Article(id=1322608066252624461, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202504476, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745596800000, receivedDateStr=2025-04-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263935863, onlineDateStr=2026-10-29, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263935863, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263935863, creator=13701087609, updateTime=1793263935863, updator=13701087609, issue=Issue{id=1322608013010120712, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263923169, creator='13701087609', updateTime=1793264266929, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609454932149086, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609454932149087, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3983, endPage=3988, ext={EN=ArticleExt(id=1322608066453951055, articleId=1322608066252624461, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The chain mediating role of activities of daily living and physical pain between chronic diseases and depressive symptoms in the elderly, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective To explore the chain mediating role of activities of daily living and physical pain between chronic diseases and depressive symptoms in the elderly, and to provide new perspectives and intervention strategies for the prevention and alleviation of depressive symptoms in the elderly.
Methods Based on the data of the 2020 China Health and Retirement Longitudinal Survey (CHARLS), the chain mediation model was constructed with the help of the PROCESS 4.1 program, and 5 000 repeated samplings were conducted using the Bootstrap method to verify the mediation variables.
Results A total of 7 505 elderly people aged 60 and above were included. Chronic diseases in the elderly were positively correlated with depressive symptoms (r=0.284, P<0.01), activities of daily living (r=0.265, P<0.01), and physical pain (r=0.379, P<0.01). The mediation test showed that chronic diseases in the elderly had a direct effect on depressive symptoms (β=0.451, 95% CI: 0.384-0.520), and activities of daily living (β=0.302, 95% CI: 0.280-0.324) and pain (β=0.522, 95% CI: 0.486-0.558) had significant individual mediating effects between the two. The chain mediating effect of activities of daily living and physical pain between the number of chronic diseases and depressive symptoms was significant (β=0.036, 95% CI: 0.029-0.044), and the total mediating effect and chain mediating effect accounted for 48.46% and 4.10% of the total effect, respectively.
Conclusion Chronic diseases are significantly associated with depressive symptoms in the elderly. Activities of daily living and physical pain have a chain mediating effect between chronic diseases and depressive symptoms in the elderly. Emphasis should be placed on the synergistic effect of pain management and functional rehabilitation in the elderly. Early prevention should be carried out to reduce depressive symptoms in patients with chronic diseases and improve the quality of life of the elderly.
, authors=Qing YU
1, Jin-lei ZHANG
1, Wen-yu SU
1, Hui-yu JIA
1, Shan JIANG
1, Wen-jing CHANG
1, Gui-feng MA
1, Jian-ming LIU
2, authorsList=Qing YU, Jin-lei ZHANG, Wen-yu SU, Hui-yu JIA, Shan JIANG, Wen-jing CHANG, Gui-feng MA, Jian-ming LIU, authorCompany=null, correspAuthors=Jian-ming LIU, 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=1322608067074708053, articleId=1322608066252624461, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=日常活动能力与躯体疼痛在老年人慢性病和抑郁症状之间的链式中介作用研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的 探讨日常活动能力和躯体疼痛在老年人慢性病与抑郁症状之间的链式中介作用，为预防和缓解老年人抑郁症状提供新的视角和干预策略。
方法 基于2020年中国健康与养老追踪调查(CHARLS)数据，借助PROCESS 4.1程序进行链式中介模型构建，利用bootstrap法进行5 000次重复抽样以验证中介变量。
结果 共纳入60岁及以上老年人7 505例，老年人慢性病与抑郁症状(r=0.284，P<0.01)、日常活动能力(r=0.265，P<0.01)和躯体疼痛(r=0.379，P<0.01)之间呈正相关。中介检验显示，老年人慢性病对抑郁症状有直接效应(β=0.451，95% CI：0.384～0.520)，日常活动能力(β= 0.302，95% CI：0.280～0.324)和疼痛(β=0.522，95% CI：0.486～0.558)在两者之间单独中介效应显著；日常活动能力和躯体疼痛在慢性病和抑郁症状之间链式中介效应显著(β=0.036，95% CI：0.029～0.044)，总中介效应和链式中介效应在总效应中分别占48.46%和4.10%。
结论 慢性病与老年人抑郁症状存在显著关联，日常活动能力和躯体疼痛在老年人慢性病与抑郁症状间存在链式中介效应。应重视老年人疼痛管理与功能康复的协同作用，及早预防以减少慢性病患者的抑郁症状，提高老年人生命质量。
, authors=于晴
1, 张敬磊
1, 苏文钰
1, 贾蕙毓
1, 姜姍
1, 常雯静
1, 马桂峰
1, 刘建明
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于晴（2000—），女，硕士在读，研究方向：慢性病，公共卫生与社区管理
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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=ZE3X29GYTj68Oqra+G85VQ==, magXml=CE0ygEROw1mDFCe874X9YQ==, pdfUrl=null, pdf=8MPaDeOzEFYeF64mpBk44w==, pdfFileSize=823016, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=evqYk/y6WuVk93BgSHeRug==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=C80b1mjdAXx5KlyLYd5PoA==, mapNumber=null, fund=null)}, authors=[Author(id=1322608067410252380, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, 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=1322608067494138462, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, authorId=1322608067410252380, language=EN, stringName=Qing YU, firstName=Qing, middleName=null, lastName=YU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=
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et al. Mediating effects of somatic pain level and sleep duration on the number of chronic illnesses and depressive symptoms in older adults [J].
