicine, 2026 , 53 (15) : 2833 -2839 . DOI: 10.20043/j.cnki.MPM.202601293
近年来,我国老龄化程度不断加重,老年人心理健康问题愈发凸显。《中国老龄发展报告2024:中国老年人心理健康状况》显示,我国26.4%的老年人存在抑郁症状[1]。抑郁症不仅影响生活质量,还会增加医疗成本和社会负担。在导致抑郁的众多因素中,感官维度尤其是听力障碍对抑郁的影响逐渐受到关注。研究显示,我国60岁以上的老年人患听力损失相关疾病率达69%[2],但大多数人却认为老年人听力功能的衰退是正常生理现象,不重视其引发的心理问题,而听力功能直接影响其生活质量、社交感受和自尊[3],从而升高抑郁风险。
近年来,众多学者对听力障碍与抑郁症的关联展开研究。一项美国研究显示,11.4%听力障碍的老年人患有中重度抑郁症,19.1%表现出轻度抑郁症[4]。国内学者发现听力受损的老年人检出率为34.9%,抑郁症状的检出率为46.1%,不同听力状况老年人的抑郁症状具有差异[5]。睡眠与抑郁的关联也受到关注,过长或过短时间睡眠是抑郁症状发生的危险因素[6]。现有研究极少以队列数据探讨听力障碍与抑郁的关系,也未明确睡眠时间在其中的作用机制。本研究主要探讨听力障碍对中老年人抑郁症状的影响,并分析睡眠时间在其中的调节作用,为听力障碍人群的抑郁防控提供依据。
采用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)四期(2013—2020年)数据,该调查是中国首个针对中老年人的全国性调查,问卷包含社会人口学信息、心理健康状况和健康状态等。研究纳入标准:2013年完成基线调查且至2020年成功随访;年龄≥45岁;基期无抑郁症状;听力状况、睡眠时间等变量信息完整。排除标准:随访过程中失访者;抑郁、听力、睡眠时间等关键变量信息缺失者;基期存在抑郁症状者;年龄<45岁者。最终纳入5 398名研究对象。见图1。
为评估选择性失访对结果的潜在影响[7],进一步比较失访人群与研究对象的基线核心特征。结果显示,两组在听力状况(χ2=2.301 6,P=0.129)、慢性病患病状况(χ2=0.474 9,P=0.491)上均无统计学差异;仅在年龄上存在微小差异(t=-4.995 3,P<0.001),均值差仅0.93岁,临床与公共卫生层面意义有限。提示本研究的失访接近随机失访,未引入关键选择性偏倚。
采用流调中心抑郁量表[8]评估抑郁症状。量表包含10个评估条目,每个条目采用0~3分计分法,总得分范围为0~30分,以≥10分为识别抑郁症状的临界值[9],该量表的克朗巴赫α系数为0.783。
通过自我报告法判定听力障碍,该方法已被证实具有可靠性[10]。采用CHARLS问卷中“您的听力情况如何?极好、很好、好、一般、差?”选择“差”的个体被认为存在听力障碍,选择其他选项被认为正常。
睡眠时间为夜间睡眠与午睡之和,通过以下问题评估:“过去一个月内,您每晚实际睡眠时间为多久?”“过去一个月内,您通常午睡时长为多久?”参考美国国家睡眠基金会的标准及相关文献[11],分为短时间(<7h/d)、正常(7~9h/d)和长时间(>9h/d)三类睡眠。
参考以往研究[12-13],纳入以下因素作为协变量:社会人口学(性别、年龄、受教育程度、婚姻状况、居住地类型)、健康行为(吸烟、饮酒、社会参与)、健康状况(日常生活活动能力、身体疼痛、慢性病状况)。
描述性统计中,连续变量以(均数±标准差)表示,分类变量以频数(百分比)表示。比较听力障碍组与正常组变量基线差异时,连续变量采用t检验,分类变量采用χ2检验。采用多变量Cox比例风险回归模型分析听力障碍与抑郁症状的关联,并进行分层分析、纳入交互项检验,检验睡眠时间在二者关联中的调节效应。此外,通过排除患有癌症、心脏病或中风的参与者进行敏感性分析;按性别和年龄进行亚组分析。统计分析采用SPSS 27.0和Stata MP 18.0软件完成。检验水准α=0.05。
