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Article

Role of Multifaceted Social Relationships on the Association of Loneliness with Depression Symptoms: A Moderated Mediation Analysis

by
Yang Liu
1,
Dandan Jiao
1,2,
Mengjiao Yang
1,3,
Mingyu Cui
1,
Xiang Li
1,
Zhu Zhu
1,
Yuko Sawada
4,
Kumi Watanabe Miura
5,
Taeko Watanabe
6,
Emiko Tanaka
7 and
Tokie Anme
8,*
1
School of Comprehensive Human Science, University of Tsukuba, Tsukuba 3058577, Japan
2
Department of Nursing, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
3
Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
4
Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 5598611, Japan
5
RIKEN Center for Advanced Intelligence Project, Tokyo 1030027, Japan
6
Faculty of Nursing, Shukutoku University, Chiba 2608701, Japan
7
Faculty of Nursing, Musashino University, Tokyo 1358181, Japan
8
Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 3058577, Japan
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(1), 124; https://doi.org/10.3390/healthcare11010124
Submission received: 9 December 2022 / Revised: 28 December 2022 / Accepted: 29 December 2022 / Published: 31 December 2022
Browse Figures
Versions Notes

Abstract

:
Strong relationship exists between loneliness and depression in older adults. However, the effect of multifaceted social relationships on the relationship between loneliness and depression has not been explored. The purpose of the current study was to find out how multifaceted social relationships affect the aforementioned processes. We investigated and evaluated the loneliness status, depression symptoms, social relationships, and demographic information of 1116 older adults aged ≥65 years living in rural Japan. The final 555 participants were included in the analysis. Statistical evidence showed a direct effect between loneliness and depression symptoms. Additionally, the mediation model found that social curiosity and participation acted as mediators between loneliness and depression symptoms. Further, independence and participation, independence, and feeling safe played a conditional moderating role in the model of loneliness–social curiosity–depression symptoms and loneliness–participation–depression symptoms, respectively. Interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator. The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators.

1. Introduction

Recently, human life expectancy rapidly increased [1] An unprecedented number of people are growing older, with a decline in fertility [2], and the resulting aging has become a global phenomenon [3]. In 2019, the World Health Organization reported that the number of people aged ≥60 was 1 billion, which will increase to 1.4 billion by 2030 [4].
Older adults often experience a decline in physical health, such as increased multimorbidity [5,6] and decreased instrumental activities of daily living [7,8]. These experiences increase their risk and vulnerability to depression; however, depression is not a normal part of aging [9,10]. According to the definition of the National Institute of Mental Health [11], depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. As the most frequent cause of emotional distress in later life [12], it affects people’s feelings, thinking, and handling of daily activities [11]. Furthermore, it has caused more ‘years lost’ to disability than any other disease [13] and greatly reduces the quality of life of older adults [12]. With the dramatic increase in the number of older adults, preventing depression in older adults is a great challenge.
The evidence indicated that the risk of depression decreases in both men and women after menopausal age [14]. Moreover, sex differences peak in adolescence, diminish, and remain stable in later adulthood [15]. Additionally, exercise stimulates a complex system and leads to higher resilience to stress-related mental disorders, preventing depression [16]. Economic status [17] and chronic diseases [18,19,20,21,22,23,24,25,26,27] are also associated with depression. To prevent depression in older adults, an important method is to lessen loneliness because loneliness is significantly correlated with depression symptoms [28]. Domènech-Abella et al. (2019) [29] reported a bidirectional longitudinal association between loneliness and a higher likelihood of major depressive disorder after 2 years in people aged over 50 years. Erzen and Çikrikci conducted a meta-analysis and concluded that loneliness is an important variable affecting depression [30]. Lee et al. (2021) demonstrated that higher loneliness scores at baseline were significantly associated with depression symptom scores over 12 years after controlling for other social experiences in people aged >50 years [31].
However, after clarifying that lessening loneliness helps to prevent depression in older adults, another question arises: are there other factors contributing to the effects of loneliness on depression? Social relationships have recently been suggested to explain this.
Social relationships are measured by the presence or absence of human relationships in the local community, and the frequency of relationships within one’s environment [32] was linked to loneliness and depression. Cacioppo and Hawkley(2009) indicated that loneliness can be spread among people and can further reduce their social relationships [33]. Prince et al. (1997) reported that social support deficits are strongly associated with depression [34], and Lee et al. (2020) showed that support from friends and romantic partners might lessen depression [35]. Furthermore, Arslantaş et al. (2015) reported that a lack of hobbies increases loneliness and is associated with depression symptoms [36]. Seabrook et al. (2016) and Yang et al. (2021) found that positive interactions, social support, and social connections on social networking sites lessen depression and anxiety [37,38]. To better understand the role that social relationships play in the association between loneliness and depression, social relationships are studied as a mediator and moderator. Park et al. (2019) used family and friend networks and perceived community support to assess the mediating effects of social engagement on loneliness and depression. [39] Burholt and Scharf (2014) focused on how social resources (marital status, sociability, religious and other community groups) and social participation (number of activities attended in a month) mediate loneliness and depression [40]. In addition, Liu et al. (2016) measured the mediating effect of social support on loneliness and depression in 320 older adults using the support of family, friends, and others. [41]. Zhao et al. (2018) used the same strategy as Liu et al. (2016) to explore the moderating effect of social support on loneliness and depression [42]. However, social relationships were measured using multifaceted factors, and each aspect has a different focus. For example, social curiosity (social engagement through the internet, newspapers, and books) and interaction (face-to-face socialization with people) are both part of social relationships, but they have completely different emphases. The previous studies only focused on the part of social relationships or treated all aspects as a whole factor, and only general and vague results were provided regarding which part of the social relationship mediates or moderates the effects of loneliness on depression. Furthermore, it remains unknown whether different aspects of social relationships interact with each other regarding the relationship between loneliness and depression.
In the current study, we set two research questions to address this research gap: (1) Are there any relationships between loneliness, social relationships, and depression symptoms? (2) What role do multifaceted social relationships play in the relationship between loneliness and depression symptoms?

