Article(id=1322590130485964862, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409006, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725120000000, receivedDateStr=2024-09-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259659644, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259659644, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259659644, creator=13701087609, updateTime=1793259659644, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=86, endPage=91, ext={EN=ArticleExt(id=1322590130712457279, articleId=1322590130485964862, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of internet use on depression among empty nesters: the chain mediating role of activities of daily living and social participation, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the mediating role of Activities of Daily Living (ADL) and social participation in the relationship between internet use and depression among empty nesters, providing references for reducing the risk of depression and improving quality of life in this population.

Methods

A total of 3 974 empty nesters aged 60 and above from the 2020 China Health and Retirement Longitudinal Study were selected as the research subjects. The ADL scale and the CESD-10 scale were used to measure the ADL and depression status of the empty nesters, respectively. Spearman correlation analysis was conducted to explore the relationships among internet use, ADL, social participation, and depression among empty nesters. The mediating effects of ADL and social participation in the relationship between internet use and depression were analyzed using Model 6 of the Process 4.1 plugin in SPSS.

Results

Internet use had a significant direct effect on depression among empty nesters (β=-2.125, 95%CI: -2.593 to -1.654). The individual mediating effect of ADL was significant (β=-0.516, 95%CI: -0.641 to -0.389), as was the individual mediating effect of social participation (β=-0.159, 95%CI: -0.263 to -0.062). The chain mediating effect of ADL and social participation was also significant (β=-0.007, 95%CI: -0.011 to -0.002).

Conclusion

Internet use can directly negatively impact depression among empty nesters, and it can also influence depression through the individual or chain mediating effects of ADL and social participation.Therefore, to reduce the risk of depression among empty nesters, it is essential to increase their internet usage, enhance their ADL levels, and promote their social participation, thereby alleviating their depressive symptoms.

, authors=Wen-chao WANG, Xiao-chen FENG, Guo-wei XIAN, Yun-na GONG, Bao-xuan ZHANG, Ru-xu GE, Yong MA, authorsList=Wen-chao WANG, Xiao-chen FENG, Guo-wei XIAN, Yun-na GONG, Bao-xuan ZHANG, Ru-xu GE, Yong MA, authorCompany=null, correspAuthors=Yong MA, 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=1322590134680268880, articleId=1322590130485964862, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=互联网使用对空巢老人抑郁的影响——日常生活活动能力和社会参与的链式中介作用, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

探讨日常生活活动能力(activities of daily living,ADL)和社会参与在互联网使用和空巢老人抑郁间的中介作用,为降低空巢老人抑郁发生风险,提高生活质量提供参考。

方法

选取2020年中国健康与养老追踪调查中3 974例≥60岁的空巢老人作为研究对象,使用ADL量表、CESD-10量表分别测量空巢老人ADL和抑郁状况;运用Spearman相关分析法探究互联网使用、ADL、社会参与和空巢老人抑郁间的相关性,使用SPSS中Process4.1插件模型6分析ADL、社会参与在互联网使用和空巢老人抑郁间的中介作用。

结果

互联网使用对空巢老人抑郁的直接效应显著(β=-2.125,95%CI:-2.593~-1.654),ADL的单独中介效应显著(β=-0.516,95%CI:-0.641~-0.389),社会参与的单独中介效应显著(β=-0.159,95%CI:-0.263~-0.062),ADL和社会参与的链式中介效应显著(β=-0.007,95%CI:-0.011~-0.002)。

结论

互联网使用可以直接负向影响空巢老人抑郁情况,也可以通过ADL和社会参与的单独或链式中介作用影响空巢老人抑郁情况。因此,为减轻空巢老人抑郁的发生风险,应提高空巢老人互联网使用率,提升ADL水平,增加社会参与程度,从而缓解空巢老人的抑郁状况。

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王文超(2000—),男,硕士在读,研究方向:卫生政策与卫生管理

