社会支持对老年维持性血液透析患者抑郁症状影响的研究

doi:10.3761/j.issn.0254-1769.2025.19.005

摘要/Abstract

摘要：

目的探讨社会支持对老年维持性血液透析患者抑郁症状的影响及阈值效应，为改善患者抑郁状况提供依据。方法便利选取2024年10月—2025年2月昆山市3所综合医院血液透析中心的440例老年维持性血液透析患者作为调查对象。采用一般资料调查表、社会支持评定量表、简版老年抑郁量表进行调查，通过Logistic回归及阈值效应分析其影响因素及影响程度。结果回收有效问卷432份，有效问卷回收率为98.18%。老年维持性血液透析患者抑郁检出率为27.78%，社会支持量表得分为（32.53±5.58）分，处于中等水平。Logistic回归分析结果显示：助行工具、透析模式、婚姻状况、社会支持及血管通路类型是老年维持性血液透析患者抑郁症状的主要影响因素（P<0.05）。限制性立方样条结果提示社会支持和抑郁症状呈非线性关系（P<0.001），阈值效应分析表明，社会支持得分≥23分时抑郁症状随社会支持得分的增加而减轻（P<0.05）。结论社会支持对老年维持性血液透析患者抑郁症状的影响存在临界阈值，提示临床医护人员需优先干预低社会支持患者，通过提升社会支持水平改善其身心健康及生活质量。

关键词: 老年人, 维持性血液透析, 社会支持, 抑郁, 阈值效应, 影响因素分析, 护理

Abstract:

Objective This study aims to explore the influence of social support on depressive symptoms and its threshold effect in elderly patients undergoing maintenance hemodialysis（MHD），thereby providing a basis for improving patients’ depressive conditions. Methods A convenience sample of 440 elderly MHD patients was recruited from the hemodialysis centers of 3 general hospitals in Kunshan between October 2024 and February 2025. Data collection involved the use of a general information questionnaire，the Social Support Rating Scale（SSRS），and the Short Form Geriatric Depression Scale（GDS-15）. Logistic regression and threshold effect analyses were conducted to identify influencing factors and assess their impact. Results A total of 432 valid questionnaires were recovered，yielding a response rate of 98.18%. The prevalence of depressive symptoms among elderly MHD patients was 27.8%，with an average social support score of 32.53 ± 5.58，indicating a moderate level of social support. Logistic regression analysis revealed that the use of assistive devices，dialysis modality，marital status，social support，and type of vascular access were significant factors influencing depressive symptoms（P<0.05）. Restricted cubic spline analysis indicated a non-linear relationship between social support and depressive symptoms（P<0.001）. Threshold effect analysis showed that when the social support score was ≥23，depressive symptoms decreased as the social support score increased（P<0.05）. Conclusion The impact of social support on depressive symptoms in elderly MHD patients has a critical threshold. This finding suggests that clinical healthcare providers should prioritize interventions for patients with low social support to improve their physical and mental health and quality of life by enhancing social support levels.

Key words: Aged, Maintenance Hemodialysis, Social Support, Depression, Threshold Effect, Root Cause Analysis, Nursing Care

陆沁怡, 金学勤. 社会支持对老年维持性血液透析患者抑郁症状影响的研究[J]. 中华护理杂志, 2025, 60(19): 2333-2339.

LU Qinyi, JIN Xueqin. The influence of social support on depressive symptoms among elderly maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2025, 60(19): 2333-2339.

图/表 5

表1 老年维持性血液透析患者的一般资料及抑郁症状的单因素分析

Table 1 Univariate analysis of general characteristics and depressive symptoms in elderly patients undergoing maintenance hemodialysis

表2 自变量赋值方式

Table 2 Assignment of independent variables

表3 老年维持性血液透析患者抑郁症状的Logistic回归分析结果（n=432）

Table 3 Logistic regression analysis results of depressive symptoms in elderly patients undergoing maintenance hemodialysis（n=432）

图1 社会支持与抑郁症状的限制性立方样条曲线

Figure 1 RCS curve for social support and depressive symptoms

表4 社会支持与抑郁症状关系的阈值效应分析结果（n=432）

Table 4 Threshold effects of social support on depressive symptoms（n=432）

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