2. Materials and Methods

2.1. Design

The Community Empowerment and Care for Well-being and Healthy Longevity: Evidence from a Cohort study (CEC) started in 1991 and is ongoing. The survey is conducted every 3 years (the current survey was conducted in 2020), and the self-report questionnaires include sociological, medical, and psychological information. The current study is cross-sectional, with data from the 2017 CEC cohort study.

2.2. Participants

In 2017, we surveyed 1116 participants aged ≥65 years. After excluding missing data for six demographic variables, 15 chronic diseases, 18 social relationships, loneliness, and two depression items, 555 participants were finally included in the analysis.

2.3. Measures

2.3.1. Loneliness

Loneliness was measured using a signaling question (“Do you experience feelings of loneliness?”), This measurement method has been widely used in studies worldwide as a quick measure of loneliness [43,44,45]. There were four answers to the question: (1) none, (2) rarely, (3) sometimes, and (4) often. Those who answered “non” or “rarely” were considered to have no feelings of loneliness, and those who answered “sometimes” or “often” were considered to have feelings of loneliness.

2.3.2. Depression Symptoms

Depression symptoms were evaluated using a Two-Question Screen. This method has been validated in previous studies worldwide [46,47] and in Japan [48]. The Two-Question Screen consists of (1) During the past month, have you often been bothered by feeling down, depressed, or hopeless? and (2) During the past month, have you often been bothered by little interest in or pleasure in doing things? Each question had two responses: ‘yes’ and ‘no’. Participants who answered ‘Yes’ to either or both questions were considered to have depression symptoms, and those who answered ‘No’ to both questions were considered free of depression symptoms.

2.3.3. Social Relationships

We used the Index of Social Interaction (ISI) scale developed by Tokie Anme and colleagues [32]. This is used to measure participants’ social relationships. The index comprises five aspects of social relationships (independence, social curiosity, interaction, participation, and feeling safe) and 18 items to evaluate social relationships at personal and impersonal levels. Each question has 4 responses in decreasing order of degree or frequency (everyday/always/very, twice a week/sometimes/general, once a week/seldom/little, less than once a month/never/no). If participants respond, “less than once a month” or “never” or “no”, they are given 0 points, while other responses are given 1 point. The total score will be calculated to evaluate the participant’s social relationship level. The total ISI scale was 18, and the scores on the independence, social curiosity, interaction, participation, and feeling safe subscales ranged from 0–4, 0–5, 0–3, 0–4, and 0–2, respectively. It has also been validated among older adults in Japan [49,50,51,52].
The independence subscale comprises four questions: (1) Are you motivated to live a healthy life? (2) Do you have a regular lifestyle? (3) Do you have the motivation to live an active life? (4) Do you talk about an active approach to life?
The social curiosity subscale comprises five questions: (1) Do you read newspapers? (2) Do you read books and magazines? (3) Do you use tools such as the internet, smartphones, and mobile phones? (4) Do you enjoy your hobbies? (5) What do you think you can do to help society?
The interaction subscale includes three questions: (1) How often do you talk to non-family members and non-relatives? (2) How often do you talk to your family and relatives? (3) How often do you visit others?
The participation subscale comprises four questions: (1) How often do you participate in social groups? (2) How well do you know your neighbors? (3) Do you watch television? (4) Do you have a specific role, such as a job or being responsible for household chores?
The feeling safe subscale includes two questions:1) Is there someone you can consult when you are troubled? (2) Is there someone who can help you in an emergency?

2.3.4. Covariables

Age, sex, exercise, alcohol consumption, smoking, economic status, hypertension, stroke, heart disease, diabetes, hyperlipidemia, respiratory disease, stomach disease, kidney disease, muscle disease, cancers, immune diseases, dementia, Parkinson’s disease, eye diseases, and ear diseases were collected using self-report questionnaires and included in the current study as covariables.
Age was divided into 65–74 years and ≥75 years. Sex was classified into two groups: men and women. Exercise was categorized into two groups: exercise and no exercise. Alcohol consumption and smoking were divided into two groups: daily alcohol consumption or smoking and non-daily alcohol consumption or smoking. Economic status was divided into three groups: not good, normal, and good. Finally, sixteen types of diseases were separated into two groups: those with and without diseases.

2.4. Statistical Analysis

First, sociodemographic characteristics were described, and the distribution of depressive symptoms was tested using the chi-square test. Subsequently, the intercorrelations of loneliness, depression symptoms, independence subscales, social curiosity subscales, interaction subscales, participation subscales, and feeling safe subscales were tested using Pearson’s correlation analysis.
Second, we conducted a mediation analysis and set independence, social curiosity, interaction, participation, and feeling safe subscales as mediators to find the potential significant mediation models (Figure 1).
Finally, we individually added the other four subscales of social relationship to the significant mediation model to test the moderated mediation effect (Figure 2). α was set to 0.05 in all steps. All analyses were performed using the IBM SPSS 28.0.0 software and the process macro in SPSS (version 28.0.0).

