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Article(id=1323941360159555596, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506308, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750262400000, receivedDateStr=2025-06-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793581817902, onlineDateStr=2026-11-02, pubDate=1765296000000, pubDateStr=2025-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793581817902, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793581817902, creator=13701087609, updateTime=1793581817902, updator=13701087609, issue=Issue{id=1323941237702668764, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='23', pageStart='4225', pageEnd='4416', issueExtLink='null', onlineDate='null', pubDate='1765296000000', pubDateStr='2025-12-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793581788707, creator='13701087609', updateTime=1793581887795, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1323941653374959780, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1323941653374959781, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4377, endPage=4382, ext={EN=ArticleExt(id=1323941360415408141, articleId=1323941360159555596, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of instrumental activities of daily living on self-rated health in older adults: the chain mediating effects of sleep duration and depressive status, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating roles of sleep duration and depressive symptoms in the relationship between instrumental activities of daily living (IADL) and self-rated health (SRH) among older adults.

Methods

A total of 8 363 older adults (≥60 years) from the 2020 China Health and Retirement Longitudinal Study (CHARLS) were included. Spearman’s rank correlation analysis was employed to assess correlations among IADL, sleep duration, depressive symptoms, and SRH. Bootstrap analysis was used to examine the mediating effects of sleep duration and depressive symptoms on the association between IADL and SRH.

Results

IADL exerted a significant direct effect on SRH (β=-0.074, 95% CI: -0.081~-0.066). Significant mediating effects were observed for sleep duration alone (β=-0.002, 95% CI: -0.003~-0.001), depressive symptoms alone (β=-0.029, 95% CI: -0.032~-0.001), and the chained pathway through sleep duration and depressive symptoms (β=-0.002, 95% CI: -0.003~-0.001).

Conclusion

IADL limitations may directly and negatively impact SRH in older adults, and may also indirectly affect SRH through the independent or sequential mediating effects of sleep duration and depressive symptoms.Interventions aimed at enhancing IADL capacity, optimizing sleep duration, and alleviating depressive symptoms could improve SRH and promote physical and mental well-being among older adults.

, authors=Qing-wen ZHANG1, Wen-jun CHEN1, Xiao QIN1, Jie GAO2, authorsList=Qing-wen ZHANG, Wen-jun CHEN, Xiao QIN, Jie GAO, authorCompany=null, correspAuthors=Jie GAO, 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=1323941363573719066, articleId=1323941360159555596, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=老年人工具性日常生活能力对自评健康的影响——睡眠时长和抑郁状况的链式中介效应, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨睡眠时长和抑郁状况在老年人工具性日常生活能力（instrumental activities of daily living，IADL）与自评健康间的中介作用。

方法

选取 2020 年中国健康与养老追踪调查中 8 363 例≥60 岁的老年人作为研究对象，采用Spearman秩相关分析法，评估IADL、睡眠时长、抑郁症状与自评健康四变量间的相关性，采用 bootstrap 法检验睡眠时长与抑郁状况在老年人IADL和自评健康的中介效应。

结果

IADL对老年人自评健康的直接效应显著（β=-0.074，95% CI:-0.081 ~ -0.066)，睡眠时长和抑郁状况在IADL对老年人自评健康的单独中介效应显著（β=-0.002，95% CI:-0.003 ~ -0.001；β=-0.029，95% CI:-0.032 ~ -0.001)，睡眠时长和抑郁状况在IADL对老年人自评健康的链式中介效应显著（β=-0.002，95% CI:-0.003 ~ -0.001)。

结论

IADL受限可以直接负向影响老年人自评健康情况，也可以通过睡眠时长和抑郁状况在IADL对老年人自评健康单独或链式中介作用影响老年人自评健康水平。因此，可以通过提升老年人IADL水平、改善睡眠状况、减少抑郁症状来改善老年人自评健康水平，促进老年人身心健康发展。

