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Abstract：
Studies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults.
Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes\' PROCESS macro (Model 7).
HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents.
The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.
Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes\' PROCESS macro (Model 7).
HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents.
The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.
摘要：
背景：研究表明，老年人的家庭和社区医疗保健服务（HCBHS）利用与抑郁症状密切相关。然而,在中国农村，还没有研究探索这种关系的潜在机制。这项研究旨在评估日常生活工具活动（IADL）和婚姻状况在中国农村老年人HCBHS利用与抑郁症状之间的关系中的作用。
方法：数据来自2018年中国健康与退休纵向研究，纳入5,981名农村受访者(≥60岁)。使用十项流行病学研究中心抑郁量表计算抑郁评分。应用Hayes\'过程宏（模型7）进行了调节中介分析。
结果：使用HCBHS对抑郁症状具有直接和负面影响。此外，婚姻状况调节了HCBHS利用率和IADL之间的关联，这属于上半年对HCBHS利用与抑郁症状之间关联的间接影响。在单身但已婚受访者中，HCBHS利用率与IADL相关。
结论：结果表明，婚姻状况调节了HCBHS使用率与抑郁症状之间的间接关系，在单身但非已婚受访者中，HCBHS利用率与IADL呈负相关。政府应该关注农村老年人，尤其是那些单身且IADL功能较差的人，改善HCBHS的供应以缓解抑郁症状。
方法：数据来自2018年中国健康与退休纵向研究，纳入5,981名农村受访者(≥60岁)。使用十项流行病学研究中心抑郁量表计算抑郁评分。应用Hayes\'过程宏（模型7）进行了调节中介分析。
结果：使用HCBHS对抑郁症状具有直接和负面影响。此外，婚姻状况调节了HCBHS利用率和IADL之间的关联，这属于上半年对HCBHS利用与抑郁症状之间关联的间接影响。在单身但已婚受访者中，HCBHS利用率与IADL相关。
结论：结果表明，婚姻状况调节了HCBHS使用率与抑郁症状之间的间接关系，在单身但非已婚受访者中，HCBHS利用率与IADL呈负相关。政府应该关注农村老年人，尤其是那些单身且IADL功能较差的人，改善HCBHS的供应以缓解抑郁症状。