3. Results

We described and compared the distribution of demographic characteristics according to depression symptoms (Table 1).
Depressive symptoms were more frequent in those aged 65–74 years than in those aged ≥75 years (32.9% vs. 31.1%), more frequent in men than in women (32.7% vs. 31.7%), more frequent for those undertaking no exercise than in exercise (36.5% vs. 29.2%), more frequent in no daily alcohol consumption and no daily smoking than in daily alcohol consumption and daily smoking (33.8% vs. 26.7% and 33.2% vs. 25.4%), and more frequent in those who did not have a good economic status than in those with normal and good economic status (44.2% vs. 28.5% vs. 18.5%). In addition, there were statistically significant differences in depressive symptoms depending on economic status, heart disease, respiratory disease, kidney disease, cancer, eye disease, and ear diseases.
The intercorrelations among loneliness, depression symptoms, and social relationships are presented in Table 2.
The results showed statistically significant differences between any set of two variables, except loneliness and feeling safe. When we focused on depression symptoms as an outcome variable, the results showed a significant correlation between loneliness and depression symptoms, social curiosity and depression symptoms, independence and depression symptoms, interaction and depression symptoms, participation and depression symptoms, and feeling safe and depressive symptoms.
The mediation effect of the multifaceted social relationship between loneliness and depression symptoms is shown in Table 3.
The direct path of loneliness and depression symptoms was significant in all mediation models (p < 0.01). It is noteworthy that social curiosity and participation acted as mediators between loneliness and depression symptoms, with significant indirect paths for loneliness and social curiosity (B = 0.280, SE = 0.101, and p < 0.01), social curiosity and depression symptoms (B = 0.317, SE = 0.093, and p < 0.01), loneliness and participation (B = 0.195, SE = 0.0070, p < 0.01), and participation and depression symptoms (B = 0.367, SE = 0.134, p < 0.01).
Social curiosity and participation can be mediators between loneliness and depression symptoms. We then tested whether other aspects of social relationships (independence, interaction, feeling safe) could play the role of moderators (Table 4 and Table 5).
According to Table 4, independence (B = −0.375, SE = 0.167, 95% confidence interval [CI] = −0.703, −0.047) and participation (B = −0.241, SE = 0.110, and 95% CI = −0.458, −0.025) played a moderating role in the pre-indirect path, loneliness—social curiosity. In Table 5, independence (B= −0.256, SE = 0.125, and 95% CI= −0.501, −0.011) played a moderating role in the pre-indirect path of loneliness –participation, and feeling safe (B = 0.515, SE = 0.248, and 95% CI = 0.028, 1.001) played a moderating role in the post-indirect path of participation–depression symptoms. In addition, the results show that interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator.
Although independence, participation, feeling safe, and interaction may act as moderators, they may have conditional effects. We tested conditional indirect effects and conditional effects of loneliness on depression symptoms at values of multifaceted social relationships (Table 6).
There was a significant effect when the moderator equaled −1 SD independence (B = 0.112, SE = 0.067, 95% CI = 0.015, 0.274) and when the moderator had equal mean independence (B = 0.060, SE = 0.036, 95% CI = 0.003, 0.145). In addition, a significant effect existed when the moderator equaled −1 SD participation (B = 0.114, SE = 0.064, 95% CI = 0.015–0.260). Furthermore, there was a significant effect when the moderator value was −1 SD independence (B = 0.104, SE = 0.068, 95% CI = 0.006, 0.266) with mean independence (B = 0.055, SE = 0.036, 95% CI = 0.003, 0.140). Similarly, a significant effect was observed when feeling safe was the mean value (B = 0.079, SE = 0.045, 95% CI = 0.012, 0.185) with 1 SD (B = 0.090, SE = 0.049, 95% CI = 0.017, 0.204). In addition, the conditional effects of loneliness on depression symptoms moderated by the interaction were significant when the interaction was −1 SD (B = 1.738, SE = 0.314, 95% CI = 1.112, 2.354) with mean (B = 1.283, SE = 0.218, 95% CI = 0.856, 1.710), and 1 SD (B = 1.122, SE = 0.229, 95% CI = 0.673, 1.571).

4. Discussion

The ISI measures five aspects of social relationships (independence, social curiosity, interaction, participation, and feeling safe). The current study aimed to determine the role that multifaceted social relationships play in the association between loneliness and depression symptoms. According to the statistical evidence, loneliness affected depressive symptoms through social curiosity and participation. In addition, in the model of loneliness–social curiosity–depression symptoms, independence and participation moderated the effect of loneliness–social curiosity. Moreover, in the model of loneliness–participation–depression symptoms, independence and feeling safe moderated the effect of loneliness–participation and participation–depressive symptoms, respectively.
Although no temporal changes can be derived, we confirmed the results of previous studies, where age and sex did not significantly affect depressive symptoms at older ages [14,15]. Moreover, as in previous studies [17], economic status was significantly associated with depression symptoms. Additionally, we found that the risk of depression symptoms in older adults gradually decreases as their economic status improves. This suggests that economic and material affluence is beneficial in lessening the mental stress of older adults. Therefore, improving the economic status is an effective way of improving quality of life and preventing depression symptoms. Furthermore, in a comparison with previous studies [18,19,20,21,22,23,24,25,26,27], the current study also found that participants with heart, respiratory, kidney, cancer, eye, and ear disorders showed significant differences in depression symptoms compared with those who did not have these diseases. We did not find any statistical evidence for other diseases and exercise affecting depression symptoms. However, this does not mean that there is no association between them. More evidence is required in the future. Future studies are required to explain why the long duration of the disease increases a patient’s stress, whereas these diseases exhibit the same pathological mechanisms as depression symptoms. Therefore, chronic diseases should be investigated further.
As in previous studies [28,29,30,31], loneliness was significantly correlated with depression symptoms. Compared with previous studies [34,35,36,37,38], we found a correlation between various aspects of social relationships (social curiosity, independence, interaction, participation, and feeling safe) and depression symptoms. This may be explained by the fact that satisfying social relationships are essential for good mental and physical health [53,54]. The lack of enriching social relationships causes depression in lonely people.
In the mediation analysis, statistical evidence suggested that social relationships can mediate the relationships between loneliness and depression symptoms. Previous studies showed social resources and participation [40,41] mediates relationships between loneliness and depression symptoms. Besides this evidence, we also found that social curiosity and participation may play a mediating role in this process. A potential mechanism may be that people may be motivated to seek information (from newspapers, books, magazines, and the internet) when they feel lonely [55,56], which, in turn, promotes exploratory acts and affects depression symptoms [57]. Social curiosity and participation as significant mediators between loneliness and depression symptoms should be emphasized in geriatric medicine. Meanwhile, the results of the present study showed that independence, interaction, and feeling safe did not play a mediating role; however, the statistical results suggested a significant direct association with depression symptoms. Thus, a comprehensive improvement in the social relationships of older adults is an effective way to prevent depressive symptoms.
The moderated mediation model found a more complex interaction effect among multifaceted social relationships, loneliness, and depression symptoms, while previous studies only found that social support could moderate the relationships between loneliness and depression symptoms [42]. While social curiosity mediates the effect of loneliness on depression symptoms, independence and participation moderated the effect of loneliness on social curiosity, which changed the whole model’s effect. The same situation occurred in the model with participation as a mediator, independence moderated the effect of loneliness on participation, and feeling safe moderated the effect of participation on depression symptoms. In addition, the interaction could directly moderate the effect of loneliness on depression symptoms. However, social relationships cannot be moderators without limitations in this process. In the model of loneliness–social–curiosity–depression symptoms, independence and participation had a moderating effect only when the value was −1 standard deviation of the mean and when b was −1 standard deviation. Similarly, in the loneliness–participation–depression symptoms model, the moderating effect disappeared when the independence over its mean and feeling safe was lower than its mean. Interaction could act as a moderator in all ranges of values. When preventing depression symptoms in older adults, improving social curiosity and participation while conditionally supporting other social relationships will have a more significant effect.
We performed moderated mediation analysis to test the role of multifaceted social relationships in the association between loneliness and depression symptoms. These results prove the existence of complex interaction effects and provide new insights for the prevention of depression in older adults.
However, our study has some limitations. First, it was a cross-sectional study. We could only identify correlations between social relationships, loneliness, and depression symptoms, but not causal associations. Second, we considered many covariables, which caused a high rate of missing data. Future longitudinal studies with a higher data quality are needed to overcome these limitations.