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马勇,E-mail:
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Modern Preventive Medicine, 2017, 44(21):3962-3965, 3986.(In Chinese), articleTitle=Study on the happiness of the disabled elderly and its influencing factors, refAbstract=null)], funds=[Fund(id=1322590148202705040, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, awardId=20CFX017, language=CN, fundingSource=国家社会科学基金项目(20CFX017), fundOrder=null, country=null), Fund(id=1322590148286591121, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, awardId=21YJC820050, language=CN, fundingSource=教育部人文社会科学基金项目(21YJC820050), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322590135150030929, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, xref=null, ext=[AuthorCompanyExt(id=1322590135154225234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, companyId=1322590135150030929, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shandong Second Medical University, Weifang, Shandong 252422, China), AuthorCompanyExt(id=1322590135166808147, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, companyId=1322590135150030929, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山东第二医科大学管理学院,山东 潍坊 252422)])], figs=[ArticleFig(id=1322590144343945345, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Figure 1, caption=Flow chart of screening, figureFileSmall=QC4D7aX3LHnfJWaTMlUfSA==, figureFileBig=ILP7udLxflVpt3eenLQMYg==, tableContent=null), ArticleFig(id=1322590144432025730, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=CN, label=图1, caption=筛选流程图, figureFileSmall=QC4D7aX3LHnfJWaTMlUfSA==, figureFileBig=ILP7udLxflVpt3eenLQMYg==, tableContent=null), ArticleFig(id=1322590144826290307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Figure 2, caption=Diagram of the chained mediation model, figureFileSmall=pXu7BfdwKVTwWgf9Hi7q2w==, figureFileBig=SjlMydqqCeJmaWknWUKZQA==, tableContent=null), ArticleFig(id=1322590144910176388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=CN, label=图2, caption=链式中介模型图

注:***表示P<0.001;**表示P<0.01;*表示P<0.05。

, figureFileSmall=pXu7BfdwKVTwWgf9Hi7q2w==, figureFileBig=SjlMydqqCeJmaWknWUKZQA==, tableContent=null), ArticleFig(id=1322590145161834629, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Table 1, caption=

Categorical variable assignment table

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
性别男性=1,女性=2
年龄(岁)60~64=1,65~69=2,70~74=3,≥75=4
婚姻状况有配偶=1,无配偶=2
是否慢性病共病是=1,否=2
是否吸烟是=1,否=2
是否饮酒是=1,否=2
是否有医疗保险是=1,否=2
是否有养老保险是=1,否=2
), ArticleFig(id=1322590145262497926, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=CN, label=表1, caption=

分类变量赋值表

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
性别男性=1,女性=2
年龄(岁)60~64=1,65~69=2,70~74=3,≥75=4
婚姻状况有配偶=1,无配偶=2
是否慢性病共病是=1,否=2
是否吸烟是=1,否=2
是否饮酒是=1,否=2
是否有医疗保险是=1,否=2
是否有养老保险是=1,否=2
), ArticleFig(id=1322590145585459335, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Table 2, caption=

Comparison of depression scores among empty nesters with different demographic characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数比例(%)抑郁得分()统计量t/F值P值
性别男2 02453.357.75±6.0313.037<0.001
女1 77046.6510.58±6.89
年龄(岁)60~641 16530.718.61±6.453.6050.013
65~691 18231.159.91±6.56
70~7478020.569.58±6.77
≥7566717.589.08±6.66
婚姻状况有配偶3 16783.478.74±6.42-6.521<0.001
无配偶62716.5310.76±7.22
是否慢性病共病是2 50065.8910.01±6.8013.037<0.001
否1 29434.117.27±6.76
是否吸烟是1 81347.798.11±6.23-8.691<0.001
否1 98152.219.95±6.80
是否饮酒是1 33535.197.69±6.03-9.948<0.001
否2 45964.819.82±6.77
是否有医疗保险是3 60394.979.04±6.60-1.4660.991
否1915.039.75±6.51
是否有养老保险是3 25081.789.02±6.57-1.1920.192
否54418.229.38±6.75
), ArticleFig(id=1322590145669345416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=CN, label=表2, caption=

