{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:33:31Z","timestamp":1784874811018,"version":"3.55.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objective<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean scores were as follows: depression (1.91\n \n \n \u00b1<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n 1.67), bidirectional social support (38.49\n \n \n \u00b1<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n 8.43), personal mastery(21.51\n \n \n \u00b1<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n 4.95), and SVI (0.49\n \n \n \u00b1<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n 0.19). Depression was positively correlated with social frailty (\n r<\/jats:italic>\n \u202f=\u202f0.716,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01), whereas both personal mastery and bidirectional social support were negatively correlated with social frailty (\n r<\/jats:italic>\n \u202f=\u202f\u22120.721, \u22120.760, both\n p<\/jats:italic>\n \u202f&lt;\u202f0.01). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2025.1647396","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:32:53Z","timestamp":1761111173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Depression and social frailty in elderly patients receiving maintenance hemodialysis: multiple mediating roles of bidirectional social support and personal mastery"],"prefix":"10.3389","volume":"12","author":[{"given":"Neng","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejiao","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.3760\/cma.j.cn441217-20220418-00158","article-title":"White paper on the current status of peritoneal dialysis management in China","volume":"38","author":"Xiang","year":"2022","journal-title":"Chin J Nephrol"},{"key":"ref2","year":"2019"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/s0140-6736(97)09411-7","article-title":"Haemodialysis","volume":"353","author":"Mallick","year":"1999","journal-title":"Lancet"},{"key":"ref4","year":"2018"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"A6","DOI":"10.1053\/j.ajkd.2019.09.003","article-title":"US renal data system 2019 annual data report: epidemiology of kidney disease in the United States","volume":"75","author":"Saran","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"913","DOI":"10.19538\/j.nk2021110101","article-title":"Research progress on prognostic factors in elderly hemodialysis patients","volume":"41","author":"Zhang","year":"2021","journal-title":"Chin J Pract Intern Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1681\/ASN.V12122797","article-title":"Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis","volume":"12","author":"Kalantar-Zadeh","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1186\/s12888-025-07228-x","article-title":"Suicidality among people with mild cognitive impairment: a sustematic review","volume":"25","author":"S\u00e1nchez-Gil","year":"2025","journal-title":"BMC Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e250268","DOI":"10.1001\/jamanetworkopen.2025.0268","article-title":"Prevalence of depression and anxiety among adults with chronic pain: a systematic review and Meta-analysis","volume":"8","author":"Aaron","year":"2025","journal-title":"JAMA Netw Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1681\/ASN.2004070550","article-title":"Suicide in the United States end-stage renal disease program","volume":"16","author":"Kurella","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"239","DOI":"10.16690\/j.cnki.1007-9203.2022.05.055","article-title":"The \"14th five-year plan for healthy ageing\" issued","volume":"30","author":"Dong","year":"2022","journal-title":"J Tradit Chin Med Manag"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1080\/0886022X.2022.2077761","article-title":"Prevalence of depression and anxiety and their predictors among patients undergoing maintenance hemodialysis in northern China: a cross-sectional study","volume":"44","author":"Meng","year":"2022","journal-title":"Ren Fail"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1186\/s12882-024-03835-0","article-title":"Better health-related quality of life is associated with prolonged survival and reduced hospitalization risk among dialysis-dependent chronic kidney disease patients: a historical cohort study","volume":"25","author":"Rincon","year":"2024","journal-title":"BMC Nephrol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.3390\/ijerph18073544","article-title":"Influence of depression and anxiety on hemodialysis patients: the value of multidisciplinary care","volume":"18","author":"Delgado-Dom\u00ednguez","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s10433-017-0414-7","article-title":"Social frailty in older adults: a scoping review","volume":"14","author":"Bunt","year":"2017","journal-title":"Eur J Ageing"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"220","DOI":"10.12114\/j.issn.1007-9572.2023.0917","article-title":"Social frailty status and interpretable analysis of influencing factors in patients with chronic heart failure","volume":"28","author":"Lu","year":"2025","journal-title":"Chin Gen Pract"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1080\/00223891.2011.594124","article-title":"The development of the 2-way social support scale: a measure of giving and receiving emotional and instrumental support","volume":"93","author":"Shakespeare-Finch","year":"2011","journal-title":"J Pers Assess"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1177\/0956797614559284","article-title":"Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness","volume":"26","author":"Cohen","year":"2015","journal-title":"Psychol Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.gerinurse.2023.08.003","article-title":"The mediating effects of social support and depressive symptoms on activities of daily living and social frailty in older patients with chronic heart failure","volume":"53","author":"Wang","year":"2023","journal-title":"Geriatr