5. Conclusions

The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators. In the villages in which the study participants live, the government has developed gymnastics and sports meet according to the local culture to increase the socialization of residents. In addition, since many older adults are still working in the Japanese society, this can greatly increase social interaction among older adults and improve their economic status. Moreover, the government provides complimentary medical screening for people over 65 years old, which allows for diseases to be diagnosed and treated earlier. We suggest that other villages increase local cultural activities and provide more employment and medical services and financial support for older adults to prevent depression symptoms in older adults.

Author Contributions

Y.L.: Conceptualization, Methodology, Formal analysis, Writing—original draft, Funding acquisition. D.J.: Writing—review. M.Y.: Investigation M.C.: Investigation X.L.: Investigation Z.Z.: Investigation Y.S.: Investigation K.W.M.: Investigation T.W.: Investigation E.T.: Investigation T.A.: Conceptualization, Investigation, Writing—review and editing, Project administration, Funding acquisition. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by JST, the establishment of university fellowships towards the creation of science technology innovation (Grant Number JPMJFS2106), and JSPS KAKENHI (Grant Number JP21K18449).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the University of Tsukuba (approval number 1331-4, 24 June 2022).

Informed Consent Statement

Patient consent was waived due to the data used in this study are anonymized data provided by the local government and the Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects.

Data Availability Statement

Not applicable.