, authors=张庆雯1, 陈文君1, 秦潇1, 高杰2, authorsList=张庆雯, 陈文君, 秦潇, 高杰, authorCompany=null, correspAuthors=高杰, authorNote=

张庆雯（2000—），女，硕士在读，研究方向：儿少卫生与妇幼保健学

, correspAuthorsNote=
高杰，E-mail：
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张庆雯（2000—），女，硕士在读，研究方向：儿少卫生与妇幼保健学

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CNS &Neurological Disorders Drug Targets, 2024, 23 (9): 1085-1100., articleTitle=Circadian rhythms and sleep disorders associated to major depressive disorder:pathophysiology and therapeutic opportunities, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1323941363858931739, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, xref=1., ext=[AuthorCompanyExt(id=1323941363867320348, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, companyId=1323941363858931739, 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=1323941363875708957, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, companyId=1323941363858931739, 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=1323941363988955166, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, xref=2., ext=[AuthorCompanyExt(id=1323941364001538079, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, companyId=1323941363988955166, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心，山东　济南　250014)])], figs=[ArticleFig(id=1323941368833376318, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Figure 1, caption=Flowchart of respondent inclusion, figureFileSmall=ia63GnxKnKeyu9CzDmuUkg==, figureFileBig=9V0OgSON03fH5vZ8bIYIRg==, tableContent=null), ArticleFig(id=1323941368942428223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=CN, label=图1, caption=受访者纳入流程图, figureFileSmall=ia63GnxKnKeyu9CzDmuUkg==, figureFileBig=9V0OgSON03fH5vZ8bIYIRg==, tableContent=null), ArticleFig(id=1323941369303138368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Figure 2, caption=Diagram of the chained mediation mode, figureFileSmall=ABfzzwD8xr7WAv2+UJ8AoA==, figureFileBig=Wdz/Yy5M17Ul/JpTg77haw==, tableContent=null), ArticleFig(id=1323941369399607361, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, 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=ABfzzwD8xr7WAv2+UJ8AoA==, figureFileBig=Wdz/Yy5M17Ul/JpTg77haw==, tableContent=null), ArticleFig(id=1323941369462521922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Table 1, caption=

Self-rated health among older adults with diverse characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数自评健康(n=1 832)自评不健康(n=6 531)χ2/t值P值
性别12.322<0.001
男4 1989863 212
女4 1658463 319
年龄（岁）8.3490.015
60 ~ 695 5261 2434 283
70 ~ 792 5005031 997
≥8033786251
受教育程度37.282<0.001
文盲2 1945161 678
小学3 7867283 058
初中1 4663351 131
高中及以上917253664
婚姻状态10.7850.376
已婚6 6491 4435 206
其他1 7143891 325
吸烟8.9160.003
是2 1755261 649
否6 1881 3064 882
饮酒41.857<0.001
是2 8887492 139
否5 4751 0834 392
患有慢性病477.984<0.001
是7 2091 2945 915
否1 154538616
参加社交活动1.6060.205
是3 9088803 028
否4 4559523 503
养老保险0.0050.942
是7 2991 5985 701
否1 064234830
医疗保险0.1990.656
是7 9641 7416 223
否39991308
抑郁456.226<0.001
是3 4303543 076
否4 9331 4783 455
睡眠时长(h)8 3637.12±2.18*6.49±2.32*-10.304<0.001
夜间睡眠时长(h)8 3636.39±1.98*5.75±2.06*-12.043<0.001
), ArticleFig(id=1323941369550602307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=CN, label=表1, caption=

