AbstractSocial isolation was associated with emotional problems (depression and anxiety) among older adults, however, little is known in China. Thus, we conducted a cross-sectional study including 6,664 ≥ 65 years older adults in Ningbo, China. We collected data on social isolation, depression, and anxiety by specific scales.

摘要社会隔离与老年人的情绪问题（抑郁和焦虑）有关，然而，在中国知之甚少。因此，我们在中国宁波进行了一项横断面研究，包括6664名≥65岁的老年人。我们通过特定的量表收集了有关社交孤立，抑郁和焦虑的数据。

The relationship between social isolation and emotional problems was estimated by multivariate-adjusted logistic regression models. The population–attributable risk percentage (PAR%) was used to explore the contribution of social isolation to emotional problems. Overall, the percentage of participants who had experienced social isolation, depression, and anxiety was 12.67%, 4.83%, and 2.63%.

社会隔离与情绪问题之间的关系通过多变量调整的逻辑回归模型进行估计。人口归因风险百分比（PAR%）用于探索社会隔离对情绪问题的贡献。总体而言，经历过社交孤立，抑郁和焦虑的参与者比例分别为12.67%，4.83%和2.63%。

Compared with the elderly without social isolation, the adjusted odds ratios (95% confidence interval) of depression and anxiety with social isolation were 1.77 (1.25–2.51) and 1.66 (1.05–2.63), respectively. The PAR analysis showed that 10.66% of depression and 9.03% of anxiety could be attributable to social isolation.

与没有社会隔离的老年人相比，抑郁和焦虑与社会隔离的校正比值比（95%置信区间）分别为1.77（1.25-2.51）和1.66（1.05-2.63）。PAR分析显示，10.66%的抑郁症和9.03%的焦虑可归因于社会隔离。

In the gender subgroup, ORs and PAR% were only significantly observed in female participants. In Chinese older adults, social isolation has been linked to depression and anxiety, suggesting the importance of taking effective and feasible interventions to reduce social isolation and emotional problems, especially among females..

在性别亚组中，仅在女性参与者中观察到OR和PAR%。在中国老年人中，社会隔离与抑郁和焦虑有关，这表明采取有效可行的干预措施以减少社会隔离和情绪问题的重要性，尤其是在女性中。。

IntroductionDepression and anxiety are the most frequent emotional problems experienced by older adults worldwide1. In China, nearly 3.8% and 4.7% of older adults (over 65 years) were reported to suffer from depressive and anxiety disorders, respectively2, resulting in a high burden of disease in this population.

引言抑郁和焦虑是全球老年人最常见的情绪问题1。在中国，据报道，近3.8%和4.7%的老年人（65岁以上）分别患有抑郁症和焦虑症2，导致该人群的疾病负担很高。

Depression and anxiety are generated both by biological factors (e.g., sex, somatic illness, functional disability) and psychosocial factors (e.g., low contact frequency, a childless or unmarried status)3. Changes in some psychosocial factors may reduce emotional problems in older adults3.Social isolation refers to a poor living condition involving a lack of social contact and participation or inadequate social interactions with friends, relatives, and others4.

抑郁和焦虑是由生物因素（例如性别，躯体疾病，功能障碍）和心理社会因素（例如低接触频率，无子女或未婚状态）产生的3。一些心理社会因素的变化可能会减少老年人的情绪问题3。社会孤立是指生活条件差，缺乏社交接触和参与，或者与朋友，亲戚和其他人的社交互动不足4。

Social isolation can be measured by the following variables: whether one lives alone, the frequency of conversations with relatives and friends, and the frequency of participation in social activities5. A study conducted in the United States found that approximately 24.0% of community-dwelling adults older than 65 years old were socially isolated6.