Acknowledgments

We appreciate all the study participants, the staff of Tobishima, and their investigators.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Partridge, L.; Deelen, J.; Slagboom, P.E. Facing up to the Global Challenges of Ageing. Nature 2018, 561, 45–56. [Google Scholar] [CrossRef] [Green Version]
  2. Cosco, T.D.; Howse, K.; Brayne, C. Healthy Ageing, Resilience and Wellbeing. Epidemiol. Psychiatr. Sci. 2017, 26, 579–583. [Google Scholar] [CrossRef]
  3. Akiyama, H. Aging Well: An Update. Nutr. Rev. 2020, 78, 3–9. [Google Scholar] [CrossRef]
  4. Ageing. Available online: https://www.who.int/health-topics/ageing (accessed on 2 December 2022).
  5. Forman, D.E.; Maurer, M.S.; Boyd, C.; Brindis, R.; Salive, M.E.; Horne, F.M.; Bell, S.P.; Fulmer, T.; Reuben, D.B.; Zieman, S.; et al. Multimorbidity in Older Adults with Cardiovascular Disease. J. Am. Coll. Cardiol. 2018, 71, 2149–2161. [Google Scholar] [CrossRef]
  6. McGilton, K.S.; Vellani, S.; Yeung, L.; Chishtie, J.; Commisso, E.; Ploeg, J.; Andrew, M.K.; Ayala, A.P.; Gray, M.; Morgan, D.; et al. Identifying and Understanding the Health and Social Care Needs of Older Adults with Multiple Chronic Conditions and Their Caregivers: A Scoping Review. BMC Geriatr. 2018, 18, 231. [Google Scholar] [CrossRef] [PubMed]
  7. Chen, S.-W.; Chippendale, T. Factors Associated with IADL Independence: Implications for OT Practice. Scand. J. Occup. Ther. 2017, 24, 109–115. [Google Scholar] [CrossRef] [PubMed]
  8. Kiyoshige, E.; Kabayama, M.; Gondo, Y.; Masui, Y.; Inagaki, H.; Ogawa, M.; Nakagawa, T.; Yasumoto, S.; Akasaka, H.; Sugimoto, K.; et al. Age Group Differences in Association between IADL Decline and Depressive Symptoms in Community-Dwelling Elderly. BMC Geriatr. 2019, 19, 309. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  9. Alexopoulos, G.S. Depression in the Elderly. Lancet 2005, 365, 1961–1970. [Google Scholar] [CrossRef]
  10. Ezeokonkwo, F.C.; Sekula, K.L.; Theeke, L.A. Loneliness in Homebound Older Adults: Integrative Literature Review. J. Gerontol. Nurs. 2021, 47, 13–20. [Google Scholar] [CrossRef]
  11. Depression. Available online: https://www.nimh.nih.gov/health/topics/depression (accessed on 2 December 2022).
  12. Blazer, D.G. Depression in Late Life: Review and Commentary. J. Gerontol. A Biol. Sci. Med. Sci. 2003, 58, M249–M265. [Google Scholar] [CrossRef]
  13. Smith, K. Mental Health: A World of Depression. Nature 2014, 515, 180–181. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  14. Faravelli, C.; Alessandra Scarpato, M.; Castellini, G.; Lo Sauro, C. Gender Differences in Depression and Anxiety: The Role of Age. Psychiatry Res. 2013, 210, 1301–1303. [Google Scholar] [CrossRef] [PubMed]
  15. Salk, R.H.; Hyde, J.S.; Abramson, L.Y. Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms. Psychol. Bull. 2017, 143, 783–822. [Google Scholar] [CrossRef] [PubMed]
  16. Ströhle, A. Physical Activity, Exercise, Depression and Anxiety Disorders. J. Neural Transm. 2009, 116, 777–784. [Google Scholar] [CrossRef] [PubMed]
  17. Anand, P.; Esposito, L.; Villaseñor, A. Depression and Economic Status: Evidence for Non-Linear Patterns in Women from Mexico. J. Ment. Health 2018, 27, 529–551. [Google Scholar] [CrossRef]
  18. Sbolli, M.; Fiuzat, M.; Cani, D.; O’Connor, C.M. Depression and Heart Failure: The Lonely Comorbidity. Eur. J. Heart Fail. 2020, 22, 2007–2017. [Google Scholar] [CrossRef]
  19. Wu, Y.; Zhu, B.; Chen, Z.; Duan, J.; Luo, A.; Yang, L.; Yang, C. New Insights into the Comorbidity of Coronary Heart Disease and Depression. Curr. Probl. Cardiol. 2021, 46, 100413. [Google Scholar] [CrossRef]
  20. Aldabayan, Y.S.; Alqahtani, J.S.; Al Rajeh, A.M.; Abdelhafez, A.I.; Siraj, R.A.; Thirunavukkarasu, V.; Aldhahir, A.M. Prevalence and Predictors of Sleep Disturbance, Anxiety and Depression among Patients with Chronic Respiratory Diseases. Int. J. Environ. Res. Public Health 2022, 19, 12819. [Google Scholar] [CrossRef]
  21. Palmer, S.; Vecchio, M.; Craig, J.C.; Tonelli, M.; Johnson, D.W.; Nicolucci, A.; Pellegrini, F.; Saglimbene, V.; Logroscino, G.; Fishbane, S.; et al. Prevalence of Depression in Chronic Kidney Disease: Systematic Review and Meta-Analysis of Observational Studies. Kidney Int. 2013, 84, 179–191. [Google Scholar] [CrossRef] [Green Version]
  22. Linden, W.; Vodermaier, A.; Mackenzie, R.; Greig, D. Anxiety and Depression after Cancer Diagnosis: Prevalence Rates by Cancer Type, Gender, and Age. J. Affect. Disord. 2012, 141, 343–351. [Google Scholar] [CrossRef]
  23. Wang, Y.-H.; Li, J.-Q.; Shi, J.-F.; Que, J.-Y.; Liu, J.-J.; Lappin, J.M.; Leung, J.; Ravindran, A.V.; Chen, W.-Q.; Qiao, Y.-L.; et al. Depression and Anxiety in Relation to Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies. Mol. Psychiatry 2020, 25, 1487–1499. [Google Scholar] [CrossRef]
  24. Jonas, J.B.; Wei, W.B.; Xu, L.; Rietschel, M.; Streit, F.; Wang, Y.X. Self-Rated Depression and Eye Diseases: The Beijing Eye Study. PLoS ONE 2018, 13, e0202132. [Google Scholar] [CrossRef] [PubMed]
  25. Vieira, G.C.F.; Rodrigues, B.R.d.O.; da Cunha, C.E.X.; de Morais, G.B.; Ferreira, L.H.R. de M.; Ribeiro, M.V.M.R. Depression and Dry Eye: A Narrative Review. Rev. Assoc. Med. Bras. 2021, 67, 462–467. [Google Scholar] [CrossRef] [PubMed]
  26. Cosh, S.; Helmer, C.; Delcourt, C.; Robins, T.G.; Tully, P.J. Depression in Elderly Patients with Hearing Loss: Current Perspectives. Clin. Interv. Aging 2019, 14, 1471–1480. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Rutherford, B.R.; Brewster, K.; Golub, J.S.; Kim, A.H.; Roose, S.P. Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline. Am. J. Psychiatry 2018, 175, 215–224. [Google Scholar] [CrossRef] [Green Version]
