The Effect Of Chronic Diseases On Depressive Symptoms In The Elderly

Objective:The purpose of this study is to understand the current status of chronic diseases and depressive symptoms of the elderly,to explore the impact of chronic diseases on depressive symptoms of the elderly,and to verify the mediating role of sleep quality in the relationship between chronic diseases and depressive symptoms,and the moderating role of empty nest state in the mediation effect,so as to provide reference for formulating scientific and reasonable intervention measures and effectively preventing and alleviating depressive symptoms of the elderly.Methods:This study was conducted in Taiyuan City of Shanxi Province from October to November 2018,and 3800 elderly people aged 60 and above were selected by multi-stage random cluster sampling.The survey contents included: general demographic characteristics questionnaire,health related factors questionnaire,chronic diseases,Short Form Geriatric Depression Scale(GDS-15),Pittsburgh Sleep Quality Index(PSQI).A total of 3637 valid questionnaires were collected and analyzed using SPSS 22.0 software.A descriptive analysis for general data,Harman single factor test was used to test whether there were common method deviation in the research data,Chi-square test was used to analyze the characteristics of chronic diseases and depressive symptoms of the elderly,Spearman correlation was used to analyze the correlation among chronic diseases,sleep quality and depressive symptoms,and Bootstrap program and Simple slope method were used to test the significance of mediating effect of sleep quality and moderating effect of empty nest state.Results:1.The basic information of the respondents: the survey involved 3637 elderly people in Taiyuan,with an average age of(70.03±12.34)years old,of which 1816(49.9%)were aged 60～69 years old.There were 1864 males(51.3%)and 1773 females(48.7%),79.8% of the elderly were married,28.4% of the elderly had junior high school education,the living area was mostly urban(58.4%).The elderly in the empty nest state accounted for 48.1%,and the highest proportion of monthly income was in the group of 1000 yuan～.2.In this survey,the prevalence of chronic diseases in the elderly was 68.9%(2504),of which 47.9%(1742)suffered from one chronic disease,and 21.0%(762)suffered from two or more chronic diseases at the same time.The results of univariate analysis showed that there were significant differences in chronic diseases among the elderly with different age,marital status,education level,living area,occupation before retirement,family monthly income,relationship with children,relationship with spouse and level of physical activity(P<0.05).Among the elderly surveyed,1213(33.4%)had depressive symptoms,including950(26.1%)with mild depression and 263(7.2%)with moderate or severe depression.The results showed that there were significant differences in depression scores among the elderly with different gender,age,marital status,education level,living area,preretirement occupation,family monthly income,relationship with children,relationship with spouse and level of physical activity(P<0.05).3.In this study,the score of sleep quality of the elderly was(5.43±3.16),and the average score of subjective sleep quality was(1.16±0.40),which was the highest score in all dimensions of sleep quality.Spearman correlation analysis showed that sleep quality and its scores in various dimensions were positively correlated with chronic diseases and depression(P<0.01).4.The mediating effect results showed that the total effect(path c)of chronic diseases on depressive symptoms was 0.431(95% CI: 0.252,0.610),and the indirect paths of sleep quality between chronic diseases and depressive symptoms were: chronic diseases—sleep quality(path a: 1.151;95% CI: 0.935,1.367)and sleep quality—depressive symptoms(path b: 0.162;95% CI: 0.136,0.189),indirect effects(path a × path b)was 0.187(95% CI: 0.142,0.238).After adding sleep quality,the direct effect of chronic diseases on depression(path c’)was 0.244(95% CI: 0.066,0.422,P=0.007),which was still statistically significant,indicating that sleep quality played a partial mediating role in the prediction of chronic diseases on depression,and the mediating effect was 43.4%.Further results of the moderating effect of empty nest state in this mediating effect showed that empty nest state only moderated the first half of the path in the mediation model,namely path a(β=-0.431,95% CI: 1-859,-0.004),and compared with non-empty nest group,the effect of chronic diseases on sleep quality of empty nest group was stronger.Conclusions:The prevalence of chronic diseases in the elderly in Taiyuan was relatively high,and there were different degrees of depression symptoms,among them,there were more mild depression,which should be paid attention to.Chronic diseases have an important impact on the depressive symptoms of the elderly,and the greater the number of chronic diseases,the more obvious the depressive symptoms.Sleep quality mediates the relationship between chronic diseases and depressive symptoms,and chronic diseases have a stronger predictive effect on sleep quality of the elderly in empty nest group.It is suggested that intervention measures related to sleep quality and empty nest state can be taken to improve the depressive symptoms of the elderly with chronic diseases.