【作者】 刘阳；

【导师】 周成超；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2025， 硕士

【摘要】 研究背景抑郁是中国中老年人最常见的慢性心理症状,我国抑郁疾病负担较高,且抑郁患病率随着年龄的增加而升高,同时也会引起慢性病以及全因死亡率的增加。童年不良经历作为最受关注的社会心理逆境因素之一,但是关于其具体如何对中晚年抑郁症状产生影响的潜在机制缺乏纵向研究支持。此外,多部位疼痛已成为一种新型的老年综合症,包括抑郁在内的许多心理和精神因素以及生命早期不良经历已被证实都会增加多部位疼痛的易感性。在不同的研究中,多部位疼痛与抑郁症状的关联并不一致。因此,需进一步研究多部位疼痛与抑郁症状之间关联的具体方向。此外,以往的研究表明,早年遭受的慢性压力可能会增加对多部位疼痛的易感性,并干扰日后对疼痛刺激的反应,这与生命历程理论是一致的。然而,童年不良经历与抑郁症状、多部位疼痛间的潜在作用机制尚未明确。研究目的本研究从生命历程视角出发,了解我国中老年人童年不良经历、多部位疼痛以及抑郁症状的发生现状,基于纵向数据进一步探索童年不良经历、多部位疼痛以及抑郁症状之间的潜在作用机制。明确中老年人出现抑郁症状及多部位疼痛的高风险人群,并梳理抑郁及疼痛管理的干预靶点,为更好地实施“全生命健康周期管理”以及健康老龄化的实现提供借鉴。研究方法本研究使用了中国健康与退休纵向研究(CHARLS)数据库2014年生活史调查以及2018年到2020年随访调查数据。根据本研究的纳入、排除标准,最终纳入7566名中老年人。我们从CHARLS数据集中提取了 12项童年不良经历。多部位疼痛的测量方法是询问受访者是否感到身体任何部位疼痛。本研究使用CESD-10量表的中文版来对抑郁症状进行评估,该工具在中国社区老年人中已被证明具有良好的信效度。对所有研究变量进行了描述性分析。采用Spearman相关分析来初步探索各主要变量之间的关系,并筛选控制变量。采用交叉滞后面板模型来检验童年不良经历、多部位疼痛和抑郁症状之间的潜在机制,并通过在不同性别及不同年龄分组中分别建立交叉滞后模型来进一步检验三者之间的关系。所有分析均采用 Mplus8.3 版(Muthén&Muthén,2017 年)和 Stata16.0 版(StataCorp.)研究结果本研究发现,在7566人中,73.70%的人至少有过一次童年不良经历,12.71%的人报告接触过4次或更多次童年不良经历。本研究中抑郁症状和多部位疼痛的患病率在2018年(T1)分别为34.02%和49.99%,在2020年(T2)分别为49.67%和45.68%。童年不良经历对T1阶段的抑郁症状(Estimated=0.161,P<0.001),对T2阶段的抑郁症状(Estimated=0.037,P<0.05)的差异具有显著性。这说明遭受过童年不良经历的研究对象在晚年出现抑郁症状的风险更高(b=0.037,P<0.001)。同时,童年不良经历对T1阶段的多部位疼痛(Estimated=0.134,P<0.001)的影响有统计学意义,说明童年不良经历可能会增加中老年人患有多部位疼痛的风险。多部位疼痛在童年不良经历与抑郁症状之间的关系中发挥了部分中介作用(b=0.036,P<0.001)。同时,童年不良经历与多部位疼痛之间通过抑郁症状的间接途径(b=0.062,P<0.001)也得到了证实。在不同性别组中,与总人群相比,女性中老年人的童年不良经历对T2阶段抑郁症状的直接效应不显著,但总效应和间接效应仍然显著。男性中老年人童年不良经历对T2阶段抑郁症状的直接效应不显著,但总效应和间接效应仍然显著。在不同年龄组中,与总人群相比,童年不良经历对中年人T2阶段抑郁症状的直接效应不显著,但总效应和间接效应仍然显著。在老年人群中,三者的分析路径相同。结论与建议:结论:本研究发现了我国中老年人的童年不良经历与多部位疼痛、抑郁症状三者之间存在纵向关联。有过童年不良经历的中老年人往往出现多部位疼痛和抑郁症状的风险较高。经历过童年不良经历的人往往会因为更高的多部位疼痛风险而出现抑郁症状,同时,经历过童年不良经历的人往往因抑郁症状的存在而出现更明显的多部位疼痛症状。三者之间的总体机制在不同性别和年龄组中也有所不同。建议:1.加强我国中老年人童年不良经历的筛查和评估。2.注重提高我国中老年人的多部位疼痛和抑郁症状的自我管理水平。3.加强我国中老年人多部位疼痛与抑郁症状的综合管理。更多还原

