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Serial mediation analysis of self-efficacy and social support in the relationship between chronic disease and depression/anxiety in middle-aged and older adults

Yusupujiang Tuersun,Weiqi Tao,Qingping Zhou,Yifei Wang,Ruiyan Wang,Zhenning Liang,Jiao Yang,Lehuan Li,Yian Liu,Yuntian Xu,Fangjing Wu,Yifan Kan,Yi Qian,Jiangyun Chen

Published 2025 in BMJ Open

ABSTRACT

Objectives To investigate the mental health mechanisms linking chronic disease and mental health, specifically examining the mediating roles of self-efficacy and perceived social support in the associations with depressive and anxiety symptoms. Design This cross-sectional study with chain mediation analysis was performed using regression-based methods with bootstrapping. Data were collected from a national survey conducted in China between July and September 2021. Setting Data were obtained from 23 provinces, 5 autonomous regions and four municipalities across China, covering both urban and rural areas. A total of 3365 participants were included in the study. Participants The study involved 3365 participants (51.9% male, 48.1% female) aged ≥46 years. Participants were selected from diverse demographic backgrounds to ensure national representativeness. Primary and secondary outcome measures Primary outcomes were symptoms of depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Secondary measures included self-efficacy (New General Self-Efficacy Scale) and perceived social support (Perceived Social Support Scale). Results Chronic disease was statistically significantly associated with increased severity of symptoms of depression (β=1.050, p<0.001) and anxiety (β=0.758, p<0.001). Self-efficacy was negatively associated with symptoms of both depression (β=−0.034, p>0.05) and anxiety (β=−0.036, p=0.050), whereas perceived social support was statistically significant negatively associated with symptoms of both depression (β=−0.077, p<0.001) and anxiety (β=−0.061, p<0.001). Chain mediation analysis indicated that self-efficacy and perceived social support partially mediated the effects of chronic disease on symptoms of both depression (indirect effect=0.064, p<0.001) and anxiety (indirect effect=0.051,p=0.002). Conclusions This study demonstrates that chronic diseases exacerbate symptoms of depression and anxiety through the dual mediating pathways of self-efficacy and perceived social support. Enhancing self-efficacy and perceived social support may be crucial in developing effective mental health interventions for patients with chronic disease, particularly for those at risk of social isolation, such as older adults. Future interventions should focus on improving self-efficacy and expanding social support networks.

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