不同特征老年人自评健康情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数自评健康(n=1 832)自评不健康(n=6 531)χ2/t值P值
性别12.322<0.001
男4 1989863 212
女4 1658463 319
年龄（岁）8.3490.015
60 ~ 695 5261 2434 283
70 ~ 792 5005031 997
≥8033786251
受教育程度37.282<0.001
文盲2 1945161 678
小学3 7867283 058
初中1 4663351 131
高中及以上917253664
婚姻状态10.7850.376
已婚6 6491 4435 206
其他1 7143891 325
吸烟8.9160.003
是2 1755261 649
否6 1881 3064 882
饮酒41.857<0.001
是2 8887492 139
否5 4751 0834 392
患有慢性病477.984<0.001
是7 2091 2945 915
否1 154538616
参加社交活动1.6060.205
是3 9088803 028
否4 4559523 503
养老保险0.0050.942
是7 2991 5985 701
否1 064234830
医疗保险0.1990.656
是7 9641 7416 223
否39991308
抑郁456.226<0.001
是3 4303543 076
否4 9331 4783 455
睡眠时长(h)8 3637.12±2.18*6.49±2.32*-10.304<0.001
夜间睡眠时长(h)8 3636.39±1.98*5.75±2.06*-12.043<0.001
), ArticleFig(id=1323941369676431428, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Table 2, caption=

Results of IADL, sleep duration, depression status, and self-rated health (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量IADL睡眠时长抑郁状况得分自评健康夜间睡眠时长
IADL1.000
睡眠时长-0.147**1.000
抑郁状况得分0.346**-0.253**1.000
自评健康-0.360**0.178**-0.396**1.000
夜间睡眠时长-0.162**0.934**-0.272**0.195**1.000
), ArticleFig(id=1323941369747734597, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=CN, label=表2, caption=

IADL、睡眠时长、抑郁状况和自评健康的相关分析结果（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量IADL睡眠时长抑郁状况得分自评健康夜间睡眠时长
IADL1.000
睡眠时长-0.147**1.000
抑郁状况得分0.346**-0.253**1.000
自评健康-0.360**0.178**-0.396**1.000
夜间睡眠时长-0.162**0.934**-0.272**0.195**1.000
), ArticleFig(id=1323941371412873287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Table 3, caption=

Analysis results of chain mediation model regression

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型一 睡眠时长模型二 抑郁状况模型三 自评健康
β tβ tβ t
常量8.0340.22036.532***13.6070.61722.050***3.7330.09639.030***
年龄-0.0570.046-1.237-0.5770.120-4.804***0.0140.0180.792
性别-0.6980.063-11.110***0.8360.1655.066***0.0990.0253.963***
受教育程度0.0360.0291.257-0.9610.075-12.858***-0.0380.011-3.367***
婚姻状况0.2140.0653.317***-1.1630.168-6.910***-0.0700.025-2.740**
吸烟0.0770.0651.1950.4700.1682.796**0.0170.0250.652
饮酒-0.0750.057-1.307-0.6200.149-4.163***0.1430.0236.347***
患有慢性病-0.3230.073-4.457***1.9170.18910.135***-0.5680.029-19.804***
社交活动-0.0800.050-1.583-0.3160.131-2.410*0.0180.0200.931
养老保险0.0550.0750.727-0.0950.196-0.4870.0040.0300.125
医疗保险-0.1700.118-1.438-0.3290.308-1.065-0.0470.047-0.1.007
IADL-0.0800.010-8.161***0.6340.02624.764***-0.0740.004-18.421***
睡眠时长-0.5460.029-19.137***0.0280.0046.335***
抑郁状况-0.0460.002-27.704***
R2值0.0460.1980.237
F值36.152***171.914***199.832***
), ArticleFig(id=1323941371584839752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=CN, label=表3, caption=

