The Relationship Between Physical Frailty And Depressive Symptoms:the Mediating And Moderating Role Of Social Support

ObjectiveTo explore the relationship between frailty and depressive symptoms among Chinese community-dwelling older adults;to explore the mediating role of three dimensions of social support(objective support,perceived support and support utilization)in the relationship of frailty and depressive symptoms and their interaction with frailty on depressive symptoms among community-dwelling older adults.MethodsA total of 1779 community-dwelling older adults aged 60 years and older were recruited from August 2015 to December 2016 in Jinan city,Shandong province.Depressive symptoms,frail status,and social support were measured by the 5-Item Geriatric Depression Scale(GDS-5),the Physical Frailty Phenotype(PFP)and the Social Support Rating Scale(SSRS),respectively.In addition,a self-designed questionnaire was used to collect socio-demographic data,a 1-item question was used to measure chronic diseases,and the Short Portable Mental Status Questionnaire(SPMSQ)was used to assess cognitive function.Descriptive analysis,t-test,?2 test,multivariate logistic regression,multivariate liner regression,simple slope analysis and Johnson-Neyman technique were conducted using SPSS 22.0 and STATA 15.0.The bias-corrected non-parametric percentile Bootstrap method was used to examine the mediating effect of social support between frailty and depressive symptoms.Results1.Of the 1779 participants,11.6%reported the prevalence of depression.The prevalence of pre-frailty and frailty were 40.4%and 4.4%,respectively,whereas robust 55.2%.2.The univariate analysis showed that,compared to older adults without depression,those with depression had a higher prevalence of frailty(P<0.001)and were more likely to report less objective support(P<0.001).perceived support(P<0.001)and support utilization(P<0.001).In addition,older adults with depression were more likely to be female(P = 0.041),obtain less years of schooling(P = 0.011).have lower monthly income(P = 0.011),and have higher probability of developing diseases(P<0.001).3.The results of Logistic regression analyses showed that pre-frailty(OR = 3.868.P<0.001)and frailty(OR = 22.929,P<0.001)increased the risk of depression.The results of Linear regression analyses showed that both the pre-frailty(??-0.425.P =0.001)and frailty(? =-0.878,P = 0.004)reduced the amount of objective support;pre-frailty(?=-1.204,P<0.001)and frailty(? =-2.744,P<0.001)reduced the amount of perceived support;pre-frailty(? =-0.458,P<0.001)and frailty(? =-].453,P<0.001)reduced the amount of support utilization.Perceived support(OR =0.851,P<0.001)and support utilization(OR = 0.919,P = 0.009)reduced the risk of depression,whereas objective support not(OR = 0.961,P = 0.258).4.The results of Linear regression analysis showed that frailty components were negatively associated with objective support(? =-0.260,P<0.001),perceived support(B =-0.895,P<0.001)and support utilization(? =-0.393,P<0.001).Frailty components were significantly associated with depressive symptoms(? = 0.402.P<0.001).With the inclusion of social support,the association of frailty components with depressive symptoms was ameliorated but still significant(? = 0.350,P<0.001).Perceived support(? =-0.044,P<0.001)and support utilization(? ?-0.030,P<0.001)were negatively associated with depressive symptoms.Further Bootstrap test confirmed that perceived support(?= 0.040,P<0.05)and support utilization(? =0.012,P<0.05)partially mediated the association of frailty components with depressive symptoms.whereas objective support did not(? = 0.001.P>0.05).Simultaneously,compared with support utilization(? = 0.012,P<0.05),the mediating effect of perceived support(? = 0.040.P<0.05)on the association between frailty components and depressive symptoms was the strongest(C3:?= 0.028,P<0.05),accounting for approximately 75.4%of the total indirect effect.5.The results of linear regression showed that perceived support(perceived support x frailty components:? =-0.084.P<0.001)and support utilization(support utilization × frailty components:? ?-0.087,P<0.001)moderated the association between frailty components and depressive symptoms,whereas objective support did not(objective support × frailty components:?= 0.022,P = 0.273).Conclusions1.Frailty is positively associated with depression,whereas three dimensions of social support(objective support,perceived support and support utilization)were negatively related with depression.2.The relationship between frailty and depressive symptoms is mediated by perceived support and support utilization.The mediating effect of perceived support outweighs that of support utilization.The perceived support and support utilization could also moderate the relationship between frailty and depressive symptoms,whereas objective support couldn't..