Although social frailty does not directly impact depression or anxiety in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), it influences these outcomes indirectly through social support, according to a study published in BMC Pulmonary Medicine.1
Depression and anxiety are common comorbidities in patients with COPD that may occur together; they can reduce treatment adherence, extend hospitalization length, and elevate AECOPD risks. Numerous factors influence anxiety and depression in patients with COPD, including age, disease severity, and exercise.
Social frailty and social support have gained attention recently due to their significant impact on health outcomes. Social frailty is the lack of social relationships and the inability to actively participate in society. Conversely, social support is the extent of support people receive from their surroundings.
Past studies have found conflicting results regarding the impact of social frailty on anxiety and depression in patients with AECOPD. The role of social support in social frailty’s relationship with anxiety and depression in patients with AECOPD also remains unclear.
Therefore, the researchers conducted a study to determine if social frailty and social support are associated with anxiety and depression among patients hospitalized for AECOPD. Their study also explored whether social support mediates the association between social frailty and anxiety and depression in patients with AECOPD.
The researchers conducted a logistic regression analysis to examine the associations of social frailty and social support with anxiety and depression; they also performed mediation analyses to determine whether social support mediates the relationship between social frailty with anxiety and depression. To do so, they used data from patients hospitalized with AECOPD at the respiratory intensive care unit of a large tertiary care institution in China between August 2022 and June 2023.
The researchers assessed social frailty using the HALFT scale, which represents its 5 components: help, participation, loneliness, finances, and talk.2 Patients received 1 point for each criterion met and 0 points otherwise. Scores ranged from 0 to 5 points, with 0 points indicating no social frailty; 1 to 2 points, presocial frailty; and 3 to 5 points, social frailty.
Similarly, each patient's social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), consisting of 12 items.3 Patients rated each item on a 7-point scale, ranging from 1 (“very strongly disagree”) to 7 (“very strongly agree”). The maximum possible score was 84 points, with higher scores indicating higher social support levels.
Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), a 14-item scale, with 7 items each assessing anxiety (HADS-A) and depression (HADS-D).4 Each scale had 7 related items, which the patients rated on a 4-point scale, with scores of 3 representing the most negative response and 0 representing the most positive response. Both scales ranged from 0 to 21, with scores greater than 7 considered indicative of depression and anxiety.
Although the researchers initially identified 315 eligible patients with AECOPD, they analyzed 306.1 Most of the study population consisted of men (73.9%) who did not have anxiety (85.9%) or depression (86.3%); however, most had presocial frailty (70.6%).
The adjusted logistic regression analysis revealed that social support was significantly associated with anxiety (OR, 0.97; 95% CI, 0.95-0.99) and depression (OR, 0.95; 95% CI, 0.93-0.98). However, compared with patients without social frailty in the adjusted model, those with presocial frailty did not demonstrate significant associations with anxiety (OR, 1.53; 95% CI, 0.17-14.05) or depression (OR, 1.35; 95% CI, 0.15-12.54). Similarly, patients with social frailty also did not show significant associations with anxiety (OR, 1.9; 95% CI, 0.19-19.34) or depression (OR, 1.81; 95% CI, 0.18-18.54) in the adjusted model.
Additionally, the mediation analysis demonstrated that social frailty exerted an indirect effect on anxiety and depression through social support despite not directly affecting them both.
“...our findings suggest that, in patients with AECOPD, social frailty does not directly affect anxiety and depression, but rather influences these outcomes indirectly through social support,” the authors wrote. “These findings highlight the importance of bolstering social support systems to alleviate anxiety and depression in this population.”
The researchers acknowledged their limitations, one being the low prevalence of anxiety and depression among their study population. They noted that this may explain the absence of an observable relationship between social frailty and anxiety or depression. Despite their limitations, the researchers made treatment suggestions based on their findings.
“...we recommend that health care providers integrate assessments and interventions for social support into routine clinical care,” the authors concluded. “This approach can help address the mental health needs of these patients, leading to improved overall well-being and quality of life.”
References
1. Liu Y, Yang M, Zhao Y, et al. Social support mediates social frailty with anxiety and depression. BMC Pulm Med. 2024;24(1):390. doi:10.1186/s12890-024-03202-7
2. Ma L, Sun F, Tang Z. Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. J Nutr Health Aging. 2018;22(8):989-995. doi:10.1007/s12603-018-1054-0
3. Dahlem NW, Zimet GD, Walker RR. The multidimensional scale of perceived social support: a confirmation study. J Clin Psychol. 1991;47(6):756-761. doi:10.1002/1097-4679(199111)47:6<756::aid-jclp2270470605>3.0.co;2-l
4. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
News
Article
Social Frailty Indirectly Affects Anxiety, Depression in Patients With AECOPD Through Social Support
Author(s):
Social frailty in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) does not directly impact anxiety or depression but influences these conditions indirectly through social support.