不同人口学特征的空巢老人在抑郁得分上的差异

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数比例(%)抑郁得分()统计量t/F值P值
性别男2 02453.357.75±6.0313.037<0.001
女1 77046.6510.58±6.89
年龄(岁)60~641 16530.718.61±6.453.6050.013
65~691 18231.159.91±6.56
70~7478020.569.58±6.77
≥7566717.589.08±6.66
婚姻状况有配偶3 16783.478.74±6.42-6.521<0.001
无配偶62716.5310.76±7.22
是否慢性病共病是2 50065.8910.01±6.8013.037<0.001
否1 29434.117.27±6.76
是否吸烟是1 81347.798.11±6.23-8.691<0.001
否1 98152.219.95±6.80
是否饮酒是1 33535.197.69±6.03-9.948<0.001
否2 45964.819.82±6.77
是否有医疗保险是3 60394.979.04±6.60-1.4660.991
否1915.039.75±6.51
是否有养老保险是3 25081.789.02±6.57-1.1920.192
否54418.229.38±6.75
), ArticleFig(id=1322590145736454281, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Table 3, caption=

Correlation analysis of cognitive function in empty nesters with internet use, ADL, social participation, and depression(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量互联网使用ADL社会参与抑郁
互联网使用1———
ADL0.155***1——
社会参与0.213***0.089***1—
抑郁-0.201***-0.391***-0.089***1
), ArticleFig(id=1322590146000695434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=CN, label=表3, caption=

互联网使用、ADL、社会参与和抑郁的空巢老年人认知功能的相关分析结果(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量互联网使用ADL社会参与抑郁
互联网使用1———
ADL0.155***1——
社会参与0.213***0.089***1—
抑郁-0.201***-0.391***-0.089***1
), ArticleFig(id=1322590146063609995, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590130485964862, language=EN, label=Table 4, caption=

Analysis results of chain mediation model regression

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1:ADL模型2:社会参与模型3:抑郁程度
β t值β t值β t值
常量33.9470.38987.237***-0.3470.322-1.07826.3281.04025.327***
互联网使用0.2680.1526.328***0.9630.07313.244***-2.1250.240-8.848***
ADL0.0410.0085.285***-0.5380.025-21.409***
社会参与-0.1650.053-3.140**
性别-0.4500.182-2.472*0.3350.0873.855***2.0340.2817.250***
年龄-0.2970.061-4.893***0.0610.0292.104*-0.3410.094-3.635***
婚姻状况0.1540.1720.844-0.0880.0821.0751.5050.2655.683***
慢性病共病1.3140.13110.053***-0.1400.063-2.208*-1.9220.204-9.421***
吸烟-0.2490.1741.428-0.0680.082-0.820-0.1410.269-0.527
饮酒-0.5560.142-3.904***-0.2750.068-4.045***0.4050.2201.841
R2值0.0590.0640.220
F值34.163***32.462***118.597***
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链式中介模型回归分析结果

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变量模型1:ADL模型2:社会参与模型3:抑郁程度
β t值β t值β t值
常量33.9470.38987.237***-0.3470.322-1.07826.3281.04025.327***
互联网使用0.2680.1526.328***0.9630.07313.244***-2.1250.240-8.848***
ADL0.0410.0085.285***-0.5380.025-21.409***
社会参与-0.1650.053-3.140**
性别-0.4500.182-2.472*0.3350.0873.855***2.0340.2817.250***
年龄-0.2970.061-4.893***0.0610.0292.104*-0.3410.094-3.635***
婚姻状况0.1540.1720.844-0.0880.0821.0751.5050.2655.683***
慢性病共病1.3140.13110.053***-0.1400.063-2.208*-1.9220.204-9.421***
吸烟-0.2490.1741.428-0.0680.082-0.820-0.1410.269-0.527
饮酒-0.5560.142-3.904***-0.2750.068-4.045***0.4050.2201.841
R2值0.0590.0640.220
F值34.163***32.462***118.597***
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Chain mediation path analysis

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路径效应值(95%CI) 相对中介效应(%)
总效应-2.806(-3.292~-2.320)0.248100
直接效应-2.125(-2.595~-1.654)0.24075.72
总间接效应-0.681(-0.848~-0.524)0.08224.28
路径1-0.516(-0.641~-0.389)0.06418.39
路径2-0.159(-0.263~-0.062)0.0525.66
路径3-0.007(-0.011~-0.002)0.0020.23
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链式中介路径分析