Journal of Nanjing Medical University（Social Sciences）,
2024,
24 (5): 470-476. (In Chinese), articleTitle=Mediating effects of somatic pain level and sleep duration on the number of chronic illnesses and depressive symptoms in older adults, refAbstract=null)], funds=[Fund(id=1322608070811832983, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, awardId=SDYJSJGC2023068, language=CN, fundingSource=山东省研究生教育教学改革研究项目(SDYJSJGC2023068), fundOrder=null, country=null), Fund(id=1322608070933467800, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, awardId=M2023344, language=CN, fundingSource=山东省本科高校教学改革研究项目(M2023344), fundOrder=null, country=null), Fund(id=1322608071025742489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, awardId=2023YB077, language=CN, fundingSource=山东省十四五教育科学规划课题(2023YB077), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322608067267646038, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, xref=1., ext=[AuthorCompanyExt(id=1322608067271840343, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, companyId=1322608067267646038, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1322608067280228952, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, companyId=1322608067267646038, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=
1.山东第二医科大学公共卫生学院，山东 潍坊 261053)]), AuthorCompany(id=1322608067343143513, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, xref=2., ext=[AuthorCompanyExt(id=1322608067351532122, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, companyId=1322608067343143513, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=
2.山东第二医科大学基础医学院，山东 潍坊 261053)])], figs=[ArticleFig(id=1322608069863920269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=EN, label=Figure 1, caption=
Model diagram of chain mediation effect, figureFileSmall=4dISdLt9XSezTuGHMDdS5A==, figureFileBig=evqYk/y6WuVk93BgSHeRug==, tableContent=null), ArticleFig(id=1322608069926834830, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=CN, label=图1, caption=
链式中介效应模型图注：***表示P<0.001。
, figureFileSmall=4dISdLt9XSezTuGHMDdS5A==, figureFileBig=evqYk/y6WuVk93BgSHeRug==, tableContent=null), ArticleFig(id=1322608070119772815, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=EN, label=Table 1, caption=
Comparison of depressive symptoms among elderly people with different characteristics［n=7 505，n（%）］
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | 人数 | 抑郁症状 | χ2/t值 | P值 |
|---|
| 有抑郁症状 | 无抑郁症状 |
|---|
| 性别 | | | | 222.798 | <0.001 |
| 男 | 3 695(49.23) | 1 228(33.23) | 2 467(66.77) | | |
| 女 | 3 810(50.77) | 1 914(50.23) | 1 896(49.77) | | |
| 年龄（岁） | | | | 9.235 | 0.010 |
| 60～69 | 5 004(66.68) | 2 038(40.72) | 2 966(59.28) | | |
| 70～79 | 2 123(28.29) | 947(44.61) | 1 176(55.39) | | |
| ≥80 | 378(5.03) | 157(41.53) | 221(58.47) | | |
| 居住地 | | | | 140.366 | <0.001 |
| 城镇中心 | 1 703(22.69) | 521(30.60) | 1 182(69.40) | | |
| 乡镇结合 | 802(10.69) | 297(37.03) | 505(63.97) | | |
| 农村 | 5 000(66.62) | 2 324(46.48) | 2 676(53.52) | | |
| 受教育水平 | | | | 245.775 | <0.001 |
| 文盲 | 2 029(27.04) | 964(52.40) | 1 065(47.60) | | |
| 小学及以下 | 3 450(45.97) | 1 320(43.07) | 2 130(56.93) | | |
| 初中 | 1 283(17.10) | 358(27.90) | 925(72.10) | | |
