Relationship Between Social Participation and Depressive Symptoms in Patients with Multimorbidity: The Chained Mediating Role of Cognitive Function and Activities of Daily Living

Abstract

Objective: The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity. Methods: We selected 3,782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analysis were used to explore the chained mediating effects of social participation, cognitive function, activities of daily living, and depressive symptoms. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms. Results: Higher levels of social participation (coefficient = −0.2050, p = 0.023), good cognitive function (coefficient = −0.1300, p < 0.001), and good activities of daily living (coefficient = 0.2250, p < 0.001) were significantly associated with lower levels of depressive symptoms. Cognitive function and ADLs were found to have a chained mediating effect between social participation and depressive symptoms (total effect = −0.3530, 95%CI (−0.5314, −0.1746); direct effect = −0.2050, 95%CI (−0.3818, −0.0281); indirect effect = −0.1480, 95%CI (−0.1900, −0.1105)). Conclusion: A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.