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路径效应值(95%CI) 相对中介效应(%)
总效应-2.806(-3.292~-2.320)0.248100
直接效应-2.125(-2.595~-1.654)0.24075.72
总间接效应-0.681(-0.848~-0.524)0.08224.28
路径1-0.516(-0.641~-0.389)0.06418.39
路径2-0.159(-0.263~-0.062)0.0525.66
路径3-0.007(-0.011~-0.002)0.0020.23
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互联网使用对空巢老人抑郁的影响——日常生活活动能力和社会参与的链式中介作用
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王文超 , 冯晓晨 , 鲜国炜 , 宫云娜 , 张宝轩 , 葛汝旭 , 马勇
现代预防医学 | 基层卫生服务 2025,52(1): 86-91
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现代预防医学 |基层卫生服务 2025 , 52 (1) : 86 -91
互联网使用对空巢老人抑郁的影响——日常生活活动能力和社会参与的链式中介作用
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王文超, 冯晓晨, 鲜国炜, 宫云娜, 张宝轩, 葛汝旭, 马勇
作者信息
  • 山东第二医科大学管理学院,山东 潍坊 252422
通讯作者:
马勇,E-mail:
作者简介:

王文超(2000—),男,硕士在读,研究方向:卫生政策与卫生管理

The impact of internet use on depression among empty nesters: the chain mediating role of activities of daily living and social participation
Wen-chao WANG, Xiao-chen FENG, Guo-wei XIAN, Yun-na GONG, Bao-xuan ZHANG, Ru-xu GE, Yong MA
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shandong 252422, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202409006
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目的

探讨日常生活活动能力(activities of daily living,ADL)和社会参与在互联网使用和空巢老人抑郁间的中介作用,为降低空巢老人抑郁发生风险,提高生活质量提供参考。

方法

选取2020年中国健康与养老追踪调查中3 974例≥60岁的空巢老人作为研究对象,使用ADL量表、CESD-10量表分别测量空巢老人ADL和抑郁状况;运用Spearman相关分析法探究互联网使用、ADL、社会参与和空巢老人抑郁间的相关性,使用SPSS中Process4.1插件模型6分析ADL、社会参与在互联网使用和空巢老人抑郁间的中介作用。

结果

互联网使用对空巢老人抑郁的直接效应显著(β=-2.125,95%CI:-2.593~-1.654),ADL的单独中介效应显著(β=-0.516,95%CI:-0.641~-0.389),社会参与的单独中介效应显著(β=-0.159,95%CI:-0.263~-0.062),ADL和社会参与的链式中介效应显著(β=-0.007,95%CI:-0.011~-0.002)。

结论

互联网使用可以直接负向影响空巢老人抑郁情况,也可以通过ADL和社会参与的单独或链式中介作用影响空巢老人抑郁情况。因此,为减轻空巢老人抑郁的发生风险,应提高空巢老人互联网使用率,提升ADL水平,增加社会参与程度,从而缓解空巢老人的抑郁状况。

空巢老人  /  互联网  /  日常生活活动能力  /  社会参与  /  抑郁
Objective

To investigate the mediating role of Activities of Daily Living (ADL) and social participation in the relationship between internet use and depression among empty nesters, providing references for reducing the risk of depression and improving quality of life in this population.

Methods

A total of 3 974 empty nesters aged 60 and above from the 2020 China Health and Retirement Longitudinal Study were selected as the research subjects. The ADL scale and the CESD-10 scale were used to measure the ADL and depression status of the empty nesters, respectively. Spearman correlation analysis was conducted to explore the relationships among internet use, ADL, social participation, and depression among empty nesters. The mediating effects of ADL and social participation in the relationship between internet use and depression were analyzed using Model 6 of the Process 4.1 plugin in SPSS.

Results

Internet use had a significant direct effect on depression among empty nesters (β=-2.125, 95%CI: -2.593 to -1.654). The individual mediating effect of ADL was significant (β=-0.516, 95%CI: -0.641 to -0.389), as was the individual mediating effect of social participation (β=-0.159, 95%CI: -0.263 to -0.062). The chain mediating effect of ADL and social participation was also significant (β=-0.007, 95%CI: -0.011 to -0.002).