Nurs"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"337","DOI":"10.2307\/2136676","article-title":"The stress process","volume":"22","author":"Pearlin","year":"1981","journal-title":"J Health Soc Behav"},{"key":"ref21","first-page":"557","article-title":"Personal mastery status and influencing factors analysis in community-dwelling older adults","volume":"36","author":"Jiao","year":"2022","journal-title":"Chin Nurs Res"},{"key":"ref22","first-page":"36","article-title":"Research progress on sense of personal mastery and its influencing factors in elderly patients with chronic diseases","volume":"24","author":"Fan","year":"2024","journal-title":"Shanghai Nurs J"},{"key":"ref23","first-page":"22","article-title":"Characteristics and applications of structural equation modeling","volume":"10","author":"Cheng","year":"2006","journal-title":"Stat Decis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"66","DOI":"10.13342\/j.cnki.cjhp.2025.01.013","article-title":"Latent profile analysis of personal mastery and its influencing factors in patients with chronic heart failure","volume":"33","author":"Qiu","year":"2025","journal-title":"China J Health Psychol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1111\/j.1532-5415.1999.tb03848.x","article-title":"Development and testing of a five-item version of the geriatric depression scale","volume":"47","author":"Hoyl","year":"1999","journal-title":"J Am Geriatr Soc"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e2232","DOI":"10.1371\/journal.pone.0002232","article-title":"Social vulnerability, frailty and mortality in elderly people","volume":"3","author":"Andrew","year":"2008","journal-title":"PLoS One"},{"key":"ref27","first-page":"1095","article-title":"Status quo and influencing factors of social vulnerability in elderly patients with knee osteoarthritis","volume":"9","author":"Bai","year":"2023","journal-title":"Chin Evid-based Nurs"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2307\/2136319","article-title":"The structure of coping","volume":"19","author":"Pearlin","year":"1978","journal-title":"J Health Soc Behav"},{"key":"ref29","first-page":"78","article-title":"Development characteristics of positive psychological qualities in migrant children","volume":"4","author":"Yu","year":"2008","journal-title":"Chin J Spec Educ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2106908020","DOI":"10.1177\/2050312119836020","article-title":"Reliability and validity of the brief 2-way social support scale: an investigation of social support in promoting older adult well-being","volume":"7","author":"Obst","year":"2019","journal-title":"SAGE Open Med"},{"key":"ref31","first-page":"94","article-title":"Cross-cultural adaptation and validation of the simplified bidirectional social support scale in community-dwelling older adults","volume":"37","author":"Cui","year":"2022","journal-title":"J Nurs Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1111\/jgs.15812","article-title":"The social vulnerability index: assessing replicability in predicting mortality over 27 years","volume":"67","author":"Ouvrard","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s40520-021-01968-y","article-title":"Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults","volume":"34","author":"Inoue","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"ref34","first-page":"98","article-title":"Study on the status and influencing factors of social isolation among community-dwelling oldest-old","volume":"37","author":"Liu","year":"2022","journal-title":"J Nurs Sci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/psyg.12696","article-title":"Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao longevity and aging study","volume":"21","author":"Chen","year":"2021","journal-title":"Psychogeriatrics"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.jad.2023.10.012","article-title":"Association of depression with incident sarcopenia and modified effect from healthy lifestyle: the first longitudinal evidence from the CHARLS","volume":"344","author":"Liu","year":"2024","journal-title":"J Affect Disord"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.neubiorev.2019.04.011","article-title":"Motivation and cognitive control in depression","volume":"102","author":"Grahek","year":"2019","journal-title":"Neurosci Biobehav Rev"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol Bull"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1186\/s12890-024-03202-7","article-title":"Social support mediates social frailty with anxiety and depression","volume":"24","author":"Liu","year":"2024","journal-title":"BMC Pulm Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1037\/0033-2909.126.2.247","article-title":"Self-regulation and depletion of limited resources: does self-control resemble a muscle?","volume":"126","author":"Muraven","year":"2000","journal-title":"Psychol Bull"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.nefro.2019.06.008","article-title":"Psychological inflexibility and clinical impact: adaptation of the acceptance and action questionnaire-II in a sample of patients on haemodialysis treatment","volume":"40","author":"Delgado","year":"2020","journal-title":"Nefrologia (Engl Ed)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1016\/j.kint.2019.05.017","article-title":"Depression in patients undergoing hemodialysis: time to treat","volume":"96","author":"Shirazian","year":"2019","journal-title":"Kidney Int"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1647396\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:32:59Z","timestamp":1761111179000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1647396\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":42,"alternative-id":["10.3389\/fmed.2025.1647396"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1647396","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"article-number":"1647396"}}