5 398名中老年人中,男性2 945名(54.56%),女性2 453名(45.44%);平均年龄为(57.58±8.07)岁;1 472名(27.27%)参与者随访中出现抑郁症状。见表1。
结果显示,存在听力障碍的中老年人发生抑郁风险更高。分层分析发现,在短时间睡眠组和长时间睡眠组中均存在听力障碍与抑郁症状风险升高的关联,正常睡眠组中无关联。短时间睡眠组和长时间睡眠组中,听力障碍者出现抑郁症状的HR分别为1.35(95%CI:1.01~1.81)和1.78(95%CI:1.01~2.99)。见表2。
分层分析仅反映不同亚组中听力障碍对抑郁影响的组间差异,无法验证该差异显著性。为验证睡眠时间的调节效应,本研究以正常睡眠为参照组构建睡眠时间哑变量,在回归模型中纳入听力障碍与短睡眠、长睡眠的交互项,通过检验交互项的统计学显著性判定调节作用是否存在。在全样本中(模型a),短时间睡眠对听力障碍与抑郁的关联无显著调节作用;长时间睡眠存在显著调节作用,即在长时间睡眠人群中,听力障碍对抑郁发生的影响显著增强。见表3。
排除基线患有癌症、心脏病或中风的参与者(n=573)后进行敏感性分析,存在听力障碍的中老年人抑郁发生风险更高,且该关联在短时间睡眠组和长时间睡眠组中仍存在。短时间睡眠组和长时间睡眠组中,听力障碍者出现抑郁症状的HR分别为1.43和1.74;正常睡眠组中无此关联,见表4。同理于2.3的交互作用分析,模型b与模型a结果一致,长时间睡眠存在显著调节作用。见表3。
亚组分析结果差异显著,见图2。女性中,短时间睡眠组观察到听力障碍与抑郁症状风险升高的关联,听力障碍女性的抑郁症状风险高出71%。男性中,结果则相反,尽管在男性全样本中未发现听力障碍与抑郁风险升高相关,但长时间睡眠组中,听力障碍男性的抑郁症状风险高出130%。年龄亚组中,仅在60岁及以上人群中观察到听力障碍与抑郁风险升高的关联。
交互作用检验结果与主要结论基本一致,进一步揭示该调节效应存在异质性。在男性亚组中(模型c),仅长时间睡眠与听力障碍的交互效应具有统计学意义;女性亚组中(模型d)交互效应不显著,但仍呈现与全样本一致的趋势。按年龄分层后可见,60岁及以上老年人群(模型e)是该调节效应的主要载体,短时间睡眠与长时间睡眠均能显著放大听力障碍对抑郁的影响;而60岁以下中年人群(模型f)中未观察到显著交互效应。结合性别与年龄交叉分析显示,60岁以上男性(模型g)与女性群体(模型h)均存在显著交互效应,60岁以上男性亚组中提示长时间睡眠是放大老年男性听力障碍者抑郁风险的关键因素;60岁以上女性亚组中,短时间睡眠与听力障碍的交互效应更为显著(P=0.005),而长时间睡眠交互项虽也达显著性水平,但效应强度与统计显著性均弱于短睡眠组,提示老年女性对睡眠时长不足的敏感性更高。见表5。
本研究基于CHARLS队列数据,分析我国中老年人听力障碍与抑郁症状的关联,并揭示睡眠时间在二者间的调节效应及人群异质性特征,为深入理解听觉功能、睡眠状态与心理健康间的复杂机制提供了新证据,对开展老年人心理健康干预及公共卫生策略制定具有重要意义。
研究发现,听力障碍显著增加老年人抑郁症状发生风险,与既往研究结果一致[14]。从心理、认知和社会存在角度思考,听力障碍会导致老年人在社交中碰壁,增加社会隔离等负面反应概率;听力障碍会加速老年人认知功能衰退,导致精神疲劳和慢性压力,引发抑郁情绪[15]。从生理学角度而言,听力障碍会诱导大脑听觉中枢及相关神经网络重塑,干扰神经递质分泌与调节而导致抑郁[16];研究证实听力功能敏感性下降可直接反映为注意机制异常,削弱个体的注意力导向能力,最终成为抑郁症等精神障碍的诱因[17]。