Although social frailty does not directly impact depression or anxiety in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), it influences these outcomes indirectly through social support, according to a study published in BMC Pulmonary Medicine.1
Depression and anxiety are common comorbidities in patients with COPD that may occur together; they can reduce treatment adherence, extend hospitalization length, and elevate AECOPD risks. Numerous factors influence anxiety and depression in patients with COPD, including age, disease severity, and exercise.
Social frailty and social support have gained attention recently due to their significant impact on health outcomes. Social frailty is the lack of social relationships and the inability to actively participate in society. Conversely, social support is the extent of support people receive from their surroundings.
Past studies have found conflicting results regarding the impact of social frailty on anxiety and depression in patients with AECOPD. The role of social support in social frailty’s relationship with anxiety and depression in patients with AECOPD also remains unclear.
Therefore, the researchers conducted a study to determine if social frailty and social support are associated with anxiety and depression among patients hospitalized for AECOPD. Their study also explored whether social support mediates the association between social frailty and anxiety and depression in patients with AECOPD.
Social frailty indirectly impacts anxiety and depression in patients with acute exacerbations of COPD through social support. | Image Credit: Julien Eichinger - stock.adobe.com
The researchers conducted a logistic regression analysis to examine the associations of social frailty and social support with anxiety and depression; they also performed mediation analyses to determine whether social support mediates the relationship between social frailty with anxiety and depression. To do so, they used data from patients hospitalized with AECOPD at the respiratory intensive care unit of a large tertiary care institution in China between August 2022 and June 2023.
The researchers assessed social frailty using the HALFT scale, which represents its 5 components: help, participation, loneliness, finances, and talk.2 Patients received 1 point for each criterion met and 0 points otherwise. Scores ranged from 0 to 5 points, with 0 points indicating no social frailty; 1 to 2 points, presocial frailty; and 3 to 5 points, social frailty.
Similarly, each patient's social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), consisting of 12 items.3 Patients rated each item on a 7-point scale, ranging from 1 (“very strongly disagree”) to 7 (“very strongly agree”). The maximum possible score was 84 points, with higher scores indicating higher social support levels.
Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), a 14-item scale, with 7 items each assessing anxiety (HADS-A) and depression (HADS-D).4 Each scale had 7 related items, which the patients rated on a 4-point scale, with scores of 3 representing the most negative response and 0 representing the most positive response. Both scales ranged from 0 to 21, with scores greater than 7 considered indicative of depression and anxiety.
Although the researchers initially identified 315 eligible patients with AECOPD, they analyzed 306.1 Most of the study population consisted of men (73.9%) who did not have anxiety (85.9%) or depression (86.3%); however, most had presocial frailty (70.6%).
The adjusted logistic regression analysis revealed that social support was significantly associated with anxiety (OR, 0.97; 95% CI, 0.95-0.99) and depression (OR, 0.95; 95% CI, 0.93-0.98). However, compared with patients without social frailty in the adjusted model, those with presocial frailty did not demonstrate significant associations with anxiety (OR, 1.53; 95% CI, 0.17-14.05) or depression (OR, 1.35; 95% CI, 0.15-12.54). Similarly, patients with social frailty also did not show significant associations with anxiety (OR, 1.9; 95% CI, 0.19-19.34) or depression (OR, 1.81; 95% CI, 0.18-18.54) in the adjusted model.
Additionally, the mediation analysis demonstrated that social frailty exerted an indirect effect on anxiety and depression through social support despite not directly affecting them both.
“...our findings suggest that, in patients with AECOPD, social frailty does not directly affect anxiety and depression, but rather influences these outcomes indirectly through social support,” the authors wrote. “These findings highlight the importance of bolstering social support systems to alleviate anxiety and depression in this population.”
The researchers acknowledged their limitations, one being the low prevalence of anxiety and depression among their study population. They noted that this may explain the absence of an observable relationship between social frailty and anxiety or depression. Despite their limitations, the researchers made treatment suggestions based on their findings.
“...we recommend that health care providers integrate assessments and interventions for social support into routine clinical care,” the authors concluded. “This approach can help address the mental health needs of these patients, leading to improved overall well-being and quality of life.”
References
1. Liu Y, Yang M, Zhao Y, et al. Social support mediates social frailty with anxiety and depression. BMC Pulm Med. 2024;24(1):390. doi:10.1186/s12890-024-03202-7
2. Ma L, Sun F, Tang Z. Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. J Nutr Health Aging. 2018;22(8):989-995. doi:10.1007/s12603-018-1054-0
3. Dahlem NW, Zimet GD, Walker RR. The multidimensional scale of perceived social support: a confirmation study. J Clin Psychol. 1991;47(6):756-761. doi:10.1002/1097-4679(199111)47:6<756::aid-jclp2270470605>3.0.co;2-l
4. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
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