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获奖论文标题：《老年人孤独感与全因死亡率联系的元分析》
Psychiatry Research, Article 115430. Vol 328, Oct. 2023. 《精神病学研究》文章# 115430. 第328卷，2023年10月 作者：周翔，阳方，高有融（上海大学社会学院社会工作系） 摘要：尽管孤独感与老年人全因死亡率之间有着公认的联系，但这种联系在不同性别的老年人中是否仍然存在，以及是否受到不同样本和研究特征的影响，目前尚不清楚。因此，这项元分析旨在检验老年人孤独感与全因死亡率之间联系的调节因素。因此，在PubMed、Embase、PsycINFO、Web of Science、中国知网、维普数据库和万方数据库（起始至2023年5月）检索相关文献，并在CMA 3.3软件中进行分析。此外，为探究异质性的来源，进行了亚组分析，同时检验了潜在的调节变量。漏斗图、Begg检验和Egger线性回归检验用于检验发表偏倚，敏感性分析用于检验结果的稳健性。这项元分析包括36项研究，涉及12,8927名老年人。总体来看，孤独感与老年人全因死亡率的增加显著相关（HR=1.09，95% CI=1.06–1.12，I2=63.31%，p<0.001），对老年男性的总体影响大小为1.18（95% CI=1.04–1.33，p=0.010）。孤独感与全因死亡率之间的联系受数据来源国家、随访时间以及慢性病作为协变量的影响。总之，老年人的孤独感值得更多关注，需要提供服务来改善他们的心理健康。 关键词：老年人 孤独感 全因死亡率 元分析 获奖论文选摘：（英译中，自动翻译，仅作参考） 孤独是一种不愉快的主观体验，由个人社会关系网络的缺陷引起，无论是数量上还是质量上（Perlman & Peplau，1981）。与其他年龄组相比，老年人经历孤独的风险明显更高。孤独的风险随着年龄、丧偶、健康状况下降、行动限制、社会联系减少以及社会经济资源缺乏而增加（Fakoya, McCorry, & Donnelly, 2020；Kemperman, 2019；Pinquart & Sörensen, 2003）。最近，由于 COVID-19 大流行而实施的社会限制和封锁减少了老年人的社会联系，增加了他们的社会孤立和孤独感（Wu，2020）。因此，孤独感在老年人中变得越来越普遍。 对29个国家老年人的元分析显示，孤独感总体患病率为 28.5%，75 岁以上老年人孤独感患病率达到 31.3%（Chawla 等，2021）。在 11个国家居住在寄养院和疗养院的老年人中，中度孤独感的平均发生率为 61%，重度孤独感的平均发生率估计为 35%（Gardiner 等，2020）。过去几十年来，中国经历了广泛的社会和经济转型，其特点是人口流动加速、传统家庭规模缩小、传统孝道受到侵蚀。这些发展引发了空巢老人数量的增加和孤独感的增加（Yan 等，2014；Yang、Zhang 和 Wang，2018）。 在老年人中，孤独已被确定为抑郁症（Bodner & Bergman，2016；Gan et al.，2015）、认知障碍（Zhou et al.，2018）、主观幸福感下降（Ong、Uchino & Wethington 2016）、睡眠障碍（Qi 等人，2023）、生活质量下降（Doci、Hosak 和 Kovarova，2003 年；Liu 和Guo，2007 年）以及自杀倾向（de Mendonça Lima 等人，2021 年；Niu 等人，2020）。老年人孤独感的负面后果给养老服务和医疗资源带来了额外的挑战。 除了上述孤独感的不良影响外，许多研究试图将孤独感与老年人的死亡率联系起来（Drageset et al., 2013; Holwerda et al., 2012; O´Súilleabháin Gallagher & Steptoe, 2019; Wang et al., 2020 ）。但学者们尚未达成共识。例如，一些纵向研究（Holwerda et al., 2012；Newall et al., 2013；O´Súilleabháin et al., 2019；Zhen, Feng, & Gu, 2015）报告称，孤独感表明老年人死亡率较高 。相比之下，其他研究（Cuijpers，2001；Drageset 等，2013；Pitkala 等，2004；Shahtahmasebi、Davies 和 Wenger，1992；Stek 等，2005；Stessman 等，2014；Tilvis 等。，2012；Tilvis 等，2012；Wang 等，2020；Yu 等，2020）不支持老年人孤独感与死亡率之间的关联。因此，现有研究结果之间的冲突促使我们进一步研究这种关联。 之前的元分析（Holt-Lunstad 等，2015；Rico-Uribe 等，2018；Schutter 等，2022）已证实孤独会增加死亡率。然而，还有几个问题有待解决。首先，就年龄而言，Holt-Lunstad 等人。(2015) 涵盖了 28 岁至 92 岁的参与者，并没有将他们的分析限于老年人。同样，Rico-Uribe 等人。(2018) 在他们的元分析中，并没有将分析限于老年人，他们纳入了 35 项涉及 18 岁以上成年人的研究。相反，Schutter 等人。(2022) 在元分析中针对 60 岁及以上的老年人；然而，这项研究需要进一步丰富，因为最近的出版物报道了更多关于老年人的数据（Liu＆Guo，2022；Wei等人，2022；Yu，Steptoe，＆Chen，2022）。此外，文献中也得到了相互矛盾的结果。例如，Liu＆Guo（2022）和Wei等人。（2022）发现老年人的孤独感是死亡的一个重要危险因素。然而，Yu 等人。（2022）观察到，在调整健康指标和低心理健康水平时，孤独感和死亡率之间的关联并不显箸。其次，现有的元分析，例如 Holt-Lunstad 等人。（2015 年；I2 = 97.8%），Schutter 等人。（2022 年；I2 = 72%），以及 Rico-Uribe 等人。（2018；I2 = 94.4%），报告高度异质性。随着异质性的增加，从元分析中得出正确推论的可能性会降低（Melsen et al., 2014）。尽管舒特等人。(2022) 试图根据协变量和 NOS 量表标准来解释异质性的来源，一些亚组的异质性较高 (76-81%)。第三，虽然 Rico-Uribe 等人的元分析。(2018) 报告了 d 参与者的孤独感和死亡率之间的关联。 获奖论文选摘：（英文原文） Loneliness is an unpleasant subjective experience caused by deficiencies in an individual’s network of social relationships, either quantitatively or qualitatively (Perlman & Peplau, 1981). Compared to other age groups, older adults experience a significantly higher risk of loneliness. The risk of loneliness increases with age, widowhood, declining health, mobility restrictions, reduced social connections, and lack of socioeconomic resources (Fakoya, McCorry, & Donnelly, 2020; Kemperman, 2019; Pinquart & Sörensen, 2003). Recently, the social restrictions and lockdowns imposed due to the COVID-19 pandemic have reduced the social connection of older adults and increased their social isolation and loneliness (Wu, 2020). Therefore, loneliness is becoming increasingly common among older adults. A meta-analysis of older adults in 29 countries shows that the overall prevalence of loneliness is 28.5%, and the prevalence of loneliness reaches 31.3% among older adults aged over 75 (Chawla et al., 2021). The average incidence