链式中介模型回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型一 睡眠时长模型二 抑郁状况模型三 自评健康
β tβ tβ t
常量8.0340.22036.532***13.6070.61722.050***3.7330.09639.030***
年龄-0.0570.046-1.237-0.5770.120-4.804***0.0140.0180.792
性别-0.6980.063-11.110***0.8360.1655.066***0.0990.0253.963***
受教育程度0.0360.0291.257-0.9610.075-12.858***-0.0380.011-3.367***
婚姻状况0.2140.0653.317***-1.1630.168-6.910***-0.0700.025-2.740**
吸烟0.0770.0651.1950.4700.1682.796**0.0170.0250.652
饮酒-0.0750.057-1.307-0.6200.149-4.163***0.1430.0236.347***
患有慢性病-0.3230.073-4.457***1.9170.18910.135***-0.5680.029-19.804***
社交活动-0.0800.050-1.583-0.3160.131-2.410*0.0180.0200.931
养老保险0.0550.0750.727-0.0950.196-0.4870.0040.0300.125
医疗保险-0.1700.118-1.438-0.3290.308-1.065-0.0470.047-0.1.007
IADL-0.0800.010-8.161***0.6340.02624.764***-0.0740.004-18.421***
睡眠时长-0.5460.029-19.137***0.0280.0046.335***
抑郁状况-0.0460.002-27.704***
R2值0.0460.1980.237
F值36.152***171.914***199.832***
), ArticleFig(id=1323941371765194825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=EN, label=Table 4, caption=

Chain mediation path analysis

, figureFileSmall=null, figureFileBig=null, tableContent=
路径效应值Boot标准误95% CI下限95% CI上限效应占比（%）
总直接效应-0.0740.004-0.081-0.06669.16
总中介效应-0.0330.002-0.037-0.03030.84
IADL-睡眠时长-自评健康-0.0020.001-0.003-0.0011.87
IADL-抑郁状况-自评健康-0.0290.002-0.032-0.02627.10
IADL-睡眠时长-抑郁状况-自评健康-0.0020.000-0.003-0.0011.87
总效应-0.1070.004-0.115-0.099100.00
), ArticleFig(id=1323941371836497994, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941360159555596, language=CN, label=表4, caption=

链式中介反应路径

, figureFileSmall=null, figureFileBig=null, tableContent=
路径效应值Boot标准误95% CI下限95% CI上限效应占比（%）
总直接效应-0.0740.004-0.081-0.06669.16
总中介效应-0.0330.002-0.037-0.03030.84
IADL-睡眠时长-自评健康-0.0020.001-0.003-0.0011.87
IADL-抑郁状况-自评健康-0.0290.002-0.032-0.02627.10
IADL-睡眠时长-抑郁状况-自评健康-0.0020.000-0.003-0.0011.87
总效应-0.1070.004-0.115-0.099100.00
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老年人工具性日常生活能力对自评健康的影响——睡眠时长和抑郁状况的链式中介效应
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张庆雯 1 , 陈文君 1 , 秦潇 1 , 高杰 2
现代预防医学 | 健康与社会行为 2025,52(23): 4377-4382
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现代预防医学 |健康与社会行为 2025 , 52 (23) : 4377 -4382
老年人工具性日常生活能力对自评健康的影响——睡眠时长和抑郁状况的链式中介效应
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张庆雯1, 陈文君1, 秦潇1, 高杰2
作者信息
  • 1.山东第二医科大学公共卫生学院，山东　潍坊　261053
  • 2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心，山东　济南　250014
通讯作者:
高杰，E-mail：
作者简介:

张庆雯（2000—），女，硕士在读，研究方向：儿少卫生与妇幼保健学

The impact of instrumental activities of daily living on self-rated health in older adults: the chain mediating effects of sleep duration and depressive status
Qing-wen ZHANG1, Wen-jun CHEN1, Xiao QIN1, Jie GAO2
Affiliations
  • School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-12-10 doi: 10.20043/j.cnki.MPM.202506308
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摘要
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目的

探讨睡眠时长和抑郁状况在老年人工具性日常生活能力（instrumental activities of daily living，IADL）与自评健康间的中介作用。

方法

选取 2020 年中国健康与养老追踪调查中 8 363 例≥60 岁的老年人作为研究对象，采用Spearman秩相关分析法，评估IADL、睡眠时长、抑郁症状与自评健康四变量间的相关性，采用 bootstrap 法检验睡眠时长与抑郁状况在老年人IADL和自评健康的中介效应。