| 高中及以上 | 743(9.89) | 142(19.11) | 601(76.2) | | |
| 婚姻状况 | | | | 80.859 | <0.001 |
| 已婚 | 5 978(79.65) | 2 348(39.28) | 3 630(60.72) | | |
| 未婚/离异/丧偶 | 1 527(20.34) | 794(52.00) | 733(48.00) | | |
| 是否饮酒 | | | | 101.319 | <0.001 |
| 是 | 2 578(34.35) | 875(33.94) | 1 703(66.06) | | |
| 否 | 4 927(65.65) | 2 267(46.01) | 2 660(53.99) | | |
| 是否吸烟 | | | | 96.727 | <0.001 |
| 是 | 3 339(44.49) | 1 189(35.61) | 2 150(64.39) | | |
| 否 | 4 166(55.51) | 1 953(46.88) | 2 213(53.12) | | |
| 睡眠时间(h) | | | | 380.876 | <0.001 |
| <6 | 3 049(40.63) | 1 686(55.30) | 1 363(44.70) | | |
| 6～8 | 2 833(37.75) | 918(32.40) | 1 915(67.60) | | |
| >8 | 1 623(21.62) | 538(33.15) | 1 085(66.85) | | |
| 是否社交 | | | | 11.153 | 0.001 |
| 是 | 3 495(46.57) | 1 392(39.83) | 2 103(60.17) | | |
| 否 | 4 010(53.43) | 1 750(43.52) | 2 260(56.48) | | |
| 自评健康 | | | | 805.223 | <0.001 |
| 好 | 1 604(21.37) | 317(19.77) | 1 287(80.23) | | |
| 一般 | 3 818(50.87) | 1 465(38.37) | 2 348(61.63) | | |
| 不好 | 2 086(27.76) | 1 359(65.15) | 727(34.85) | | |
| 疼痛 | | | | 488.677 | <0.001 |
| 非多重疼痛 | 4 120(54.90) | 1 068(25.92) | 3 052(74.08) | | |
| 多重疼痛 | 3 385(45.10) | 1 716(50.69) | 1 669(49.31) | | |
), ArticleFig(id=1322608070207853200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=CN, label=表1, caption=
不同特征的老年人群抑郁症状比较［n=7 505，n（%）］
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | 人数 | 抑郁症状 | χ2/t值 | P值 |
|---|
| 有抑郁症状 | 无抑郁症状 |
|---|
| 性别 | | | | 222.798 | <0.001 |
| 男 | 3 695(49.23) | 1 228(33.23) | 2 467(66.77) | | |
| 女 | 3 810(50.77) | 1 914(50.23) | 1 896(49.77) | | |
| 年龄（岁） | | | | 9.235 | 0.010 |
| 60～69 | 5 004(66.68) | 2 038(40.72) | 2 966(59.28) | | |
| 70～79 | 2 123(28.29) | 947(44.61) | 1 176(55.39) | | |
| ≥80 | 378(5.03) | 157(41.53) | 221(58.47) | | |
| 居住地 | | | | 140.366 | <0.001 |
| 城镇中心 | 1 703(22.69) | 521(30.60) | 1 182(69.40) | | |
| 乡镇结合 | 802(10.69) | 297(37.03) | 505(63.97) | | |
| 农村 | 5 000(66.62) | 2 324(46.48) | 2 676(53.52) | | |
| 受教育水平 | | | | 245.775 | <0.001 |
| 文盲 | 2 029(27.04) | 964(52.40) | 1 065(47.60) | | |
| 小学及以下 | 3 450(45.97) | 1 320(43.07) | 2 130(56.93) | | |
| 初中 | 1 283(17.10) | 358(27.90) | 925(72.10) | | |
| 高中及以上 | 743(9.89) | 142(19.11) | 601(76.2) | | |
| 婚姻状况 | | | | 80.859 | <0.001 |
| 已婚 | 5 978(79.65) | 2 348(39.28) | 3 630(60.72) | | |
| 未婚/离异/丧偶 | 1 527(20.34) | 794(52.00) | 733(48.00) | | |
| 是否饮酒 | | | | 101.319 | <0.001 |
| 是 | 2 578(34.35) | 875(33.94) | 1 703(66.06) | | |
| 否 | 4 927(65.65) | 2 267(46.01) | 2 660(53.99) | | |
| 是否吸烟 | | | | 96.727 | <0.001 |
| 是 | 3 339(44.49) | 1 189(35.61) | 2 150(64.39) | | |
| 否 | 4 166(55.51) | 1 953(46.88) | 2 213(53.12) | | |
| 睡眠时间(h) | | | | 380.876 | <0.001 |
| <6 | 3 049(40.63) | 1 686(55.30) | 1 363(44.70) | | |
| 6～8 | 2 833(37.75) | 918(32.40) | 1 915(67.60) | | |
| >8 | 1 623(21.62) | 538(33.15) | 1 085(66.85) | | |
| 是否社交 | | | | 11.153 | 0.001 |
| 是 | 3 495(46.57) | 1 392(39.83) | 2 103(60.17) | | |
| 否 | 4 010(53.43) | 1 750(43.52) | 2 260(56.48) | | |
| 自评健康 | | | | 805.223 | <0.001 |
| 好 | 1 604(21.37) | 317(19.77) | 1 287(80.23) | | |
| 一般 | 3 818(50.87) | 1 465(38.37) | 2 348(61.63) | | |
| 不好 | 2 086(27.76) | 1 359(65.15) | 727(34.85) | | |
| 疼痛 | | | | 488.677 | <0.001 |