本研究另一发现是睡眠时间在听力障碍与抑郁症状的关联中起调节作用,进行正常时间睡眠可缓解或抵消听力障碍致抑郁的风险,睡眠不足和睡眠过多均会增加抑郁风险,与Young[18]等学者研究结论相同。短时间睡眠与情绪低落、肥胖及心血管等疾病相关[19],可能叠加听力障碍进一步提升抑郁风险;而长时间睡眠并非单纯的调节因素,更可能作为衰弱表型或潜在慢性疾病的表征,与体力活动不足、未确诊亚临床疾病或抑郁早期代偿反应相关[20],这些因素与听力障碍共同构成“风险集群”,而非单纯调节效应,最终导致抑郁风险非线性激增。
亚组分析揭示了听力障碍、睡眠与抑郁之间关系的复杂性。性别异质性的核心机制源于生理与社会行为的双重差异[21],女性本身抑郁症和焦虑症的患病率更高,对睡眠剥夺引发的生理和情绪反应更为敏感[22];尤其是在我国传统中,老年女性由于长期承担家庭照料负担、社会参与较少、心理弹性相对较弱[23]等,听力障碍导致的沟通困难等叠加短时间睡眠引发的情绪波动产生协同负面影响,抑郁风险突出。对男性而言,长时间睡眠与抑郁的关联更为显著,可能与长睡眠男性伴随体力活动不足或隐匿性健康问题相关,这些因素与听力障碍的功能衰退叠加进一步放大抑郁风险[24]。在年龄差异方面,本研究发现听力障碍与抑郁的关联仅在60岁及以上人群中显著,老年人面临认知功能衰退、社交网络缩小等多重挑战[25],更易引发情绪紊乱和抑郁,是重点关注人群。
综上,听力障碍是抑郁症状的危险因素,且该风险受睡眠时间调节。这一发现表明,患有听力障碍的老年人可通过养成适度睡眠习惯这一经济易行的方式,预防和缓解抑郁症状或其他慢性疾病[26]。政府部门与基层医务人员应重视老年人群的听力状况与睡眠管理,结合人群异质性特征开展心理健康宣教与干预工作,助力老年友好型社会建设。
本研究尚存在局限性和不足,听力障碍采用自我报告法评估,未结合客观听力检测结果,难以精准反映听力障碍的实际严重程度;睡眠时间仅纳入基线单次数据,未追踪其动态变化,也未考虑睡眠质量等相关指标的影响。未来研究可结合真实世界客观检测与长期随访数据,纳入更多维度指标,深化相关机制探讨。
  • 2024年度教育部哲学社会科学研究重大课题攻关项目(24JZD043)
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2026年第53卷第15期
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doi: 10.20043/j.cnki.MPM.202601293
  • 接收时间:2026-01-20
  • 首发时间:2026-09-28
  • 出版时间:2026-08-10
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  • 收稿日期:2026-01-20
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2024年度教育部哲学社会科学研究重大课题攻关项目(24JZD043)
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    1.南京中医药大学卫生经济管理学院,江苏 南京 210023
    2.国家卫生健康委卫生发展研究中心
    3.江苏重大健康风险管理与中医药防控政策研究中心,江苏 南京 210023

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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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