结果

IADL对老年人自评健康的直接效应显著（β=-0.074，95% CI:-0.081 ~ -0.066)，睡眠时长和抑郁状况在IADL对老年人自评健康的单独中介效应显著（β=-0.002，95% CI:-0.003 ~ -0.001；β=-0.029，95% CI:-0.032 ~ -0.001)，睡眠时长和抑郁状况在IADL对老年人自评健康的链式中介效应显著（β=-0.002，95% CI:-0.003 ~ -0.001)。

结论

IADL受限可以直接负向影响老年人自评健康情况，也可以通过睡眠时长和抑郁状况在IADL对老年人自评健康单独或链式中介作用影响老年人自评健康水平。因此，可以通过提升老年人IADL水平、改善睡眠状况、减少抑郁症状来改善老年人自评健康水平，促进老年人身心健康发展。

工具性日常活动能力  /  睡眠时长  /  抑郁状况  /  自评健康  /  链式中介
Objective

To explore the mediating roles of sleep duration and depressive symptoms in the relationship between instrumental activities of daily living (IADL) and self-rated health (SRH) among older adults.

Methods

A total of 8 363 older adults (≥60 years) from the 2020 China Health and Retirement Longitudinal Study (CHARLS) were included. Spearman’s rank correlation analysis was employed to assess correlations among IADL, sleep duration, depressive symptoms, and SRH. Bootstrap analysis was used to examine the mediating effects of sleep duration and depressive symptoms on the association between IADL and SRH.

Results

IADL exerted a significant direct effect on SRH (β=-0.074, 95% CI: -0.081~-0.066). Significant mediating effects were observed for sleep duration alone (β=-0.002, 95% CI: -0.003~-0.001), depressive symptoms alone (β=-0.029, 95% CI: -0.032~-0.001), and the chained pathway through sleep duration and depressive symptoms (β=-0.002, 95% CI: -0.003~-0.001).

Conclusion

IADL limitations may directly and negatively impact SRH in older adults, and may also indirectly affect SRH through the independent or sequential mediating effects of sleep duration and depressive symptoms.Interventions aimed at enhancing IADL capacity, optimizing sleep duration, and alleviating depressive symptoms could improve SRH and promote physical and mental well-being among older adults.