Conclusion

Internet use can directly negatively impact depression among empty nesters, and it can also influence depression through the individual or chain mediating effects of ADL and social participation.Therefore, to reduce the risk of depression among empty nesters, it is essential to increase their internet usage, enhance their ADL levels, and promote their social participation, thereby alleviating their depressive symptoms.

Empty nesters  /  Internet  /  Activities of daily living  /  Social participation  /  Depression
王文超, 冯晓晨, 鲜国炜, 宫云娜, 张宝轩, 葛汝旭, 马勇. 互联网使用对空巢老人抑郁的影响——日常生活活动能力和社会参与的链式中介作用. 现代预防医学, 2025 , 52 (1) : 86 -91 . DOI: 10.20043/j.cnki.MPM.202409006
Wen-chao WANG, Xiao-chen FENG, Guo-wei XIAN, Yun-na GONG, Bao-xuan ZHANG, Ru-xu GE, Yong MA. The impact of internet use on depression among empty nesters: the chain mediating role of activities of daily living and social participation[J]. Modern Preventive Medicine, 2025 , 52 (1) : 86 -91 . DOI: 10.20043/j.cnki.MPM.202409006
空巢老人是指年龄≥60岁独自生活或仅与配偶共同生活的老年人[1]。随着我国老龄化程度加深及家庭结构缩小,我国空巢老人数量逐年上升,预计至2030年空巢老人将高达2亿人[2]。相较于一般老年人,空巢老人由于缺少子女陪伴与照顾,心理健康状况更差[3]。抑郁作为老年群体中典型的心理问题,不仅会降低老年人的生活质量,还可能增加自杀风险,成为社会关注的重要现实议题[4]。此外,我国老年人互联网使用率逐年上升,第51次《中国互联网络发展状况统计报告》显示,截至2022年12月我国60岁及以上的老年网民占比从2021年的11.5%提升到了14.3%[5]。以往研究表明,互联网的跨时空通信特征满足了空巢老人与其子女进行交往的需求,增加归属感,能够显著降低抑郁的发生风险[6]。
日常生活活动能力(activities of daily living,ADL)是指个体在日常生活中独立完成基本任务和活动的能力。相关研究认为,老年人ADL受损会导致社会参与度大幅降低,并且互联网使用可通过ADL的中介作用对老年人抑郁产生影响[7-8]。社会参与作为一项重要的健康促进措施,能够降低空巢老人抑郁的发生风险[9]。以往研究表明,老年人能够通过互联网获取各种信息和资源,包括健康知识、社会活动、志愿者机会等,进而提高社会参与度[10]。基于此,本研究选取社会参与和ADL作为本研究中介变量。
综上,根据国内外学者们对互联网使用、社会参与、ADL和抑郁的研究发现,大多数集中在两者或三者之间,尚缺乏四个变量间作用机制的研究;且研究大多集中在老年人,对于空巢老年群体的研究较少。基于此,本研究采用2020年中国健康与养老追踪调查数据(China Health and Retirement Longitudinal Study,CHARLS)探讨ADL和社会参与在网络使用与空巢老人抑郁间的中介作用,为降低空巢老人抑郁发生风险,提高生活质量提供参考。
