The Chronic Conditions-Depressive Symptoms Association: How Self-Rated Health Mediates and Social Frailty Moderates...

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.