Instrumental activities of daily living  /  Sleep duration  /  Depressive status  /  Self-rated health  /  Chain mediating
张庆雯, 陈文君, 秦潇, 高杰. 老年人工具性日常生活能力对自评健康的影响——睡眠时长和抑郁状况的链式中介效应. 现代预防医学, 2025 , 52 (23) : 4377 -4382 . DOI: 10.20043/j.cnki.MPM.202506308
Qing-wen ZHANG, Wen-jun CHEN, Xiao QIN, Jie GAO. The impact of instrumental activities of daily living on self-rated health in older adults: the chain mediating effects of sleep duration and depressive status[J]. Modern Preventive Medicine, 2025 , 52 (23) : 4377 -4382 . DOI: 10.20043/j.cnki.MPM.202506308
正文
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随着全球老龄化进程加速，老年人口的健康维护与生活质量提升已成为公共卫生领域的核心议题。自2000年中国正式步入老龄化社会以来，其人口老龄化进程持续加速。根据第七次全国人口普查数据，全国60岁及以上老年人口规模已达2.64亿，占总人口的18.70%[1]。自评健康（self-rated health）作为衡量个体整体健康状态的重要指标，能够全面反映个体疾病健康状况及其对生理和心理的影响，并且对老年人健康状况和死亡率具有的预测作用[2-3]，因此对老年人健康测量有重要意义[4]。
在影响健康的众多因素中，工具性日常生活能力（instrumental activities of daily living, IADL）通过限制个体独立完成复杂生活任务（如购物、理财、交通出行）的能力，深刻影响着老年人的生活自主性与健康感知[5]。相关研究表明，IADL受限可能诱发压力与挫败感，IADL受限是抑郁症状的危险因素[6]。抑郁作为强效心理中介因子，不仅直接降低健康满意度，还可能通过神经内分泌紊乱放大躯体不适感知，形成对健康状态的负向评价。IADL受限可能破坏睡眠生理节律，日常活动能力下降常伴随慢性疼痛、夜间活动需求增加（如频繁如厕）或疾病管理负担，这些因素可干扰睡眠时长与质量[7]。异常睡眠（短睡眠或片段化睡眠）通过降低免疫调节能力、增加系统性炎症[8]，进一步损害身心健康并负向预测自评健康，并且睡眠时间不足已被证明是抑郁症状的预测因子[9]，当睡眠需求得不到满足，个体的精神和心理状态也会受到影响[10]，进而影响老年人健康水平。基于此本研究选取睡眠时长和抑郁状况作为本研究的中介变量。
综合现有研究发现，国内外学界针对IADL、睡眠时长、抑郁症状及自评健康四者的研究多聚焦于两变量或三变量的关联性分析，然而对四者间作用路径的探讨仍显不足。基于此，本研究以中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据为基础，构建“IADL→睡眠时长→抑郁症状→自评健康”的链式中介模型，为制定“功能康复-睡眠管理-心理支持”三位一体的健康促进策略提供科学依据，并为实现《“健康中国2030”规划纲要》中“促进老年人功能维持与心理健康”的目标提供实践启示。
1　资料与方法
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1.1　研究对象
本研究数据来自最新公布的2020年 CHARLS 数据库。根据研究目的，本文研究对象为年龄≥60岁的老年人。根据纳入排除标准，从2020年19 359个样本中，最终纳入8 363名研究对象，具体筛选过程见图1。
1.2　变量选择
1.2.1　自变量
IADL包括通讯能力、膳食准备、药物管理、独立采购、理财、做家务六个条目。受试者根据自身情况对每项活动进行自我评估，分为四个等级：“无困难”赋值0分、“有困难但仍可独立完成”赋值1分、“有困难且需要协助”赋值2分 以及“完全无法完成”赋值3分，总分为0～18分。得分与功能受损程度呈正相关，即总分越高，表明个体在工具性日常活动中的自主能力越受限。
1.2.2　因变量
由 CHARLS 问卷中“您认为您的健康状况怎么样”来获取，赋值规则为：“很好”赋值为5分、“好”赋值为4分、“一般”赋值为3分、“不好”赋值为2分、“很不好”赋值为1分。评分采用正向赋分原则，即分值越高反映个体对自身健康状况的主观评价越积极。得分≤3 分为自评不健康，得分越低表明自评健康状况越差[11]。