本研究数据来自最新公布的2020年CHARLS。本研究根据研究目的,选取空巢老人作为研究对象,纳入标准:(1)年龄≥60岁;(2)在过去一年中,与子女共同居住时间<180 d;(3)关键变量中未有缺失值。经筛选后,最终纳入3 794名研究对象,具体筛选过程见图1。
互联网使用情况,根据问卷中:“过去一个月,您是否上网?”,选择“是”赋值为1,选择“否”赋值为0 。
本研究采用Andresen等[11]修订的简版流调中心抑郁水平评定量表(center for epidemiologic studies depression scale,CESD-10)评价抑郁。每个条目依据根据“很少或根本没有(<1 d)”“不太多(1~2 d)”“有时或者说有一半的时间(3~4 d)”“大多数时间(5~7 d)”依次计0~3分,其中“对未来充满希望”“我很愉快”为反向条目,采用反向计分。总分范围0~30分,得分越高表明抑郁程度越高。本量表的Chronbach α系数为0.792。
本研究采用Katz等人[12]设计的ADL评估量表,该量表构成上分为基础性日常生活自理能力量表(BADL)与工具性日常生活活动能力量表(IADL)。每个条目依据“无法完成”“有困难需要帮助”“有困难仍可完成”“没有困难”分为4级,依次计0~3分。总分范围0~36分,得分越高,说明ADL越好。本量表的Chronbach α系数为0.864。
社会参与通过询问近一个月是否参加以下活动:串门、跟朋友交往;打麻将、下棋、打牌、去社区活动室;跳舞、健身、练气功等;参加社团组织活动、上学或者参加培训课程;向与您不住在一起的亲人、朋友或者邻居提供帮助;志愿者活动或者慈善活动或者照顾与您不住在一起的病人或残疾人;其他。每项活动依据参与频率“不参加”“不经常”“差不多每周”“差不多每天”依次计0~3分。总分范围0~24分,得分越高表明社会参与越好。
参考以往文献[13-14],本文纳入的控制变量有性别、年龄、婚姻状态、是否吸烟、是否饮酒、慢性病共病、医疗保险、养老保险,各变量赋值情况见表1。
采用SPSS 26.0软件对数据进行统计分析,对计数资料和计量资料进行描述统计;采用t检验或方差分析对调查对象的基本特征进行比较。采用Spearman秩相关分析探究空巢老人互联网使用、ADL、社会参与和抑郁的关系。采用process宏程序,利用偏差校正非参数百分位bootstrap法分析ADL和社会参与在空巢老人互联网使用及抑郁间的链式中介效应。检验水准α=0.05。
本研究共纳入3 794名≥60岁的空巢老人。单因素分析结果显示,年龄、性别、婚姻状况、是否患有慢性病共病、吸烟、饮酒与空巢老人的抑郁程度存在显著差异(P<0.05),是否有医疗保险和是否有养老保险与空巢老人抑郁程度之间没有统计学意义(P>0.05)。见表2。
采用Harman单因子检验法,将使用互联网、ADL、社会参与和空巢老人抑郁的所有条目进行未旋转的主成分因素分析。结果表明,特征值>1的因子有7个,第一个因子解释的变异量为20.62%,小于临界值40%,说明该研究中没有明显的共同方法偏差。
Spearman相关分析结果显示,互联网使用与社会参与、ADL呈正相关,与抑郁程度呈负相关。ADL和社会参与呈正相关,与抑郁程度呈负相关。社会参与和抑郁程度呈负相关。见表3。
本研究基于描述性和相关性分析结果,将年龄、性别、婚姻状况、是否吸烟、是否饮酒、慢性病共病作为控制变量,以互联网使用为自变量,以空巢老人抑郁程度作为因变量,以ADL、社会参与作为中介变量构建链式中介模型。结果显示,互联网使用不仅能正向预测ADL和社会参与,还能负向预测空巢老人抑郁程度;ADL不仅能正向预测社会参与,而且能负向预测空巢老人抑郁程度;此外,社会参与能负向预测空巢老人抑郁程度。见表4、图2。
链式中介路径分析结果显示,互联网使用对空巢老人抑郁程度的直接效应有统计学意义(β=-2.125,95%CI:-2.595~-1.654),ADL在互联网使用与空巢老人抑郁程度的中介效应有统计学意义(β=-0.516,95%CI:-0.641~-0.389),社会参与在互联网使用与空巢老人抑郁程度的中介效应有统计学意义(β=-0.159,95%CI:-0.263~-0.062)。ADL和社会参与在互联网使用与空巢老人抑郁程度的链式中介效应有统计学意义(β=-0.007,95%CI:-0.011~-0.002)。见表5。
