失能对中老年人抑郁水平的影响——睡眠质量的中介作用

Effects of Disability on Depression among Middle-Aged and Elderly Adults—The Mediating Role of Sleep Quality

摘要: 目的：探讨失能程度对中老年人抑郁水平的影响，以及睡眠质量在其中的中介作用。方法：基于中国健康与养老调查2018年和2020年的数据，构建强平衡面板数据，采用双向固定效应模型分析失能程度对抑郁水平的影响，并通过三步法检验睡眠质量的中介效应。结果：2020年45岁及以上中老年人的抑郁症状检出率为37.30%，在控制个体和时间效应后，失能程度能够显著正向预测其抑郁水平(β = 0.461, t = 11.870, p < 0.001)，且该效应在年龄 < 65岁人群(β = 0.593)与≥65岁以上人群(β = 0.361)间差异显著(p = 0.002)。失能程度通过睡眠质量间接影响抑郁水平，中介效应占比26.58%。结论：失能程度的提高可直接导致中老年人抑郁水平的增加，亦可通过睡眠质量的中介作用产生间接影响。我国中老年人抑郁症状检出率较高，低龄失能人群的抑郁状况更应引起重视，建议加强对低龄失能人群睡眠质量问题的预防和综合干预，以提高生活质量。

Abstract: Objective: To explore the relationship between the disability level and depressive symptoms in middle-aged and elderly people, and the mediating role of sleep quality. Methods: Data from the 2018 and 2020 China Health and Retirement Longitudinal Study (CHARLS) were cleaned to construct a balanced panel dataset, and the association between disability and depression level was analyzed by a two-way fixed-effect model. Finally, the mediating effect of sleep quality was tested by a three-step mediation approach. Results: In 2020, 37.30% of individuals aged 45 and above exhibited depressive symptoms. Controlling for individual effects and time effects, a positive relationship was found between disability level and depressive symptoms in middle-aged and older adults (β = 0.461, t = 11.870, p < 0.001). This relationship showed significant differences between those under 65 years old (β = 0.593) and those over 65 years old (β = 0.361, p = 0.002). Disability level exerted an indirect effect on depressive symptoms through sleep quality, and the mediating effect accounted for 26.58% of the total effect. Conclusion: Higher disability levels are directly associated with increased depressive symptoms in middle-aged and elderly individuals, and they also exert an indirect effect through the mediating role of sleep quality. The prevalence of depressive symptoms is relatively high among China’s middle-aged and elderly population, with a particular concern for the middle-aged disabled groups. It is imperative to focus on improving the sleep quality of the disabled population and implement preventive and comprehensive interventions to enhance their quality of life.