老年人日常生活能力与抑郁症状的网络结构：基于CHARLS 2020数据的研究

Network Structure of Activities of Daily Living and Depressive Symptoms among Older Adults: A Study Based on CHARLS 2020 Data

摘要: 目的：基于精神疾病网络理论，探讨老年人日常生活活动能力与抑郁症状之间的网络结构特征。方法：基于中国健康与养老追踪调查(CHARLS) 2020年数据纳入7441名60岁及以上老年人，采用简版流调中心抑郁量表(CES-D)、基本日常生活活动能力(BADL)和工具性日常生活活动能力(IADL)量表进行评估。基于EBICglasso模型构建症状网络，并通过中心性指标分析关键节点，同时比较不同抑郁风险组的网络差异。结果：本研究老年人抑郁风险检出率为38.4%。不同户口类型、性别及婚姻状况在抑郁风险上的差异均显著(P < 0.001)。全样本网络中，“情绪低落”(CESD3)具有最高的强度和预期影响指数(1.850, 1.556)，为核心症状；“做家务”(IADL1)的中介中心性(2.792)和接近中心性(1.862)最高。亚组分析显示，有抑郁风险组“做家务”的强度(2.166)和中介中心性(2.999)最高。结论：老年人抑郁症状与日常生活能力之间存在复杂的网络关联，“情绪低落”为核心心理症状，“做家务”为连接功能受限与心理健康的关键节点。不同抑郁风险的网络结构存在异质性，为老年人抑郁的精准干预提供了理论依据。

Abstract: Objective: Based on the network theory of mental disorders, this study aims to explore the network structure characteristics between activities of daily living and depressive symptoms among older adults. Methods: A total of 7441 older adults aged 60 years and above were included from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) were assessed using the short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the BADL scale, and the IADL scale, respectively. A symptom network was constructed using the EBICglasso model, and key nodes were identified via centrality indices. Additionally, network differences were compared between different depression risk groups. Results: The detection rate of depression risk among older adults in this study was 38.4%. Significant differences in depression risk were observed across household registration types, genders, and marital statuses (all P < 0.001). In the full-sample network, “depressed mood” (CESD3) exhibited the highest strength and expected influence (1.850 and 1.556, respectively), making it the core symptom. “Doing housework” (IADL1) showed the highest betweenness centrality (2.792) and closeness centrality (1.862). Subgroup analyses revealed that among those with depression risk, “doing housework” had the highest strength (2.166) and betweenness centrality (2.999). Conclusion: There is a complex network association between depressive symptoms and daily living abilities in older adults. “Depressed mood” serves as the core psychological symptom, while “doing housework” acts as a key node connecting functional limitations with mental health. The network structures differ across depression risk groups, providing a theoretical basis for precision interventions for depression in older adults.