社会隔离可以通过以下变量来衡量：一个人是否独居，与亲戚和朋友的对话频率以及参与社会活动的频率5。在美国进行的一项研究发现，大约24.0%的65岁以上的社区居民被社会隔离6。

Two studies conducted in China showed that the prevalence of social isolation was 29.7% among community-dwelling older adults in Qingdao7 and 28.9% among their counterparts in Shanghai8.Studies generally have recognized the profound negative effect of social isolation on physical and mental health9,10.

在中国进行的两项研究表明，青岛市社区老年人的社会隔离率为29.7%，上海市为28.9%。研究普遍认识到社会隔离对身心健康的深远负面影响9,10。

The longitudinal Aging Social Survey found that social isolation independently determined the probability of depression in both China11 and the Netherlands12. A study in Ireland13 found that objective social isolation independently affected the process of depression or anxiety. However, no study has explored the proportion of cases of depression and anxiety that.

纵向老龄化社会调查发现，社会隔离独立决定了中国11和荷兰12患抑郁症的可能性12。爱尔兰的一项研究13发现，客观的社会隔离独立影响抑郁或焦虑的过程。然而，没有研究探讨抑郁症和焦虑症的比例。

ResultsIn total, 6,664 community-dwelling older adults were recruited for this study (response rate was 84.9%), of whom 45.50% were men. In Table 1, the men were significantly older than the women (72.89 ± 6.25 vs. 72.40 ± 6.05 years, P = 0.001). The percentages of participants who were current alcohol drinkers and smokers were higher among men than among women (Table 1).

结果本研究共招募6664名社区老年人（有效率为84.9%），其中男性占45.50%。在表1中，男性显着高于女性（72.89±6.25比72.40±6.05岁，P=0.001）。男性目前饮酒和吸烟者的比例高于女性（表1）。

The percentage of participants who participated in physical activity more than 3 times/week was lower among men than among women (Table 1). Compared with women, men had better sleep disturbance and sleep duration status (P < 0.001 for both) (Table 1)..

男性每周参加体育锻炼超过3次的参与者比例低于女性（表1）。与女性相比，男性的睡眠障碍和睡眠持续时间状况更好（两者均P<0.001）（表1）。。

Table 1 Baseline characteristics in men and women.Full size tableOverall, 12.67% of the participants reported that they had experienced social isolation, and the rate of social isolation was significantly higher among women than among men (15.66% vs. 9.10%, P < 0.05, Fig. 1). The prevalence of depression and anxiety among the participants was 4.83% and 2.63%, respectively.

表1男性和女性的基线特征。全尺寸表总体而言，12.67%的参与者报告说他们经历了社会隔离，女性的社会隔离率显着高于男性（15.66%比9.10%，P<0.05，图1）。参与者中抑郁和焦虑的患病率分别为4.83%和2.63%。

Univariate logistic regression analysis showed that age, sedentary, sleep disturbance, social isolation, and more diseases were significantly positively linked with depression and anxiety. Meanwhile, higher pension income, being in marital status, physical activity, longer sleep duration, healthy diet, and self-rated health were significantly negatively linked with depression and anxiety (Fig. 2).Figure 1The percentage of isolation (A), anxiety and depression (B) in the gender group among over 65 years old Chinese.Full size imageFigure 2The association factors of anxiety and depression by univariate logistic regression analysis.Full size imageMultivariate logistic regression analysis showed that older adults who had experienced social isolation were 1.77 times more likely to have depression than those who were not socially isolated (AOR = 1.77, 95% confidence interval [CI]: 1.25–2.51, P < 0.001, Table 2).

