Does positive affect mediate the association of multimorbidity on depressive symptoms?

Abstract

Objectives: Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Positive affect is a major resource for coping with chronic conditions and for the prevention of depression. Long-term multimorbidity, however, may deplete positive affect. The purpose of this paper is to investigate the role of positive affect in the association between multimorbidity and depressive symptoms. Method: We used four consecutive waves (2008, 2011, 2014, 2017) of the nationally representative German Ageing Survey (DEAS) with a total of 1,558 older adults aged 40 and over. To account for time-varying confounding, exposure-induced mediator-outcome confounding, and reciprocities, we applied the mediational g-formula with inverse-probability weighting techniques. We also tested for exposure-mediator interaction to adjust for differences in mediation across the duration of multimorbidity. Results: We confirmed a positive longitudinal relation between multimorbidity and depressive symptoms, both of which were negatively associated with while positive affect. The model without interaction indicated a share mediated of ca. 18.3% on the total effect of multimorbidity on depressive symptoms. Addition of interaction led to substantial differences for multimorbidity duration and levels of positive affect. Associations for long-term multimorbidity (at least two survey waves) were more substantial, and the share mediated doubled (>40%). Additionally, the direct effect of multimorbidity on depressive symptoms diminished for short-term multimorbidity. Conclusion: Strengthening positive affect could reduce depressive symptoms in those facing multimorbidity. This study also discusses methodological challenges in performing longitudinal mediation analysis. We advise researchers to consider the mediational g-formula and exposure-mediator interaction.

Multimorbidity and depression among older adults in India: Mediating role of functional and behavioural health

“…Further, evidence suggested that functional health may influences the relationship between multimorbidity and depression in older adults. The functional health might act as a mediator between an association of multimorbidity and depression by limiting the social and physical abilities of individuals [ 25 , 26 ], as multimorbidity escalates the deterioration of physical health leading to adverse emotional outcomes which facilitate depressive symptoms [ 27 , 28 ]. In addition to functional health risk factors, behavioural health issues such as alcohol consumption, smoking, physical activity are also linked with high depressive disorders [ 29 – 31 ].…”

“…Evidence suggests that women have a higher life expectancy, and experiences poor health in older ages [ 1 , 35 ]. As a result, older women are more vulnerable to morbidity than men because of the higher prevalence of acute, chronic, and mental disorders [ 28 , 29 , 36 ]. Studies have shown that women have a larger disease burden and the prevalence of chronic conditions increase with their age [ 37 ].…”

Everyday discrimination, co-ethnic social support and mood changes in young adult immigrants in Germany–Evidence from an ecological momentary assessment study

“…Future research should also exploit the potential of ecological momentary assessment studies to gain further insight into other mechanisms that support first-generation immigrants' coping capabilities. Research based on annual longitudinal analyses indicates that positive affect, might be of importance as an intermediate (Demirer et al, 2022).…”