中老年高血压患者社会隔离、抑郁与认知功能的关系：一项交叉滞后分析
The Relationships between Social Isolation, Depression, and Cognitive Function in Middle-aged and Older Adults with Hypertension：a Cross-lagged Panel Analysis
邱文集 1罗威 2梁海渝 1史镇坤 2郭航 1刘晓君3
作者信息
- 1. 350122 福建省福州市，福建医科大学公共卫生学院
- 2. 350122 福建省福州市，福建医科大学卫生管理学院
- 3. 350122 福建省福州市，福建医科大学卫生管理学院;350122 福建省福州市，福建省医药卫生体制改革研究会;350122 福建省福州市，福建省高校人文社科基地健康福建研究中心（福建医科大学）
- 折叠
摘要
背景 我国高血压患病率随年龄增长持续上升，中老年人群同时面临社会隔离、抑郁与认知功能下降的多重风险，但目前针对三者间的纵向相互影响及其潜在作用路径仍缺乏系统认识。目的 探讨中老年高血压患者社会隔离、抑郁与认知功能的纵向交互作用及抑郁在其中的中介效应。方法 基于中国健康与养老追踪调查（CHARLS）2015年、2018年和2020年3期纵向数据，纳入3 027例确诊高血压的中老年患者。通过自报婚姻情况、居住方式、与子女联系和见面情况、社会参与情况及居住地等变量构建社会隔离指数，利用简易流调中心抑郁量表（CES-D）测量抑郁情况，认知功能采用简易精神状态检查表（MMSE）进行测量。使用交叉滞后路径模型和偏差校正Bootstrap法，检验社会隔离与抑郁和认知功能的纵向关系。结果 社会隔离与抑郁呈双向正相关：T1社会隔离可正向预测T2抑郁（B=0.429，P<0.001），T1抑郁也可正向预测T2社会隔离（B=0.012，P<0.001）。抑郁与认知功能呈双向负相关：T1、T2抑郁均可负向预测T2、T3认知功能（B=-0.043，P<0.001；B=-0.038，P<0.001），T1、T2认知功能也可负向预测T2、T3抑郁（B=-0.089，P<0.05；B=-0.049，P<0.05）。T1社会隔离通过T2抑郁完全中介间接导致T3认知功能下降（B=-0.016，95%CI=-0.029~-0.008），总效应显著（B=-0.099，95%CI=-0.195~-0.010）。结论 在中老年高血压患者中，社会隔离与抑郁、抑郁与认知功能间存在双向恶性循环，且早期社会隔离通过抑郁完全中介导致远期认知功能衰退。早期干预社会隔离和抑郁可打破“认知-情绪”脆弱循环，改善中老年高血压患者的健康状况和生活质量。
Abstract
BackgroundThe prevalence of hypertension continues to rise with age in China, and middle-aged and older adults face multiple risks including social isolation, depression, and cognitive decline. However, there remains a lack of systematic understanding regarding the longitudinal interactions among the three factors and their underlying pathways. ObjectiveThis study aims to examine the longitudinal interplay among social isolation, depression, and cognitive function in middle-aged and older adults with hypertension, and to investigate the mediating role of depression in these relationships. MethodsBased on longitudinal data from the 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal StudyCHARLS, this study included 3 027 middle-aged and older adults diagnosed with hypertension. Social isolation was assessed using a composite index based on self-reported marital status, living arrangements, frequency of contact and visits with children, social participation, and place of residence. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression ScaleCES-D, and cognitive function was evaluated using the Mini-Mental State ExaminationMMSE. Cross-lagged panel modeling and bias-corrected bootstrap methods were employed to examine the longitudinal relationships between social isolation, depressive symptoms, and cognitive function. ResultsSocial isolation and depression showed a bidirectional positive correlation: T1 social isolation significantly positively predicted T2 depression (B=0.429, P<0.001), and T1 depression also significantly positively predicted T2 social isolation (B=0.012, P<0.001). Depression and cognitive function showed a bidirectional negative correlation: both T1 and T2 depression significantly negatively predicted T2 and T3 cognitive function (B=-0.043, P<0.001; B=-0.038, P<0.001), and both T1 and T2 cognitive function significantly negatively predicted T2 and T3 depression (B=-0.089, P<0.05; B=-0.049, P<0.05). T1 social isolation indirectly led to T3 cognitive decline through the full mediation of T2 depression (B=-0.016, 95% CI=-0.029 to -0.008), with a significant total effect (B=-0.099, 95% CI=-0.195 to -0.010). ConclusionAmong middle-aged and older adults with hypertension, bidirectional vicious cycles exist between social isolation and depression, as well as between depression and cognitive function. Early social isolation contributes to long-term cognitive decline through the full mediation of depression. Early intervention targeting social isolation and depressive symptoms may help break the cognition-emotion vulnerability cycle and improve the health status and quality of life in middle-aged and older adults with hypertension.关键词
高血压/社会隔离/抑郁/认知功能/交叉滞后模型Key words
Hypertension/Social isolation/Depression/Cognitive function/Cross-lagged model引用本文复制引用
邱文集,罗威,梁海渝,史镇坤,郭航,刘晓君.中老年高血压患者社会隔离、抑郁与认知功能的关系：一项交叉滞后分析[EB/OL].(2026-11-09)[2026-11-10].https://chinaxiv.org/abs/202611.00074.学科分类
基础医学