of moderate loneliness is 61% among older adults living in residential and nursing care homes in 11 countries, and the average prevalence of severe loneliness is estimated to be 35% (Gardiner et al, 2020). In the past few decades, China has experienced wide-ranging social and economic transitions, characterized by the acceleration of population mobility, contraction in the size of the traditional family, and erosion of traditional filial piety. These developments have triggered an increase in the number of empty nesters and a rise in the prevalence of loneliness (Yan et al., 2014; Yang, Zhang, & Wang, 2018). In older adults, loneliness has been identified as a risk factor for depression (Bodner & Bergman, 2016; Gan et al., 2015), cognitive impairment (Zhou et al., 2018), decreased subjective well-being (Ong, Uchino & Wethington 2016), sleep disorders (Qi et al., 2023), reduced quality of life (Doci, Hosak, & Kovarova, 2003; Liu & Guo, 2007), and suicidal tendency (de Mendonça Lima et al., 2021; Niu et al., 2020). The negative consequences of loneliness in older adults pose additional challenges for old-age care services and medical resources. In addition to the aforementioned undesirable effects of loneliness, numerous studies have attempted to link loneliness with mortality in older adults (Drageset et al., 2013; Holwerda et al., 2012; OʼSúilleabháin Gallagher & Steptoe, 2019; Wang et al., 2020). However, scholars have not reached a consensus yet. For example, some longitudinal studies (Holwerda et al., 2012; Newall et al., 2013; OʼSúilleabháin et al., 2019; Zhen, Feng, & Gu, 2015) report that loneliness is indicative of a higher mortality rate among older adults. In contrast, other studies (Cuijpers, 2001; Drageset et al., 2013; Pitkala et al., 2004; Shahtahmasebi, Davies & Wenger, 1992; Stek et al., 2005; Stessman et al., 2014; Tilvis et al., 2012; Tilvis et al., 2012; Wang et al., 2020; Yu et al., 2020) do not support the association between loneliness and mortality among older adults. Therefore, the conflict between existing research findings led us to further investigate this association. Previous meta-analyses (Holt-Lunstad et al., 2015; Rico-Uribe et al., 2018; Schutter et al., 2022) have confirmed that loneliness can increase mortality. However, several issues are yet to be addressed. First, in terms of age, Holt-Lunstad et al. (2015) covered participants ranging from 28 to 92 years old and did not limit their analysis to older adults. Similarly, Rico-Uribe et al. (2018), in their meta-analysis, did not limit the analysis to older adults, and they included 35 studies involving adults over the age of 18. Conversely, Schutter et al. (2022) targeted older adults aged 60 and above in their meta-analysis; however, this study needs to be enriched, as more data on older adults have been reported in recent publications (Liu & Guo, 2022; Wei et al., 2022; Yu, Steptoe, & Chen, 2022). Moreover, conflicting results have been obtained in the literature. For example, Liu & Guo (2022) and Wei et al. (2022) found that loneliness in older adults was an important risk factor for mortality. However, Yu et al. (2022) observed that the association between loneliness and mortality was not significant when adjusting for health indicators and low mental health levels. Second, existing meta-analyses, such as Holt-Lunstad et al. (2015; I2 = 97.8%), Schutter et al. (2022; I2 = 72%), and Rico-Uribe et al. (2018; I2 = 94.4%), report high heterogeneity. With an increase in heterogeneity, the possibility of drawing correct inferences from a meta-analysis decreases (Melsen et al., 2014). Although Schutter et al. (2022) attempted to account for the sources of heterogeneity in terms of covariates and NOS scale criteria, heterogeneity was higher in some subgroups (76–81%). Third, although the meta-analysis by Rico-Uribe