抑郁症状和躯体疼痛在老年高血压患者社会 隔离与衰弱间的链式中介作用

The Chain Mediating Role of Depressive Symptoms and Bodily Pain in the Relationship between Social Isolation and Frailty among Older Adults with Hypertension

摘要: 目的：探究抑郁症状和躯体疼痛在社会隔离与衰弱之间的中介作用。方法：利用中国健康与养老追踪调查(CHARLS) 2015年数据，选取1759名老年高血压患者(≥60岁)。采用社会隔离、衰弱指数、抑郁症状及躯体疼痛(疼痛部位数)进行评估。运用多元线性回归及链式中介分析(PROCESS宏模型6，Bootstrap重复抽样5000次)检验中介路径，并控制社会人口学及健康相关协变量。结果：社会隔离对衰弱的总效应显著(β = 0.097, P < 0.001)，直接效应(β = 0.050, P < 0.001)占总效应的51.55%。抑郁症状与躯体疼痛在二者间起链式中介作用，路径“社会隔离→抑郁症状→躯体疼痛→衰弱”的间接效应值为0.007 (95% CI: 0.003~0.010)，占总效应的7.22%；总间接效应占总效应的48.45%。结论：社会隔离不仅直接加重老年高血压患者衰弱，还通过“抑郁症状→躯体疼痛”的链式路径间接影响衰弱。针对该人群的干预应注重减少社会隔离、筛查抑郁症状并综合管理躯体疼痛。

Abstract: Objective: To explore the mediating role of depressive symptoms and bodily pain in the relationship between social isolation and frailty among elderly patients with hypertension. Methods: Data were derived from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS), including 1759 participants aged 60 years and older with hypertension. Social isolation, frailty index, depressive symptoms (CES-D-10), and bodily pain burden (number of painful sites) were assessed. Multiple linear regression and chain mediating effect analysis (PROCESS macro Model 6 with 5000 bootstrap resamples) were employed to examine the hypothesized pathways, adjusting for key sociodemographic and health-related covariates. Results: The total effect of social isolation on frailty was significant (β = 0.097, P < 0.001), with a direct effect (β = 0.050, P < 0.001) accounting for 51.55% of the total effect. Depressive symptoms and bodily pain jointly exerted a significant chain mediating effect between social isolation and frailty. The indirect effect through the pathway “social isolation → depressive symptoms → bodily pain → frailty” was 0.007 (95%CI: 0.003 to 0.010), explaining 7.22% of the total effect. Overall, the total indirect effect through all pathways accounted for 48.45% of the total effect. Conclusion: Social isolation not only directly exacerbates frailty but also indirectly influences frailty through the “depressive symptoms → bodily pain” chain pathway in elderly patients with hypertension. Interventions targeting frailty in this high-risk population should incorporate strategies to reduce social isolation, screen for depressive symptoms, and comprehensively manage bodily pain.