  28. Cacioppo, J.T.; Hughes, M.E.; Waite, L.J.; Hawkley, L.C.; Thisted, R.A. Loneliness as a Specific Risk Factor for Depressive Symptoms: Cross-Sectional and Longitudinal Analyses. Psychol. Aging 2006, 21, 140–151. [Google Scholar] [CrossRef]
  29. Domènech-Abella, J.; Mundó, J.; Haro, J.M.; Rubio-Valera, M. Anxiety, Depression, Loneliness and Social Network in the Elderly: Longitudinal Associations from The Irish Longitudinal Study on Ageing (TILDA). J. Affect. Disord. 2019, 246, 82–88. [Google Scholar] [CrossRef] [Green Version]
  30. Erzen, E.; Çikrikci, Ö. The Effect of Loneliness on Depression: A Meta-Analysis. Int. J. Soc. Psychiatry 2018, 64, 427–435. [Google Scholar] [CrossRef]
  31. Lee, S.L.; Pearce, E.; Ajnakina, O.; Johnson, S.; Lewis, G.; Mann, F.; Pitman, A.; Solmi, F.; Sommerlad, A.; Steptoe, A.; et al. The Association between Loneliness and Depressive Symptoms among Adults Aged 50 Years and Older: A 12-Year Population-Based Cohort Study. Lancet Psychiatry 2021, 8, 48–57. [Google Scholar] [CrossRef]
  32. Anme, T.; Shimada, C. Social interaction and mortality in a five year longitudinal study of the elderly. Nihon Koshu Eisei Zasshi 2000, 47, 127–133. [Google Scholar]
  33. Cacioppo, J.T.; Hawkley, L.C. Perceived Social Isolation and Cognition. Trends Cogn. Sci. 2009, 13, 447–454. [Google Scholar] [CrossRef] [PubMed]
  34. Prince, M.J.; Harwood, R.H.; Blizard, R.A.; Thomas, A.; Mann, A.H. Social Support Deficits, Loneliness and Life Events as Risk Factors for Depression in Old Age. The Gospel Oak Project VI. Psychol. Med. 1997, 27, 323–332. [Google Scholar] [CrossRef] [PubMed]
  35. Lee, C.-Y.S.; Goldstein, S.E.; Dik, B.J.; Rodas, J.M. Sources of Social Support and Gender in Perceived Stress and Individual Adjustment among Latina/o College-Attending Emerging Adults. Cultur. Divers. Ethnic Minor. Psychol. 2020, 26, 134–147. [Google Scholar] [CrossRef] [PubMed]
  36. Arslantaş, H.; Adana, F.; Abacigil Ergin, F.; Kayar, D.; Acar, G. Loneliness in Elderly People, Associated Factors and Its Correlation with Quality of Life: A Field Study from Western Turkey. Iran. J. Public Health 2015, 44, 43–50. [Google Scholar] [PubMed]
  37. Seabrook, E.M.; Kern, M.L.; Rickard, N.S. Social Networking Sites, Depression, and Anxiety: A Systematic Review. JMIR Ment. Health 2016, 3, e50. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  38. Yang, X.; Yip, B.H.K.; Mak, A.D.P.; Zhang, D.; Lee, E.K.P.; Wong, S.Y.S. The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation among the Younger and Older Adult Population in Hong Kong during the COVID-19 Pandemic: Population-Based Cross-Sectional Survey Study. JMIR Public Health Surveill. 2021, 7, e24623. [Google Scholar] [CrossRef] [PubMed]
  39. Park, N.S.; Lee, B.S.; Chiriboga, D.A.; Chung, S. Loneliness as a Mediator in the Relationship between Social Engagement and Depressive Symptoms: Age Differences among Community-Dwelling Korean Adults. Health Soc. Care Community 2019, 27, 706–716. [Google Scholar] [CrossRef]
  40. Burholt, V.; Scharf, T. Poor Health and Loneliness in Later Life: The Role of Depressive Symptoms, Social Resources, and Rural Environments. J. Gerontol. B Psychol. Sci. Soc. Sci. 2014, 69, 311–324. [Google Scholar] [CrossRef] [Green Version]
  41. Liu, L.; Gou, Z.; Zuo, J. Social Support Mediates Loneliness and Depression in Elderly People. J. Health Psychol. 2016, 21, 750–758. [Google Scholar] [CrossRef]
  42. Zhao, X.; Zhang, D.; Wu, M.; Yang, Y.; Xie, H.; Li, Y.; Jia, J.; Su, Y. Loneliness and Depression Symptoms among the Elderly in Nursing Homes: A Moderated Mediation Model of Resilience and Social Support. Psychiatry Res. 2018, 268, 143–151. [Google Scholar] [CrossRef]
  43. Gray, T.F.; Azizoddin, D.R.; Nersesian, P.V. Loneliness among Cancer Caregivers: A Narrative Review. Palliat. Support. Care 2020, 18, 359–367. [Google Scholar] [CrossRef] [PubMed]
  44. Nersesian, P.V.; Han, H.-R.; Yenokyan, G.; Blumenthal, R.S.; Nolan, M.T.; Hladek, M.D.; Szanton, S.L. Loneliness in Middle Age and Biomarkers of Systemic Inflammation: Findings from Midlife in the United States. Soc. Sci. Med. 2018, 209, 174–181. [Google Scholar] [CrossRef] [PubMed]
  45. Vingeliene, S.; Hiyoshi, A.; Lentjes, M.; Fall, K.; Montgomery, S. Longitudinal Analysis of Loneliness and Inflammation at Older Ages: English Longitudinal Study of Ageing. Psychoneuroendocrinology 2019, 110, 104421. [Google Scholar] [CrossRef] [PubMed]
  46. Sato, K.; Sakata, R.; Murayama, C.; Yamaguchi, M.; Matsuoka, Y.; Kondo, N. Changes in Work and Life Patterns Associated with Depressive Symptoms during the COVID-19 Pandemic: An Observational Study of Health App (CALO Mama) Users. Occup. Environ. Med. 2021, 78, 632–637. [Google Scholar] [CrossRef] [PubMed]
  47. Tsoi, K.K.F.; Chan, J.Y.C.; Hirai, H.W.; Wong, S.Y.S. Comparison of Diagnostic Performance of Two-Question Screen and 15 Depression Screening Instruments for Older Adults: Systematic Review and Meta-Analysis. Br. J. Psychiatry 2017, 210, 255–260. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  48. Noguchi, T.; Hayashi, T.; Kubo, Y.; Tomiyama, N.; Ochi, A.; Hayashi, H. Association between Family Caregivers and Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study during the COVID-19 Pandemic. Arch. Gerontol. Geriatr. 2021, 96, 104468. [Google Scholar] [CrossRef]
  49. Anme, T.; Shinohara, R.; Sugisawa, Y.; Itoh, S. Social interaction and mortality: A seven-year longitudinal study of elderly people. Nihon Koshu Eisei Zasshi 2006, 53, 681–687. [Google Scholar]