| 非多重疼痛 | 4 120(54.90) | 1 068(25.92) | 3 052(74.08) | | |
| 多重疼痛 | 3 385(45.10) | 1 716(50.69) | 1 669(49.31) | | |
), ArticleFig(id=1322608070287544977, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=EN, label=Table 2, caption=
Correlation analysis among core variables
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | 慢性病数量 | 抑郁症状 | ADL | 躯体疼痛 |
|---|
| 慢性病数量 | 1.00 | | | |
| 抑郁症状 | 0.23** | 1.00 | | |
| ADL | 0.27** | 0.27** | 1.00 | |
| 躯体疼痛 | 0.38** | 0.29** | 0.30** | 1.00 |
), ArticleFig(id=1322608070363042450, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=CN, label=表2, caption=
核心变量间的相关性分析
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | 慢性病数量 | 抑郁症状 | ADL | 躯体疼痛 |
|---|
| 慢性病数量 | 1.00 | | | |
| 抑郁症状 | 0.23** | 1.00 | | |
| ADL | 0.27** | 0.27** | 1.00 | |
| 躯体疼痛 | 0.38** | 0.29** | 0.30** | 1.00 |
), ArticleFig(id=1322608070442734227, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=EN, label=Table 3, caption=
Regression analysis among core variables
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | ADL(M1) | 疼痛(M2) | 抑郁症状(Y) |
|---|
| β | t值 | | β | t值 | | β | t值 |
|---|
| 慢性病数量 | a1 | 0.302*** | 27.508 | a2 | 0.522*** | 28.427 | c’ | 0.451*** | 13.057 |
| ADL | | | | d | 0.421*** | 22.871 | b1 | 0.796*** | 23.371 |
| 躯体疼痛 | | | | | | | b2 | 0.286*** | 13.834 |
| R值 | | 0.371*** | | | 0.495*** | | | 0.512*** | |
| R2值 | | 0.138 | | | 0.245 | | | 0.262 | |
| F值 | | 133.047 | | | 243.268 | | | 241.709 | |
), ArticleFig(id=1322608070530814612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=CN, label=表3, caption=
核心变量间的回归分析
, figureFileSmall=null, figureFileBig=null, tableContent=
| 变量 | ADL(M1) | 疼痛(M2) | 抑郁症状(Y) |
|---|
| β | t值 | | β | t值 | | β | t值 |
|---|
| 慢性病数量 | a1 | 0.302*** | 27.508 | a2 | 0.522*** | 28.427 | c’ | 0.451*** | 13.057 |
| ADL | | | | d | 0.421*** | 22.871 | b1 | 0.796*** | 23.371 |
| 躯体疼痛 | | | | | | | b2 | 0.286*** | 13.834 |
| R值 | | 0.371*** | | | 0.495*** | | | 0.512*** | |
| R2值 | | 0.138 | | | 0.245 | | | 0.262 | |
| F值 | | 133.047 | | | 243.268 | | | 241.709 | |
), ArticleFig(id=1322608070602117781, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=EN, label=Table 4, caption=
Chain mediation effect analysis
, figureFileSmall=null, figureFileBig=null, tableContent=
| 效应分类 | 效应值(95% CI) | Boot  | 效应占比(%) |
|---|
| 总效应(c) | 0.877(0.812～0.942) | 0.033 | 100.00 |
| 直接效应(c’) | 0.451(0.384～0.520) | 0.035 | 51.54 |
| 总中介效应 | 0.425(0.387～0.466) | 0.020 | 48.46 |
| 路径1 | 0.240(0.211～0.271) | 0.015 | 27.37 |
| 路径2 | 0.149(0.123～0.177) | 0.013 | 16.99 |
| 路径3 | 0.036(0.029～0.044) | 0.004 | 4.10 |
), ArticleFig(id=1322608070677615254, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608066252624461, language=CN, label=表4, caption=
链式中介效应分析
, figureFileSmall=null, figureFileBig=null, tableContent=
| 效应分类 | 效应值(95% CI) | Boot | 效应占比(%) |
|---|
| 总效应(c) | 0.877(0.812～0.942) | 0.033 | 100.00 |
| 直接效应(c’) | 0.451(0.384～0.520) | 0.035 | 51.54 |
| 总中介效应 | 0.425(0.387～0.466) | 0.020 | 48.46 |
| 路径1 | 0.240(0.211～0.271) | 0.015 | 27.37 |
| 路径2 | 0.149(0.123～0.177) | 0.013 | 16.99 |
| 路径3 | 0.036(0.029～0.044) | 0.004 | 4.10 |
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