Demirer Ibrahim, Bethge Matthias, Spyra Karla, Karbach Ute, Pfaff Holger
Institute of Medical Sociology, Health Services Research, Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Eupener Str. 129, 50933, Köln, Germany.
Department Rehabilitation and Work. Institute for Social Medicine and Epidemiology at University of Lübeck, Ratzeburger Allee 160; Haus V50, 23538, Lübeck, Germany.
SSM Popul Health. 2021 Jan 28;13:100744. doi: 10.1016/j.ssmph.2021.100744. eCollection 2021 Mar.
This study provides insights into the longitudinal relation between multimorbidity, mental wellbeing, and social support. The analysis used the German Sociomedical Panel of Employees, a study of the German working population aged 40 to 54. In the context of multimorbidity, this population has been little studied. Multimorbidity is significantly associated with reduced mental wellbeing and social support, whereas social support increases mental wellbeing. We argue that, especially among the working population, multimorbidity reduces perceived social support and decreases mental wellbeing. We elaborate on the mediation process empirically by comparing two distinct structural equation models: a cross-lagged panel mediation model that models a potential reverse-causality between social support and mental wellbeing; and a synchronous mediation model that allows for more immediate mediation. Both models estimated significant mediation. The relative size of the mediation effect, however, varied widely based on the added mediational paths (8.57% vs. 28%). Fit statistics for both models were good, and the comparison did not favour either model. We conclude that theoretical reasoning must prevail over empirical testing. The cross-lagged model implies a more longitudinal (lagged) mediation process for social support. However, we suggest an immediate, flexible mediation as more plausible. Nevertheless, we suggest that cross-lagged models, when given a data structure and time gaps, reflect the social processes adequately.
本研究深入探讨了多种疾病并存、心理健康与社会支持之间的纵向关系。该分析使用了德国员工社会医学面板数据，这是一项针对40至54岁德国劳动人口的研究。在多种疾病并存的背景下，这一人群此前鲜有研究。多种疾病并存与心理健康和社会支持的降低显著相关，而社会支持则会提升心理健康。我们认为，尤其是在劳动人口中，多种疾病并存会降低感知到的社会支持并损害心理健康。我们通过比较两种不同的结构方程模型，对中介过程进行了实证阐述：一种是交叉滞后面板中介模型，该模型对社会支持和心理健康之间潜在的反向因果关系进行建模；另一种是同步中介模型，该模型允许更直接的中介作用。两种模型均估计出显著的中介效应。然而，中介效应的相对大小因添加的中介路径不同而有很大差异（8.57%对28%）。两种模型的拟合统计量都很好，且比较结果并未偏向任何一种模型。我们得出结论，理论推理必须优先于实证检验。交叉滞后模型意味着社会支持的中介过程更具纵向性（滞后性）。然而，我们认为更合理的是一种即时、灵活的中介作用。尽管如此，我们建议，当给定数据结构和时间间隔时，交叉滞后模型能够充分反映社会过程。
