Social Support and Quality of Life in Older Adults With Chronic Disease: The Mediating Roles of Loneliness and Depressive Symptoms
Keywords:
Social support, quality of life, loneliness, depressive symptoms, older adults, chronic disease, mediation, structural equation modelingAbstract
Objective: This study aimed to examine the relationship between perceived social support and quality of life among older adults with chronic disease and to test the mediating roles of loneliness and depressive symptoms in this relationship.
Methods and Materials: This cross-sectional correlational study was conducted among 426 older adults with chronic disease in Canada. Participants were recruited from outpatient chronic disease clinics, community health centers, senior service organizations, and primary care referral networks. Eligible participants were aged 65 years or older and had at least one physician-confirmed chronic disease. Data were collected using a demographic and clinical information form, the Multidimensional Scale of Perceived Social Support, the UCLA Loneliness Scale, the 15-item Geriatric Depression Scale, and the WHOQOL-OLD. Data were analyzed using descriptive statistics, Pearson correlation analysis, and structural equation modeling. The indirect effects were examined using bootstrapping with 5,000 resamples and 95% confidence intervals.
Findings: Pearson correlation analysis showed that perceived social support was negatively correlated with loneliness (r = -0.58, p < 0.001) and depressive symptoms (r = -0.46, p < 0.001), and positively correlated with quality of life (r = 0.52, p < 0.001). Loneliness was positively correlated with depressive symptoms (r = 0.63, p < 0.001) and negatively correlated with quality of life (r = -0.61, p < 0.001). Depressive symptoms were also negatively correlated with quality of life (r = -0.66, p < 0.001). The structural model showed good fit to the data: χ²/df = 2.23, CFI = 0.972, TLI = 0.958, GFI = 0.965, RMSEA = 0.054, and SRMR = 0.041. Perceived social support had significant direct effects on loneliness (β = -0.58, p < 0.001), depressive symptoms (β = -0.15, p = 0.002), and quality of life (β = 0.19, p < 0.001). Loneliness predicted depressive symptoms (β = 0.54, p < 0.001) and quality of life (β = -0.24, p < 0.001), while depressive symptoms predicted quality of life (β = -0.42, p < 0.001). Bootstrapping confirmed significant indirect effects through loneliness, depressive symptoms, and their sequential pathway.
Conclusion: Perceived social support was directly and indirectly associated with better quality of life among older adults with chronic disease, and loneliness and depressive symptoms partially mediated this relationship.
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Copyright (c) 2026 Joel Billieux , Mehdi Rostami, Farzaneh Mardani, Bridget Abalorio (Author)
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