1.2.3　中介变量定义
（1）睡眠时长测量：通过整合夜间睡眠与日间午休时长评估个体总睡眠时间[12]。具体数据来源为CHARLS问卷中以下两项条目：夜间睡眠时长为“过去一个月内，您平均每晚实际入睡并持续睡眠的时间约为多少小时？”；午间睡眠时长为“过去一个月中，您通常每天午休多长时间？”。（2）抑郁症状测量：本研究采用流行病学研究中心抑郁量表简版（CES-D10）对老年群体抑郁症状进行标准化评估。每个条目依据根据“很少或根本没有（<1 d）”赋值0分，“不太多（1～2 d）”赋值1分，“有时或者说有一半的时间（3～4 d）”赋值2分，“大多数时间（5～7 d）”赋值3分，总分范围为0～30分。本研究将CES-D10 累积得分≥10 者定义为患有抑郁症状[13]。
1.2.4　协变量
通过阅读文献并结合实际情况[14-15]，本研究纳入的控制变量包括人口学变量（性别、年龄、受教育程度、婚姻状况）、健康行为变量（吸烟、饮酒状态）、疾病状态变量（慢性病患病情况）、社会支持变量（社交活动参与度、养老保险与医疗保险覆盖情况）。
1.3　统计学方法
本研究采用SPSS Statistics 27.0及PROCESS宏程序（4.0）进行数据分析：（1）采用χ2检验或t检验分析不同特征老年人组内之间的自评健康差异。（2）采用Spearman秩相关性分析确定IADL、睡眠时间、抑郁状况和自评健康之间的关系。（3）使用PROCESS宏程序（4.0）中的Model 6（链式多重中介模型），检验睡眠时长与抑郁状况在老年人IADL与自评健康间的中介作用路径，并采用bootstrap非参数重复抽样法对链式中介效应的统计显著性进行验证，检验水准 α=0.05。（4）敏感性分析。 夜间睡眠与午休睡眠可能存在不同的健康效应，因此进行敏感性分析。重新定义睡眠变量：仅使用夜间睡眠时长（“过去一个月内，您平均每晚实际入睡并持续睡眠的时间约为多少小时？”）。保持样本、协变量、模型不变，重新检验链式中介效应。
2　结果
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2.1　调查对象基本情况
8 363名老年人中，男性4 198名（50.20%），女性4 165（49.80%）名；1 832（21.90%）名老年人自评健康。单因素分析结果表明，老年人群自评健康水平在不同性别、年龄、受教育程度、吸烟、饮酒、患有慢性病、患有抑郁、睡眠时长及夜间睡眠时长变量间差异有统计学意义（P<0.05），婚姻状况、是否参加社交活动、有养老保险、医疗保险与老年人自评健康水平之间没有统计学意义（P>0.05）。见表1 。
2.2　IADL、睡眠时长、抑郁状况和自评健康相关性分析
相关分析结果表明，IADL与睡眠时长、夜间睡眠时长和自评健康呈负相关（P<0.05），IADL与抑郁状况呈正相关（P<0.05）；睡眠时长和夜间睡眠时长与自评健康呈正相关（P<0.05），睡眠时长和夜间睡眠时长与抑郁状况呈负相关（P<0.05）；抑郁状况与自评健康呈负相关（P<0.05）。见表2。
2.3　链式中介模型分析
本研究采用分层回归分析方法，在控制协变量的基础上，以IADL为自变量，以老年人自评健康水平为因变量，以睡眠时长和抑郁状况为中介变量构建中介模型。数据分析结果显示，老年人IADL与睡眠时长（β=-0.080，P<0.001）和自评健康（β=-0.074，P<0.001）呈现负向相关关系，与抑郁状况之间存在正向相关关系（β=0.634，P<0.001）；睡眠时长与自评健康（β=0.028，P<0.001）之间存在正向相关关系，与抑郁状况（β=-0.546，P<0.001）之间存在负向相关关系；抑郁状况与自评健康（β=-0.046，P<0.001）之间存在负向相关关系。见表3、图2。
2.4　中介效应显著性检验
中介效应检验结果显示，IADL对老年人自评健康的直接效应有统计学意义（95% CI:-0.081 ~ -0.066)，睡眠时长在IADL对老年人自评健康的中介效应有统计学意义（95% CI:-0.003 ~ -0.001)，抑郁状况在IADL对老年人自评健康的中介效应有统计学意义（95% CI:-0.032 ~ -0.001)，睡眠时长和抑郁状况在IADL对老年人自评健康的中介效应有统计学意义（95% CI:-0.003 ~ -0.001)。总效应值为 -0.107，直接效应值为 -0.074，占总效应的69.16%，总中介效应为 -0.033，占总效应的 30.84%。见表4。
2.5　敏感性分析
当仅使用夜间睡眠时长时，IADL对夜间睡眠的效应β=-0.083（P<0.001）（原总睡眠：β=-0.080）。夜间睡眠对抑郁的效应β=-0.653（P<0.001）（原总睡眠：β=-0.546）。链式中介效应占比为31.13%(95% CI：-0.372 ~ -0.300)（原分析：30.84%）。敏感性分析与主分析结果趋势一致，支持睡眠变量的中介作用具有稳健性。