【Abstract】 BackgroundDepression was a serious and debilitating mental disorder,which was common among middle-aged and older people in China,where the burden of depression is substantial.The prevalence of depression increases with age and is closely linked to a higher risk of chronic diseases as well as all-cause mortality.Adverse childhood experiences(ACEs)was a vital psychosocial risk factor of mental health and physical disorders.However,how ACEs lead to depressive symptoms in later life had not been fully elucidated.In addition,multisite pain had become a novel geriatric syndrome,and many psychological and psychiatric factors such as depression had been proved to increase the risk of multisite pain.The associations between multisite pain and depression were inconsistent in different research.Therefore,the specific direction of the association between multisite pain and depressive symptoms needed to be further clarified.Moreover,previous studies had shown that exposure to chronic stress during early life might enhance susceptibility to the multisite pain,and interfere with responses to painful stimuli in later life,which was consistent with life course theory.However,the specific mechanisms among ACEs,multisite pain,and depressive symptoms still need to be explored.ObjectiveThe aim of this study is to understand the current situation of childhood adverse experiences(ACEs),multisite pain and depressive symptoms in middle-aged and older people from the perspective of life course,and to explore the longitudinal associations between ACEs,multisite pain,and depressive symptoms among middle-aged and older people.Identify the key population of depression and pain management,provide detailed targets and paths for its prevention and control and intervention more clearly,and provide evidence for better implementation of’ whole life health cycle management’ and promotion of healthy aging.MethodsThe current study used data from the CHARLS surveys conducted in 2018 to 2020,and the life history survey conducted in 2014.According to the inclusion and exclusion criteria of this study,7566 middle-aged and older people were included as the study population.We extracted 12 ACEs from the CHARLS dataset.Multisite pain was measured by asking respondents whether they felt pain in any part of their body.This study used Depression Scale(CESD-10)to assess depressive symptoms.This tool has been proven to have good reliability and validity among elderly people in Chinese communities.Descriptive analyses were conducted for all study variables.Spearman correlation analysis were employed to explore the relationship between ACEs,multisite pain and depressive symptoms.And to explore the mediating mechanisms between ACEs,multisite pain,and depressive symptoms,we used two-wave cross-lagged panel models.To further verify the relationship between the three,this study established a cross-lagged model in different gender groups and different age groups to analyze the relationship between ACEs,multisite pain and depressive symptoms,and to compare whether there are different pathways.All the analysis were conducted by Mplus version 8.3(Muthén&Muthén,2017)and Stata version 16.0(Stata Corp.,College Station.TX,USA).ResultA total of 7566 participants were enrolled in this study,73.70%had been exposed to at least 1 ACE,and 12.71%reported 4 or more ACEs exposure.The prevalence rates of depressive symptoms and multisite pain in this study were 34.02%and 49.99%in 2018(T1),and were 49.67%and 45.68%in 2020(T2),respectively.Adverse childhood experiences had statistically significant effects on depressive symptoms at T1(Estimated=0.161,P<0.001)and T2(Estimated=0.037,P<0.05).This indicates that participants with adverse childhood experiences have a higher risk of developing depressive symptoms in later life(b=0.037,P<0.001).Additionally,adverse childhood experiences had a statistically significant impact on multisite pain at T1(Estimated=0.134,P<0.001),suggesting that such ACEs may increase the risk of multisite pain in older people.Multisite pain partially mediated the relationship between ACEs and depressive symptoms(b=0.036,95%CI:0.028,0.043,P<0.001).The indirect pathway between ACEs and multisite pain via depressive symptoms(b=0.062,95%CI:0.051,0.073,P<0.001)was confirmed,simultaneously.In different gender groups,compared with the general population,the direct effect of female middle-aged and older people’s ACEs on T2 depressive symptoms was not significant,but the total effect and indirect effect were still significant.The direct effect of ACEs on T2 depressive symptoms in male middle-aged and older people is not significant,but the total effect and indirect effect are still significant.In different age groups,compared with the general population,the direct effect of ACEs on T2 depressive symptoms in middle-aged people was not significant,but the total effect and indirect effect were still significant.In the older population,the path of analysis between the three is the same.Conclusions and SuggestionsConclusion:The study found that ACEs were longitudinally associated with multisite pain and depressive symptoms among Chinese middle-aged and older people.Individuals with ACEs in the early stage tend to suffer from depressive symptoms because of the deterioration of multisite pain.Meanwhile,depressive symptoms mediated the association between ACEs and multisite pain.And the overall mechanism among the three is different in different genders and age groups.Suggestions:1.Improve the monitoring and early intervention ability of childhood adverse experiences,and strengthen the health management of the whole life cycle.2.Strengthen the precise intervention of depressive symptoms in middle-aged and older people in China.3.Improve the multisite pain identification and management services for middle-aged and older people in China4.The intervention of adverse childhood experiences and the treatment of multisite pain are the key paths of mental health intervention.更多还原