单因素logistic回归分析显示，年龄，久坐，睡眠障碍，社交孤立和更多疾病与抑郁和焦虑显着正相关。同时，较高的养老金收入，婚姻状况，体育锻炼，更长的睡眠时间，健康的饮食和自我评估的健康状况与抑郁和焦虑显着负相关（图2）。图1 65岁以上中国人性别组中孤立（A）、焦虑和抑郁（B）的百分比。全尺寸图像图2通过单变量逻辑回归分析分析焦虑和抑郁的关联因素。全尺寸图像多变量logistic回归分析显示，经历过社交孤立的老年人患抑郁症的可能性是未经历社交孤立的老年人的1.77倍（AOR=1.77，95%置信区间[CI]:1.25-2.51，P<0.001，表2）。

Social isolation also was significantly associated with an increased likelihood of anxiety in older adults (AOR = 1.66, 95% CI: 1.05–2.63, P = 0.029, Table 2) after controlling for multiple variables. However, no significant associations of social isolation with depression and anxiety were observed in male participants [AOR (95% CI) = 1.42 (0.77–2.58) and 0.98 (0.42–2.26), respectively; P > 0.05 for both].

在控制多个变量后，社会隔离也与老年人焦虑的可能性增加显着相关（AOR=1.66，95%CI:1.05-2.63，P=0.029，表2）。然而，在男性参与者中没有观察到社会隔离与抑郁和焦虑的显着关联[AOR（95%CI）=1.42（0.77-2.58）和0.98（0.42-2.26）；两者均P>0.05]。

In contrast, female participants who had experienced social isolation were 1.99 and 1.92 times .

相比之下，经历过社会隔离的女性参与者分别是1.99倍和1.92倍。

Table 2 The multivariate adjusted association between social isolation and anxiety and depression.Full size tableThe results regarding the adjusted PAR% for social isolation are shown in Table 3. Among our participants, the PAR% related to social isolation was as high as 10.66% and 9.03% for depression and anxiety, respectively.

表2社会隔离与焦虑和抑郁之间的多变量调整关联。全尺寸表关于社会隔离调整后的PAR%的结果如表3所示。在我们的参与者中，与社交孤立相关的PAR%分别高达抑郁和焦虑的10.66%和9.03%。

Besides, the adjusted PAR% related to social isolation were as high as 15.12% and 12.84% for depression and anxiety in women. The adjusted PAR% of social isolation were no statistical significance for depression and anxiety in men (Table 4)..

此外，女性抑郁和焦虑与社会隔离相关的调整后PAR%高达15.12%和12.84%。调整后的社交隔离率对男性抑郁和焦虑无统计学意义（表4）。。

Table 3 The multivariate adjusted population attributable risk of social isolation for depression and anxiety.Full size tableTable 4 The multivariate adjusted population attributable risk of social isolation for depression and anxiety by sex.Full size tableDiscussionThis study investigated the prevalence of social isolation, depression, and anxiety in a sample of community-dwelling older adults in Ningbo, China.

表3抑郁和焦虑的社会隔离的多变量调整人群归因风险。全尺寸表4按性别对抑郁和焦虑的社会隔离的多变量调整人群归因风险。全尺寸表格讨论本研究调查了中国宁波社区老年人样本中社交孤立，抑郁和焦虑的患病率。

Overall, 12.67% of the participating older adults reported having experienced social isolation, and the prevalence of depression and anxiety in this population was 4.83% and 2.63%, respectively. The participants who had experienced social isolation were more likely to have depression and anxiety than those who were not socially isolated.

总体而言，12.67%的参与老年人报告称经历过社会隔离，该人群的抑郁和焦虑患病率分别为4.83%和2.63%。经历过社交孤立的参与者比那些没有社交孤立的参与者更容易患抑郁症和焦虑症。

Furthermore, our results shed light on some key intermediate factors that affected the relationship between social isolation and increased risks of depression and anxiety.The participants who had experienced social isolation had 1.77 and 1.66 times greater odds of having depression and anxiety than those who were not socially isolated, which was congruent with the findings of earlier studies.