3　讨论
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3.1　老年人IADL和自评健康存在显著直接效应
研究结果表明，老年人的IADL与自评健康之间存在着显著的负相关关系，即IADL受限程度高的老年人自评健康低。相关研究表明，老年人身体功能状态与其自评健康水平存在显著正向关联[5]。良好的身体功可能作为关键保护性因素，能够通过维持心理状态和生活独立性提升健康自我效能感[16]。反之，IADL受限可能关联安全焦虑、环境掌控削弱及自我价值感降低[17]。需进一步探究这些因素是否构成‘功能衰退-心理困扰’的潜在循环路径。
3.2　睡眠时长在老年人IADL和自评健康之间存在中介
研究结果表明，IADL与睡眠时长呈负相关。IADL受限可能通过功能衰退导致的躯体疼痛[18]、夜间活动频率增加或对失能的焦虑情绪，引发睡眠时长异常及睡眠质量下降。研究表明，睡眠质量下降与躯体功能损害风险升高存在显著剂量-反应关系[19]，充足睡眠时长及优质睡眠结构对维持积极自评健康具有双重保护效应[20-21]。因此老年人IADL受限可以通过影响睡眠时长，进而影响老年人的自评健康水平。
3.3　抑郁状况在老年人IADL和自评健康之间存在中介
研究结果表明，IADL和抑郁症状呈正相关，相关研究表明，IADL受损是抑郁症状发生的危险因素[22]，IADL受损通常会导致自理能力的减弱，而无法独立完成日常活动可能导致失去自主感、孤独感和愧疚感，从而增加抑郁的风险[23]。抑郁状况与自评健康呈显著负向相关，与以往研究结果一致[24]。并且抑郁水平的降低会提高老年人的自评健康水平[25]，自评健康与心理健康具有显著一致性[26]。因此，使老年人保持良好的心理状况，对提高老年人自评健康有重要的促进作用。
3.4　睡眠时长和抑郁状况在老年人IADL和自评健康之间存在链式中介作用
本研究发现，IADL受限通过“睡眠时长→抑郁症状”的链式路径间接影响自评健康。IADL受限关联睡眠问题与抑郁症状的级联效应：功能衰退伴随的日常活动挫败感或焦虑可能干扰睡眠[27]，而睡眠异常可能进一步关联神经生化改变（如5-羟色胺活性降低[28]）与心理困扰加剧。且睡眠不足人群抑郁表现高发，睡眠-心理问题存在双向作用。抑郁状态对躯体不适感知的放大作用，或是负向健康自评的机制之一。
本研究通过构建链式中介效应模型，探讨了中国老年人群IADL、睡眠时长、抑郁状况与自评健康四者间的关系及作用路径，为促进老年人身心健康发展提出以下建议：一是社区开展个性化康复训练以维持老年人IADL功能水平；二是基层卫生机构可以为IADL受限老人提供认知行为疗法（如CBT-I）改善睡眠，并抑郁筛查服务。本研究存在以下局限性：第一，横断面研究无法推断变量间的因果方向。例如，抑郁可能同时导致IADL下降和睡眠紊乱，而非单纯作为中介变量。未来需通过纵向设计或干预研究验证路径方向性。第二，尽管纳入了人口学、行为及疾病相关协变量，未测量的混杂因素（如社会支持强度、经济地位、居住环境、特定药物使用）仍可能影响结果。第三，未检验调节效应。IADL对睡眠/抑郁的影响，或睡眠/抑郁对自评健康的作用，可能在性别、年龄层或慢性病严重程度等亚组中存在异质性。未来研究应探索这些调节因素以揭示群体差异机制。第四，合并计算夜间睡眠与午休时长，可能掩盖二者对健康的不同作用模式（如长午休可能补偿夜间缺失或反映健康风险）；敏感性分析虽显示仅用夜间睡眠时中介效应仍存在，但仍需更精细的睡眠维度研究。

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2025年第52卷第23期
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doi: 10.20043/j.cnki.MPM.202506308
  • 接收时间：2025-06-19
  • 首发时间：2026-11-02
  • 出版时间：2025-12-10
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    1.山东第二医科大学公共卫生学院，山东　潍坊　261053
    2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心，山东　济南　250014

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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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