# Depression and social frailty in elderly patients receiving maintenance hemodialysis: multiple mediating roles of bidirectional social support and personal mastery

## TL;DR

This study explores how social support and personal mastery affect the link between depression and social frailty in elderly patients on hemodialysis.

## Contribution

The study identifies bidirectional social support and personal mastery as partial mediators between depression and social frailty in elderly hemodialysis patients.

## Key findings

- Depression is strongly linked to social frailty in elderly hemodialysis patients.
- Bidirectional social support and personal mastery partially mediate the depression-social frailty relationship.
- Enhancing these psychosocial factors may reduce social frailty risk in this population.

## Abstract

This study aimed to investigate the multiple mediating roles of bidirectional social support and sense of personal mastery in the relationship between depression and social frailty among elderly patients undergoing maintenance hemodialysis (MHD).

A cross-sectional survey was conducted among 248 elderly MHD patients from two tertiary hospitals in Wuhan, China. Data were collected using a general information questionnaire, the Social Vulnerability Index, the Geriatric Depression Scale-5 (GDS-5), the Brief Two-Way Social Support Scale, and the Personal Mastery Scale. Structural Equation Modeling (SEM) was performed using AMOS 28.0.

The mean scores were as follows: depression (1.91
±
1.67), bidirectional social support (38.49
±
8.43), personal mastery(21.51
±
4.95), and SVI (0.49
±
0.19). Depression was positively correlated with social frailty (r = 0.716, p < 0.01), whereas both personal mastery and bidirectional social support were negatively correlated with social frailty (r = −0.721, −0.760, both p < 0.01). Mediation analysis indicated that bidirectional social support and sense of personal mastery partially mediated the relationship between depression and social frailty, with a total indirect effect size of 0.524, accounting for 67.96% of the total effect.

Social frailty among elderly MHD patients is at a moderate level, with 27.02% experiencing moderate to severe social frailty. The prevalence of depressive symptoms was 53.6%. Depression significantly predicts social frailty, while bidirectional social support and personal mastery serve as partial mediators. Enhancing these psychosocial factors may help reduce the risk or severity of social frailty in this population.