Department of Psychology and Behavior Sciences, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Psychology and Behavior Sciences, Zhejiang University, Hangzhou, Zhejiang, China.
Am J Geriatr Psychiatry. 2019 Nov;27(11):1268-1276. doi: 10.1016/j.jagp.2019.04.014. Epub 2019 May 2.
This study aimed to investigate association between social support and hypertension (HTN) control in rural China older adults, and to what extent depression mediates this relationship. The authors hypothesized that depression severity mediated the relationship between social support and HTN control.
Data for the analyses were obtained from baseline data from a randomized controlled clinical trial of a collaborative depression care management intervention conducted in rural villages of China, with older adults with comorbid depression and HTN. Data included baseline assessments of 2,351 subjects aged 60 years and older, whose blood pressure and depression severity were measured using a calibrated manual sphygmomanometer and the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Social support was measured using the 20-item Medical Outcomes Study-Social Support Survey.
Uncontrolled HTN was associated with older age (t[df = 2349] = 3.16; p < 0.01), higher HDRS-17 score (t[df = 1488] = 5.89; p < 0.001), and lower social support (t[df = 2349] = 5.37; p < 0.001). A significant indirect effect of social support via depression severity in relation to HTN control (a × b = -0.04[0.01]), bootstrap p = 0.0015, and 95% confidence interval (-0.07, -0.02), accounting for 11% of the effect of social support on HTN control.
These findings imply that social support impacts HTN control directly and indirectly through depression. Intervention approaches such as primary care-based collaborative care models should address social support to achieve greater outcomes for depression and HTN management.
本研究旨在探讨中国农村老年人社会支持与高血压（HTN）控制之间的关联，以及抑郁在多大程度上介导了这种关系。作者假设抑郁严重程度介导了社会支持与 HTN 控制之间的关系。
本分析的数据来自中国农村村庄开展的合作性抑郁护理管理干预的随机对照临床试验的基线数据，研究对象为患有合并抑郁和 HTN 的老年人。数据包括 2351 名年龄在 60 岁及以上的受试者的基线评估，他们的血压和抑郁严重程度分别使用校准的手动血压计和 17 项汉密尔顿抑郁评定量表（HDRS-17）进行测量。社会支持使用 20 项医疗结局研究-社会支持调查进行测量。
未控制的 HTN 与年龄较大（t[df=2349] = 3.16；p < 0.01）、HDRS-17 评分较高（t[df=1488] = 5.89；p < 0.001）和社会支持较低（t[df=2349] = 5.37；p < 0.001）相关。社会支持通过抑郁严重程度对 HTN 控制的间接影响显著（a×b= -0.04[0.01]，bootstrap p=0.0015，95%置信区间为 -0.07，-0.02），占社会支持对 HTN 控制效果的 11%。
这些发现表明，社会支持通过抑郁直接和间接影响 HTN 控制。以初级保健为基础的合作护理模式等干预方法应解决社会支持问题，以实现抑郁和 HTN 管理的更大效果。