  50. Jiao, D.; Watanabe, K.; Sawada, Y.; Tanaka, E.; Watanabe, T.; Tomisaki, E.; Ito, S.; Okumura, R.; Kawasaki, Y.; Anme, T. Multimorbidity and Functional Limitation: The Role of Social Relationships. Arch. Gerontol. Geriatr. 2021, 92, 104249. [Google Scholar] [CrossRef]
  51. Jiao, D.; Watanabe Miura, K.; Sawada, Y.; Tanaka, E.; Watanabe, T.; Tomisaki, E.; Ito, S.; Okumura, R.; Kawasaki, Y.; Anme, T. Changes in Social Relationships and Physical Functions in Community-Dwelling Older Adults. J. Nurs. Res. 2022, 30, e228. [Google Scholar] [CrossRef]
  52. Watanabe, K.; Tanaka, E.; Watanabe, T.; Chen, W.; Wu, B.; Ito, S.; Okumura, R.; Anme, T. Association between the Older Adults’ Social Relationships and Functional Status in Japan. Geriatr. Gerontol. Int. 2017, 17, 1522–1526. [Google Scholar] [CrossRef]
  53. Ge, L.; Yap, C.W.; Ong, R.; Heng, B.H. Social Isolation, Loneliness and Their Relationships with Depressive Symptoms: A Population-Based Study. PLoS ONE 2017, 12, e0182145. [Google Scholar] [CrossRef] [Green Version]
  54. Heinrich, L.M.; Gullone, E. The Clinical Significance of Loneliness: A Literature Review. Clin. Psychol. Rev. 2006, 26, 695–718. [Google Scholar] [CrossRef]
  55. Losecaat Vermeer, A.B.; Muth, A.; Terenzi, D.; Park, S.Q. Curiosity for Information Predicts Wellbeing Mediated by Loneliness during COVID-19 Pandemic. Sci. Rep. 2022, 12, 7771. [Google Scholar] [CrossRef]
  56. O’Day, E.B.; Heimberg, R.G. Social Media Use, Social Anxiety, and Loneliness: A Systematic Review. Comput. Hum. Behav. Rep. 2021, 3, 100070. [Google Scholar] [CrossRef]
  57. Nikoui, V.; Ostadhadi, S.; Azhand, P.; Zolfaghari, S.; Amiri, S.; Foroohandeh, M.; Motevalian, M.; Sharifi, A.M.; Bakhtiarian, A. The Effect of Nitrazepam on Depression and Curiosity in Behavioral Tests in Mice: The Role of Potassium Channels. Eur. J. Pharmacol. 2016, 791, 369–376. [Google Scholar] [CrossRef]
Healthcare 11 00124 g001 550
Figure 1. Mediation model with multifaceted social relationships.
Figure 1. Mediation model with multifaceted social relationships.
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Healthcare 11 00124 g002 550
Figure 2. Moderated mediation model with multifaceted social relationships.
Figure 2. Moderated mediation model with multifaceted social relationships.
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Table
Table 1. Sociodemographic characteristics and distribution of depressive symptoms (N = 555).
Table 1. Sociodemographic characteristics and distribution of depressive symptoms (N = 555).
ItemCategoryn%Depression Symptomp
Yes%No%
Age65–7434361.811332.923067.10.657
≥7521238.26631.114668.9
SexMen27148.88631.718568.30.799
Women28451.29332.719167.3
ExerciseYes32558.69529.223070.80.070
No23041.48436.514663.5
Alcohol consumptionDaily12021.63226.78871.30.139
Non-daily43578.414733.828866.2
SmokingDaily6712.11725.45074.60.199
Non-daily48887.916233.232666.8
EconomicNot good12923.25744.27255.80.004
Normal38268.810928.527371.5
Good447.91318.53181.5
HypertensionYes24744.57530.417269.60.394
No30855.510433.820466.2
StrokeYes295.2931.0 2069.0 0.885
No52694.817032.335667.7
Heart DiseaseYes468.32145.72554.30.042
No50991.715831.0 35169.0
DiabetesYes8615.52832.65867.40.947
No46984.515132.231867.8
HyperlipidemiaYes6511.72335.44264.60.565
No49088.315631.833468.2
Respiratory diseaseYes27491451.91348.10.026
No52895.116531.336368.7
Stomach diseaseYes193.41052.6947.40.053
No53696.616931.536768.5
Kidney diseaseYes407.22255.01845.0 0.001
No51592.815730.535869.5
Muscle diseaseYes5810.52441.43458.60.116
No49789.515531.234268.8
CancersYes213.81152.41047.60.044
No53496.216931.636668.4
Immune diseasesYes91.6222.2777.80.516
No54698.417732.436967.6
DementiaYes112651.5548.50.110
No5449817331.837168.2
Parkinson’s diseaseYes40.7375.0125.0 0.066
No51199.317634.437565.6
Eye diseasesYes12622.75543.77156.30.002
No42977.312428.930571.1
Ear diseasesYes356.32262.91337.1<0.001
No52093.715730.236369.8
Table
Table 2. Intercorrelations among loneliness, depression symptoms, and social relationships (N = 555).
Table 2. Intercorrelations among loneliness, depression symptoms, and social relationships (N = 555).
abcdef
Loneliness1
Depression symptoms0.296 **1
Social curiosity0.244 **0.195 **1
Independence0.138 **0.121 **0.556 **1
Interaction0.104 *0.130 **0.360 **0.329 **1
Participation0.179 **0.177 **0.469 **0.434 **0.406 **1
Feeling safe0.0620.111 **0.110 **0.153 **0.311 **0.197 **
* p < 0.05; ** p < 0.01.
Table
Table 3. Mediation analysis.
Table 3. Mediation analysis.
OutcomeVariableBSE
Social curiosityLoneliness0.280 **0.101
Depression symptomSocial curiosity0.317 **0.093
Depression symptomLoneliness1.235 **0.218
R20.303
F10.504
IndependenceLoneliness0.080 0.045
Depression symptomIndependence0.414 *0.200
Depression symptomLoneliness1.268 **0.216
R20.145
F4.107
InteractionLoneliness0.0550.043
Depression symptomInteraction0.439 *0.212
Depression symptomLoneliness1.285 **0.217
R20.059
F1.526
ParticipationLoneliness0.195 **0.070
Depression symptomParticipation0.367 **0.134
Depression symptomLoneliness1.242 **0.218
R20.153
F4.382
Feeling safeLoneliness0.0630.037
Depression symptomFeeling safe0.3960.245
Depression symptomLoneliness1.2730.216
R20.063
F1.624
* p < 0.05; ** p < 0.01.
Table
Table 4. Moderated mediation analysis (social curiosity, independence, interaction, participation, and feeling safe as moderators).
Table 4. Moderated mediation analysis (social curiosity, independence, interaction, participation, and feeling safe as moderators).
OutcomeVariableBSEt/zLLCIULCI
Social curiosityLoneliness0.191 *0.0882.1700.0180.363
Independence1.235 **0.103 11.9591.0331.438
Loneliness × Independence−0.375 *0.167−2.243−0.703−0.047
