Table_1_Regional differences in the effects of healthy aging on depressive symptoms: a Korean longitudinal study of aging (2006–2020).DOCX

BackgroundDepression is a widely prevalent, often recurrent condition. To analyze the regional differences in depressive symptoms over time, we investigated urban–rural differences in change in depression over time in South Korea and the association between healthy aging and depressive symptoms among middle-aged and older adults.MethodsData collected in the Korean Longitudinal Study of Aging, from 2006 to 2020, of adult participants aged ≥45 years without depressive symptoms were analyzed. Healthy aging was defined under five principal components: absence of chronic disease, good physical function, normal cognitive function, active social engagement, and good psychological adaptation. Depressive symptoms were measured using the short version of the Center for Epidemiologic Studies Depression Scale. Using the Andersen-Gill model for recurrent time-to-event, we examined the effect of healthy aging on depressive symptoms, with a subgroup analysis based on the residential area.ResultsOf the 7,708 participants, 78.2% lived in urban areas and 39.4% achieved healthy aging. In 2008, rural residents had a higher incidence of depressive symptoms (rural 11.8%; urban 8.9%); however, after 2016, the depressive symptoms of urban residents gradually increased (rural 6.4%; urban 12.1%). Unhealthy aging (adjusted hazard ratio = 3.04, 95% confidence interval: 2.72–3.39) and urban residence (adjusted hazard ratio = 1.15, 95% confidence interval: 1.06–1.24) were risk factors for depressive symptoms. The subgroup analysis revealed that individuals who did not achieve healthy aging had an increased risk of depressive symptoms, regardless of their residential area (hazard ratio [95% confidence interval]: urban, 3.13 [2.75–3.55]; rural 2.59 [2.05–3.28]).ConclusionAs urbanization accelerates, urban residents have a higher risk of depressive symptoms than rural residents. Healthy aging is an essential factor in reducing depressive symptoms. To achieve healthy aging, appropriate interventions and policies that target the middle-aged adults and gradually extend to older adults are needed, considering individual and regional factors.

背景：抑郁情绪是一种普遍存在且常常反复发作的病症。为分析随时间推移的抑郁症状的地域差异，本研究探讨了韩国城乡在抑郁症状随时间变化上的差异，以及健康老龄化与中年及老年人群抑郁症状之间的关联。方法：分析了2006年至2020年间，韩国长期老龄化研究中，无抑郁症状的45岁及以上成年参与者的数据。健康老龄化被定义为以下五个主要组成部分：无慢性疾病、良好的生理功能、正常的认知功能、积极的社交参与和良好的心理适应。抑郁症状通过流行病学研究中心抑郁量表的简版进行测量。采用Andersen-Gill模型对复发的时间至事件进行分析，考察了健康老龄化对抑郁症状的影响，并根据居住地进行了亚组分析。结果：在7,708名参与者中，78.2%居住在城市地区，39.4%实现了健康老龄化。2008年，农村居民的抑郁症状发生率较高（农村11.8%，城市8.9%）；然而，自2016年起，城市居民的抑郁症状逐渐增加（农村6.4%，城市12.1%）。不健康老龄化（调整后的风险比=3.04，95%置信区间：2.72–3.39）和城市居住地（调整后的风险比=1.15，95%置信区间：1.06–1.24）是抑郁症状的风险因素。亚组分析显示，未实现健康老龄化的人群，无论其居住地如何，抑郁症状的风险均有所增加（风险比[95%置信区间]：城市，3.13[2.75–3.55]；农村，2.59[2.05–3.28]）。结论：随着城市化进程的加速，城市居民的抑郁症状风险高于农村居民。健康老龄化是降低抑郁症状的重要因素。为实现健康老龄化，需要采取针对中年人群并逐步扩展至老年人群的适当干预措施和政策，同时考虑个体和地区因素。