| Objective:Depressive symptoms are one of the important factors affecting the quality of life in the elderly.This study used the data of 8 longevity regions in China to explore the prevalence characteristics,influencing factors and the path relationship among depression symptoms in the elderly in longevity regions,which can not only make up for the deficiency of related studies,but also provide scientific basis for the prospective cohort study.Methods:The data of this study was from the Chinese longitudinal healthy longevity survey(CLHLS).The survey sites were 8 longevity regions identified by the Gerontological Society of China in China.After excluding the missing information of depression survey,a total of 2,180 subjects were included.The questionnaire mainly collected information such as social demographic characteristics,behavioral lifestyle,chronic diseases,functional status,relatives and social support,physical examination and laboratory examination.This study used the Center for Epidemiologic Studies Depression Scale(CES-D),a 10-item streaming Center,to determine whether the elderly had depressive symptoms.Firstly,the basic characteristics of the subjects were described and the logistic regression model of influencing factors of depressive symptoms was constructed.In single factor analysis,the chi-square test was used to compare the social demographic characteristics,behavior,way of life,chronic disease prevalence,functional status,family and social support of the elderly with and without depression symptoms,the Wilcoxon rank sum test was used to compare the differences of physical examination and laboratory examination indicators of the elderly between groups with and without depressive symptoms.Different factors(P < 0.10)were included in the multivariate logistic regression by "stepwise forward regression".In the multivariate analysis,P < 0.05 in the bilateral test was considered statistically significant,that is,the factor was an influential factor of depressive symptoms.Secondly,on the basis of logistic regression model and combining with literature report,the structural equation model of influencing factors of depressive symptoms in the elderly was constructed.The construction of structural equation model includes four steps: hypothesis model construction,model estimation,model evaluation and model modification.In this study,social support,family support and daily activities of the elderly were taken as exogenous latent variables,and sleep time,anxiety disorders,life satisfaction and depression symptoms were taken as endogenous observational variables to construct hypothesis model I.Chronic diseases were taken as endogenous latent variables,superoxide dismutase(SOD)and malondialdehyde(MDA)as exogenous observed variables,and depression symptoms as endogenous observed variables to construct hypothesis model II.The model is estimated by the weighted least square method(WLS).Chi-square value,GFI,AGFI,RMR,SRMR and RMSEA were used to evaluate the suitability of the model to the data.The model was modified with professional knowledge to explore the best model to meet the requirements of adaptation.Results:(1)The detection rate of depressive symptoms in the elderly in 8 longevity regions of China was 15.0%,and that in males and females was 11.5% and 18.5%,respectively.There were differences in the detection rates of depressive symptoms among elderly people of different ages,among which the highest rate was 20.6% in the elderly of 80~89 years old,the lowest rate was 9.2% in the elderly of 65~79 years old,19.3% in the elderly of 90~99 years old and 15.4% in the elderly of 100 years old and above.(2)Multivariate logistic regression results showed that the elderly who had educational experience(OR=0.660,95%CI: 0.463-0.941),physical exercise(OR=0.444,95%CI: 0.274-0.719),and community service(OR=0.707,95%CI: 0.518-0.966)had a lower detection rate of depressive symptoms.The elderly who were older(OR=1.023,95%CI: 1.006-1.041)or with lower life satisfaction(OR=3.483,95%CI: 2.507-4.839),sleep deprivation(OR=1.934,95%CI: 1.415-2.643),anxiety disorders(OR=17.720,95%CI: 6.303-49.816),respiratory diseases(OR=1.702,95%CI: 1.052-2.755),and gastrointestinal ulcers(OR=2.662,95%CI: 1.337-5.303),type 2 diabetes(OR=1.557,95%CI: 1.003-2.418)and poor economic conditions(OR=2.809,95%CI: 1.610-4.903)had a higher detection rate of depressive symptoms.This study also found that SOD(OR=1.014,95%CI: 1.003-1.024)and MDA(OR=1.026,95%CI: 1.001-1.052)were correlated with depression symptoms in the elderly.(3)The results of structural equation model 1 showed that social support in the elderly had both direct and indirect effects on depressive symptoms.The standardized path coefficient for the direct effect of social support on depressive symptoms was-0.28.Social support indirectly affects depressive symptoms through sleep time,anxiety disorders and life satisfaction,indirect effect of standardized path coefficient was 0.29,in which the standardized path coefficient of the indirect effect of social support on depressive symptoms through sleep time was-0.06,the standardized path coefficient of the indirect effect of social support on depressive symptoms through anxiety disorders was-0.09,and the standardized path coefficient of the indirect effect of social support on depressive symptoms through life satisfaction was-0.14.The participation in daily activities of elderly has no direct effect on depressive symptoms,the standardized path coefficient of the indirect effect of daily activities on depressive symptoms through sleep time was 0.06,the standardized path coefficient of the indirect effect of daily activities on depressive symptoms through the action of anxiety disorder was-0.07,and the standardized path coefficient of the indirect effect of daily activities on depressive symptoms through life satisfaction was-011.(4)The results of structural equation model 2 showed that chronic diseases of the elderly had a direct effect on depressive symptoms,and the standardized path coefficient was 0.37.SOD and MDA have indirect effects on depression symptoms in the elderly through chronic diseases,in which the standardized path coefficient of SOD’s influence on depression symptoms through chronic diseases was 0.07,and the standardized path coefficient of MDA’s influence on depression symptoms through chronic diseases was 0.10.Conclusion:(1)The detection rate of depressive symptoms in the elderly in 8 longevity areas of China was lower than that in ordinary areas.There were also differences in the detection rates of depressive symptoms in the elderly of different age groups,among which the detection rates of depressive symptoms were the highest in the elderly of 80-89 years old,and the lowest in the elderly of 65-79 years old.(2)Older adults with educational experience,regular physical exercise and access to community services had a lower risk of depressive symptoms.The elderly who were older,had lower life satisfaction,lack of sleep,anxiety disorders,respiratory illness,gastrointestinal ulcers,type 2 diabetes,and poor economic conditions were at higher risk for depressive symptoms.The present study also found that the higher SOD and MDA levels in the serum of the study subjects,the higher the risk of depressive symptoms in the elderly.(3)Social support had direct and indirect negative effects on depressive symptoms in the elderly,and daily activity participation has indirect negative effects on depressive symptoms.Sleep time,anxiety disorder and life satisfaction had direct effects on depressive symptoms in the elderly.Among them,sleep time and life satisfaction had direct negative effects on depressive symptoms,while anxiety disorder had direct positive effects on depressive symptoms.(4)Chronic disease in the elderly had a direct positive effect on depressive symptoms,and chronic disease,as an important mediator,regulated the effects of SOD and MDA on depressive symptoms. |
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