此外，我们的研究结果揭示了影响社会隔离与抑郁和焦虑风险增加之间关系的一些关键中间因素。经历过社交孤立的参与者患抑郁症和焦虑症的几率是没有社交孤立的参与者的1.77倍和1.66倍，这与早期研究的结果一致。

For example, in a study of Irish older adults, the lowest level of social isolation was associated with a 43% and 52% probability of depression or anxiety13. Furthermore, social disconnectedness could predict an increase in subsequent depression and anxiety symptoms due to an increase in perceived isolation among older adults in the United States29.

例如，在一项针对爱尔兰老年人的研究中，最低程度的社会隔离与43%和52%的抑郁或焦虑概率相关13。此外，由于美国老年人的孤立感增加，社交脱节可以预测随后的抑郁和焦虑症状的增加29。

Moreover, social isolation at baseline predicted higher depression and anxiety scores at follow-up (incidence rate ratio = 1.35 and 1.32, respectively) in a study of older adults in Shanghai8. As we have seen, it does seem depressive symptoms are understudied in the elderly in social isolation s.

此外，在上海的一项老年人研究中，基线时的社会隔离预示着随访时抑郁和焦虑评分较高（发病率分别为1.35和1.32）。正如我们所看到的，在社会隔离的老年人中，抑郁症状似乎没有得到充分研究。

Data availability

数据可用性

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Affiliated Kangning Hospital of Ningbo University.

由于敏感性的原因，支持本研究结果的数据无法公开获得，并且可以根据合理的要求从通讯作者那里获得。数据位于宁波大学附属康宁医院的受控访问数据存储中。

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Download referencesAcknowledgementsThe authors express their gratitude to the doctors from the office of Mental health and the community health service center who were involved in the data collection.FundingThis work was supported by the Ningbo Medical & Health Leading Academic Discipline Project (2022-F28), Ningbo Top Medical and Health Research Program (2022030410) and Ningbo Medical and Health Brand Discipline (PPXK2018-08).Author informationAuthors and AffiliationsDepartment of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, 315201, Zhejiang, ChinaLian Li, Kaijie Pan, Jincheng Li, Hongying Yang & Guolin BianDepartment of Psychiatry, Ningbo Kangning Hospital, Ningbo, 315201, Zhejiang, ChinaLian Li, Kaijie Pan, Jincheng Li, Hongying Yang & Guolin BianFenghua District Center for Disease Control and Prevention, Ningbo, 315500, ChinaMeiqin JiangThird People’s Hospital of Xiangshan, Xiangshan Hospital of Traditional Chinese Medicine Group, Ningbo, 315725, ChinaYan GaoAuthorsLian LiView author publicationsYou can also search for this author in.

下载参考文献致谢作者对参与数据收集的心理健康办公室和社区卫生服务中心的医生表示感谢。资助这项工作得到了宁波市医疗卫生领先学科项目（2022-F28），宁波市顶级医疗卫生研究计划（2022030410）和宁波市医疗卫生品牌学科（PPXK2018-08）的支持。作者信息作者和附属机构宁波大学附属康宁医院精神病学系，宁波，315201，浙江，李华莲，潘开杰，李金城，杨红英和郭琳边区精神科，宁波康宁医院，宁波，315201，浙江，李华莲，潘开杰，李金城，杨红英和郭琳边区疾病预防控制中心，宁波，315500，中国梅琴江山第三人民医院，象山中医院，宁波，315725，中国Yan GaoAuthorsLian LiView作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsL.L. conceived and designed the study, performed the statistical analysis, and drafted the article. K.P., J.L., M.J., and Y.G. collected the data. Hongying Yang and Guolin Bian contributed to the study design and the article’s critical revision.

PubMed谷歌学术贡献l。五十、 构思并设计了这项研究，进行了统计分析，并起草了这篇文章。K、 P.，J.L.，M.J。和Y.G.收集了数据。杨红英和边国林为研究设计和文章的批判性修订做出了贡献。

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Reprints and permissionsAbout this articleCite this articleLi, L., Pan, K., Li, J. et al. The associations of social isolation with depression and anxiety among adults aged 65 years and older in Ningbo, China.

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