Depression symptomLoneliness1.239 **0.2205.6160.8071.672
Social curiosity0.287 **0.1092.6470.0750.450
Independence0.008 0.610 0.013 −1.1871.203
Loneliness × Independence−0.6800.497−1.369−1.6540.294
Social curiosity × Independence−1.1140.187−0.609−0.4790.252
Social curiosityLoneliness0.237 *0.0952.4870.0500.424
Interaction0.674 **0.138 4.897 0.404 0.945
Loneliness × Interaction0.233 0.193 1.207 −0.1460.612
Depression symptomLoneliness1.242 **0.221 5.607 0.808 1.676
Social curiosity0.306 **0.104 2.933 0.101 0.511
Interaction0.770 *0.381 2.020 0.023 1.516
Loneliness × Interaction−1.161 *0.502 −2.314−2.144−0.176
Social curiosity × Interaction−0.0500.148 −0.336−0.3410.241
Social curiosityLoneliness0.1650.0931.770−0.0180.348
Participation0.680 **0.077 8.7810.5280.832
Loneliness × Participation−0.241 *0.110−2.187−0.458−0.025
Depression symptomLoneliness1.204 **0.2205.4660.7721.635
Social curiosity0.254 *0.1072.3740.0440.463
Participation0.3630.2181.665−0.0640.791
Loneliness × Participation−0.2900.272−1.067−0.8230.243
Social curiosity × Participation0.0060.0800.071−0.1500.161
Social curiosityLoneliness0.259 **0.100 2.587 0.062 0.456
Feeling safe0.150 0.166 0.904 −0.1760.472
Loneliness × Feeling safe0.420 0.231 1.819 −0.3340.873
Depression symptomLoneliness1.194 **0.220 5.437 0.764 1.625
Social curiosity0.323 **0.096 3.372 0.135 0.511
Feeling safe0.478 0.361 1.327 −0.2281.185
Loneliness × Feeling safe−0.2010.496 −0.405−1.1740.772
Social curiosity × Feeling safe0.231 0.181 1.278 −0.1230.586
* p < 0.05; ** p < 0.01.
Table
Table 5. Moderated mediation analysis (social curiosity, interaction, participation, and feeling safe as moderators).
Table 5. Moderated mediation analysis (social curiosity, interaction, participation, and feeling safe as moderators).
OutcomeVariableBSEt/zLLCIULCI
ParticipationLoneliness0.117 0.065 1.800 −0.0110.245
Social curiosity0.300 **0.035 8.641 0.232 0.368
Loneliness × Social curiosity−0.0640.050 −1.282−0.1620.034
Depression symptomLoneliness1.208 **0.220 5.484 0.776 1.640
Participation0.224 0.165 1.355 −0.1000.548
Social curiosity0.313 *0.130 2.409 0.058 0.568
Loneliness × Social curiosity−0.1450.174 0.834−0.4860.196
Participation × Social curiosity0.001 0.079 0.013 −0.1540.156
ParticipationLoneliness0.151 *0.066 2.292 0.022 0.280
Independence0.643 **0.077 8.329 0.492 0.795
Loneliness × Independence−0.256 *0.125 −2.049−0.501−0.011
Depression symptomLoneliness1.245 **0.221 5.648 0.813 1.677
Participation0.297 *0.146 2.031 0.010 0.584
Independence0.484 0.368 1.316 −0.2371.204
Loneliness × Independence−0.8080.477 −1.695−1.7430.127
Participation × Independence−0.0290.197 −0.146−0.4150.358
ParticipationLoneliness0.161 *0.065 2.466 0.033 0.289
Interaction0.652 **0.094 6.926 0.467 0.836
Loneliness × Interaction−0.0530.132 −0.402−0.3120.206
Depression symptomLoneliness1.238 **0.220 5.631 0.807 1.670
Participation0.323 *0.153 2.115 0.024 0.623
Interaction0.798 *0.385 2.073 0.044 1.553
Loneliness × Interaction−0.949 *0.479 −1.981−1.888−0.010
Participation × Interaction0.055 0.188 0.291 −0.3140.423
ParticipationLoneliness0.173 *0.069 2.515 0.038 0.309
Feeling safe0.238 0.114 2.081 0.013 0.462
Loneliness × Feeling safe0.265 0.159 1.666 −0.0470.577
Depression symptomLoneliness1.193 **0.219 5.436 0.763 1.623
Participation0.405 **0.142 2.854 0.127 0.684
Feeling safe0.570 0.377 1.513 −0.1681.308
Loneliness × Feeling safe−0.0950.510 −0.185−1.0940.905
Participation × Feeling safe0.515 *0.248 2.074 0.028 1.001
* p < 0.05; ** p < 0.01.
Table
Table 6. Conditional indirect effects and conditional effects of loneliness on depression symptoms at values of multifaceted social relationships.
Table 6. Conditional indirect effects and conditional effects of loneliness on depression symptoms at values of multifaceted social relationships.
MediatorModeratorBSELLCIULCI
Social curiosity−1 SD independence0.1220.0670.0150.274
Mean independence0.060 0.036 0.003 0.145
1 SD independence0.043 0.034 −0.0150.121
Social curiosity−1 SD participation0.1140.0640.0150.260
Mean participation0.052 0.036 −0.0070.133
1 SD participation0.005 0.038 −0.0750.076
Participation−1 SD independence0.1040.0680.0060.266
Mean independence0.0550.0360.0030.140
1 SD independence0.0420.032−0.0080.118
Participation−1 SD feeling safe0.0380.043−0.0370.136
Mean feeling safe0.0790.0450.0120.185
1 SD feeling safe0.090.049 0.0170.204
No mediator−1 SD interaction1.738 0.314 1.112 2.354
Mean interaction1.283 0.218 0.856 1.710
1 SD interaction1.122 0.229 0.673 1.571
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Liu, Y.; Jiao, D.; Yang, M.; Cui, M.; Li, X.; Zhu, Z.; Sawada, Y.; Watanabe Miura, K.; Watanabe, T.; Tanaka, E.; et al. Role of Multifaceted Social Relationships on the Association of Loneliness with Depression Symptoms: A Moderated Mediation Analysis. Healthcare 2023, 11, 124. https://doi.org/10.3390/healthcare11010124

AMA Style

Liu Y, Jiao D, Yang M, Cui M, Li X, Zhu Z, Sawada Y, Watanabe Miura K, Watanabe T, Tanaka E, et al. Role of Multifaceted Social Relationships on the Association of Loneliness with Depression Symptoms: A Moderated Mediation Analysis. Healthcare. 2023; 11(1):124. https://doi.org/10.3390/healthcare11010124

Chicago/Turabian Style

Liu, Yang, Dandan Jiao, Mengjiao Yang, Mingyu Cui, Xiang Li, Zhu Zhu, Yuko Sawada, Kumi Watanabe Miura, Taeko Watanabe, Emiko Tanaka, and et al. 2023. "Role of Multifaceted Social Relationships on the Association of Loneliness with Depression Symptoms: A Moderated Mediation Analysis" Healthcare 11, no. 1: 124. https://doi.org/10.3390/healthcare11010124

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