Importance:It is important to understand the mediation association among depressive symptoms, community participation, subjective cognitive decline (SCD), and comorbidities to prevent progressive cognitive deterioration of middle-aged and older adults. Objective: To investigate the mediating role of community participation in the association between depressive symptoms and SCD among middle-aged and older adults, as well as examine whether this mediation association is conditional on comorbid conditions. Design: A cross-sectional study. Participants: Ninety-three community-dwelling middle-aged and older adults. Outcomes and Measures: Measures included the Everyday Cognition scale for SCD (dependent variable), the Center for Epidemiologic Studies–Depression scale for depressive symptoms (independent variable), the Reintegration of Normal Living Index for community participation (mediator), and the Charlson Comorbidity Index for comorbid conditions (moderator). Mediation and moderated mediation models were built by using the Hayes SPSS PROCESS macro. Results: Community participation partially mediated the association between depressive symptoms and SCD. This mediation association was conditional on comorbid conditions, given the significant interaction between depressive symptoms and comorbid conditions: The mediation association of depressive symptoms with SCD via community participation became stronger when individuals had more severe comorbid conditions. Conclusions and Relevance: These findings suggest the importance of addressing community participation to reduce the associations between depressive symptoms and SCD among middle-aged and older adults, particularly those with more severe comorbid conditions. Plain-Language Summary: This study investigated how participation in community life influences the relationship between depressive symptoms and self-perceived decline in cognitive abilities (e.g., memory and thinking abilities) among middle-aged and older adults. We also examined whether this relationship changes based on multiple medical conditions. Ninety-three community-dwelling adults participated in this study. We used established measures to assess depressive symptoms, community participation, self-perceived cognitive decline, and multiple medical conditions. Our analysis revealed that community participation explained the link between depressive symptoms and self-perceived cognitive decline. Furthermore, the influence of community participation on this link was stronger for individuals with more severe medical conditions. These findings suggest that enhancing community participation may reduce the association between depressive symptoms and self-perceived cognitive decline, especially for those with multiple medical conditions.
Lee et al. (Fri,) studied this question.