Foong Hui Foh, Ibrahim Rahimah, Abdullah Siti Farra Zillah, Bagat Mohamad Fazdillah
Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore.
Malaysian Research Institute on Ageing (MyAgeing®), Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Psychogeriatrics. 2025 Sep;25(5):e70079. doi: 10.1111/psyg.70079.
The relationship between chronic conditions and depressive symptoms in ageing populations is complex and influenced by various factors. This study aimed to examine the mediating role of self-rated health and the moderating role of social frailty in the relationship between chronic conditions and depressive symptoms among community-dwelling middle-aged and older adults in Malaysia.
This cross-sectional study analyzed baseline data from the AGELESS study, comprising 1675 community-dwelling adults aged 56-97 years (mean age 72.4 years) in Malaysia. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Chronic conditions were assessed based on self-reported diagnoses of 17 specific health issues. Self-rated health was measured using a single-item 5-point Likert scale, and social frailty was assessed using a five-item index. Mediation and moderation analyses were conducted using PROCESS Macro in SPSS, controlling for demographic factors and cognitive function.
The number of chronic conditions was positively associated with depressive symptoms (B = 0.245, p < 0.001). Self-rated health partially mediated this relationship (indirect effect: B = 0.092, 95% CI [0.048, 0.142]). Social frailty significantly moderated the association between chronic conditions and depressive symptoms (B = 0.153, p = 0.006), with the relationship being non-significant at low levels of social frailty but significant at mean and high levels.
This study demonstrates that chronic conditions affect depressive symptoms both directly and indirectly through self-rated health perceptions. Moreover, social frailty exacerbates the impact of chronic conditions on mental health. These findings highlight the importance of addressing both psychological perceptions and social resources when managing chronic conditions in aging populations, supporting a biopsychosocial approach to healthcare interventions.
慢性病与老年人群抑郁症状之间的关系复杂，受多种因素影响。本研究旨在探讨自我健康评价在马来西亚社区居住的中老年人慢性病与抑郁症状关系中的中介作用，以及社会脆弱性的调节作用。
这项横断面研究分析了“无龄研究”的基线数据，该研究包括马来西亚1675名年龄在56 - 97岁（平均年龄72.4岁）的社区居住成年人。使用15项老年抑郁量表测量抑郁症状。根据自我报告的17种特定健康问题的诊断评估慢性病情况。使用单项5点李克特量表测量自我健康评价，并使用五项指标评估社会脆弱性。在SPSS中使用PROCESS宏进行中介和调节分析，控制人口统计学因素和认知功能。
慢性病数量与抑郁症状呈正相关（B = 0.245，p < 0.001）。自我健康评价部分中介了这种关系（间接效应：B = 0.092，95%CI[0.048, 0.142]）。社会脆弱性显著调节了慢性病与抑郁症状之间的关联（B = 0.153，p = 0.006），在低水平社会脆弱性时关系不显著，但在中等和高水平时显著。
本研究表明，慢性病通过自我健康感知直接和间接影响抑郁症状。此外，社会脆弱性加剧了慢性病对心理健康的影响。这些发现强调了在管理老年人群慢性病时，解决心理感知和社会资源问题的重要性，支持采用生物心理社会方法进行医疗保健干预。