et al. (2018) reported the association between loneliness and mortality among participants of different sex, these participants were not older adults. The association between loneliness and mortality remains unknown for older men and women. Additionally, studies have reported contradictory results on the association between loneliness and mortality in older women and men. For example, several studies have found that loneliness does not increase the risk of mortality in both older men and women (Novak et al., 2020; Tilvis et al., 2012; Yu et al., 2022). Other studies have found that loneliness is significantly associated with an increased risk of mortality in older men, but this relationship is not statistically significant in older women (Holwerda et al., 2012; Olsen et al., 1991). However, Meller et al. (2004) and Ng et al. (2021) found that loneliness increased the mortality of only older women. In short, given the sex-based differences in the effects of loneliness, the association between loneliness and mortality in different sex deserves more research. Finally, the studies included in the previous meta-analyses varied in characteristics such as the countries of participants, the tools used to assess loneliness, the length of follow-up, and the selection of control variables. Whether these differences affect the association between loneliness and mortality is unclear. Therefore, more in-depth research in these areas, especially the examination of moderating variables, is needed to bridge the gaps in previous meta-analyses and update the findings with more recent studies. 获奖论文英文标题: A meta-analysis of the association between loneliness and all-cause mortality in older adults Author：Xiang Zhou, Fang Yang, Yourong Gao （Department of Social Work, School of Sociology and Political Science, Shanghai University） Abstract: Despite the well-established association between loneliness and all-cause mortality in older adults, it remains unknown whether this association holds for older adults of different sex and whether it is influenced by different samples and study characteristics. Thus, this meta-analysis aims to examine moderators of the association between loneliness and all-cause mortality in older adults. To this end, relevant literature was retrieved from the PubMed, Embase, PsycINFO, Web of Science, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases (inception to May 2023) and was processed in the Comprehensive Meta-Analysis 3.3 software. Moreover, subgroup analysis was performed to explore the sources of heterogeneity and further explore potential moderators. Funnel plots, Begg's test, and Egger's linear regression test were used to examine the publication bias, and sensitivity analysis was used to test the robustness of the results. Thirty-six studies involving 128,927 older adults were included in this meta-analysis. In general, loneliness was related to an increase in all-cause mortality in older adults (HR = 1.09, 95% CI = 1.06–1.12, I2 = 63.31%, p < 0.001). The overall effect size for older men was 1.18 (95% CI = 1.04–1.33, p = 0.010). The association between loneliness and all-cause mortality was found to be significantly influenced by the source country of the data, follow-up length, and covariates for chronic disease as moderators. In conclusion, loneliness among older adults deserves more attention, and services are needed to improve their mental health. Keywords: Older adults, Loneliness, All-cause mortality, Meta-analysis 作者简介：周翔，上海大学社会学院2022级博士研究生；阳方，上海大学社会学院副教授，博士生导师；高有融，上海大学社会学院2023级博士研究生 获奖感言： 老年人孤独感不仅是老年人自身的心理情感问题，也是一个不可忽视的社会问题，其形成的原因涉及老年人自身、社会结构与文化背景等多方面因素。既有研究在孤独感对老年人死亡的影响上存在较大争议，本研究利用元分析技术对现有研究进行综合分析以获得更高质量的新证据。本研究的想法正是来源于此。 感谢导师的支持与帮助，感谢孙嘉明教授和上海大学社会学院“孙嘉明奖学金”对本项研究的鼓励。今后将继续在老年社会学领域深挖、耕耘，心系社会、志在利民，希望能够做出更为出色的研究。
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