本研究结果显示,互联网使用能够负向影响空巢老人的抑郁程度,与李竞博等[15]研究结果一致。空巢老人作为特殊的群体,他们在老年时期发生了角色和居住方式的改变,在生活中缺乏子女的陪伴和支持,更容易产生抑郁、孤独[1]。以科技为载体的互联网技术能够实现空巢老人生活多样化,使他们更好地融入社会,以实现他们的自信心。互联网能够跨越空间,促进空巢老人与子女之间的交流,空巢老人可以获得更多的代际支持[16]。因此,互联网使用是预防和改善空巢老年人抑郁情绪,破除不良心理状态的关键因素。
研究结果显示,互联网使用能够通过ADL影响空巢老人抑郁状况。具体来看,互联网使用能够正向影响空巢老人ADL,可能是因为空巢老人可以通过互联网获取更多的健康资讯,增强自我健康管理意识、预防疾病,促进健康行为的形成,有助于降低ADL衰退的风险[17]。此外,ADL能够负向影响空巢老人抑郁状况,与以往研究结果[18]一致。一方面,可能是因为ADL受损会导致空巢老人与外界的沟通交流减少,增加了孤独感和抑郁情绪[19]。另一方面,由于子女不在身边,ADL下降可能使空巢老人很难实现自我满足,会产生孤独感和挫败感,进而影响到空巢老人的抑郁情绪[20]。
本研究显示,互联网使用能够通过社会参与影响空巢老人抑郁状况。具体来看,互联网使用能够正向影响空巢老人社会参与程度。互联网使用使空巢老人社会交往不再受时间和空间的限制[10]。空巢老人可以通过互联网与亲朋好友保持高频次、高质量的沟通,能够有效缓解因“空巢”带来的孤独感与社交隔离,增强情感支持网络,促进社会参与程度[21]。社会参与能够负向影响空巢老人抑郁状况。社会参与是应对人口老龄化、实现健康中国重要措施,被认为是提升老年人身心健康的关键要素[22]。对于空巢老人而言,日常生活中缺乏子女的陪伴,精神相对孤独,社会交往的代偿价值会更加被放大[23]。有研究表明,更多的社会参与有助于老年人形成良好的社会网络和社会关系,进而提升了身体活动和思维锻炼的可能性,降低抑郁的发生风险[10]。
本研究显示,互联网使用先后通过ADL和社会参与这一链式中介路径影响空巢老人抑郁状况。具体来看,ADL能够正向影响空巢老人社会参与程度,即ADL受损的空巢老年人,社会参与度也会一定程度的降低,与王晓娟等[24]研究结果一致。这可能是因为ADL状况较差的空巢老年人参加社区活动、与朋友交流等活动的频率较低,导致空巢老年人产生孤独感与抑郁情绪。同时,耿硕基等[7]研究发现,较低的社会参与度与较差的ADL有关,进一步印证了本研究空巢老人“网络使用-ADL-社会参与-抑郁”的链式中介作用结果。
综上,本研究以空巢老人为研究对象,创新性地探讨了互联网使用、ADL、社会参与和空巢老人抑郁的关系及作用路径。空巢老人是社会中的弱势群体之一,关注空巢老人抑郁状况是政府的责任和家庭的义务。本研究结果提示我们,要重点关注空巢老人ADL和社会参与状况,阻断互联网使用通过ADL和社会参与影响抑郁状况的路径。积极响应国家“互联网+养老”的号召,鼓励空巢老人利用互联网进行社交、娱乐等,提高互联网在空巢老年群体中的利用率。但本研究仍有一些不足:一是,本研究为横断面研究,因果推断会存在一定局限性;二是,受数据限制,可能无法完全控制混杂因素的干扰。CHARLS调查本身存在一定的局限性,问卷中没有详细揭示具体的互联网使用行为。在后续研究中,将从不同类型的互联网使用行为入手,深入探究各个行为对空巢老年人抑郁的影响。
  • 国家社会科学基金项目(20CFX017)
  • 教育部人文社会科学基金项目(21YJC820050)
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doi: 10.20043/j.cnki.MPM.202409006
  • 接收时间:2024-09-01
  • 首发时间:2026-10-29
  • 出版时间:2025-01-10
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  • 收稿日期:2024-09-01
基金
国家社会科学基金项目(20CFX017)
教育部人文社会科学基金项目(21YJC820050)
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    山东第二医科大学管理学院,山东 潍坊 252422

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