{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T07:31:27Z","timestamp":1786692687332,"version":"build-2736575974"},"reference-count":47,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Occupational Therapy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    <jats:bold>Importance:<\/jats:bold>\n                    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.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>Ninety-three community-dwelling middle-aged and older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes and Measures:<\/jats:title>\n                    <jats:p>Measures included the Everyday Cognition scale for SCD (dependent variable), the Center for Epidemiologic Studies\u2013Depression 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5014\/ajot.2026.051258","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:20:55Z","timestamp":1769775655000},"page":"342-352","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderated Mediation Among Subjective Cognition, Community Participation, Depression, and Comorbidities of Middle-Aged and Older Adults"],"prefix":"10.1177","volume":"80","author":[{"given":"Yejin","family":"Lee","sequence":"first","affiliation":[{"name":"Yejin Lee, PhD, MSOT, is Postdoctoral Research Associate, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangmi","family":"Park","sequence":"additional","affiliation":[{"name":"Sangmi Park, PhD, OTR, is Postdoctoral Research Associate, Human Engineering Research Laboratories, School of Medicine, University of Pittsburgh, and VA Pittsburgh Healthcare System, Pittsburgh, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Tabor","family":"Connor","sequence":"additional","affiliation":[{"name":"Lisa Tabor Connor, PhD, MSOT, OTR\/L, is Professor, Program in Occupational Therapy, and Professor, Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/psyg.12674"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000471"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2015.1081152"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2017.12.004"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.01.006"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/bs14040262"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/08870448808400349"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-180501"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/0894-4105.22.4.531"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0000000000000450"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2008.07.007"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2021.114374"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/1.1.8"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2014.962683"},{"key":"e_1_3_2_17_1","volume-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.","author":"Hayes A. 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