Social Support and Depression Related to Older Adults’ Hypertension Control in Rural China

Q1) What is the primary question addressed by this study?A: Psychological mechanisms are commonly recognized as essential pathways linking social support with health outcomes, however, rare studies have provided direct evidence of the assumption.Q2) What is the main finding of this study?A: The present study demonstrates that depression severity partially mediates the effect of social support on hypertension control among older patients with depression in China.Q3) What is the meaning of the finding?A: Approaches for managing depression and hypertension such as primary care-based collaborative care models should address social support to achieve better health outcomes. This study aimed to investigate association between social support and hypertension (HTN) control in rural China older adults, and to what extent depression mediates this relationship. The authors hypothesized that depression severity mediated the relationship between social support and HTN control. Data for the analyses were obtained from baseline data from a randomized controlled clinical trial of a collaborative depression care management intervention conducted in rural villages of China, with older adults with comorbid depression and HTN. Data included baseline assessments of 2,351 subjects aged 60 years and older, whose blood pressure and depression severity were measured using a calibrated manual sphygmomanometer and the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Social support was measured using the 20-item Medical Outcomes Study–Social Support Survey. Uncontrolled HTN was associated with older age (t[df = 2349] = 3.16; p < 0.01), higher HDRS-17 score (t[df = 1488] = 5.89; p < 0.001), and lower social support (t[df = 2349] = 5.37; p < 0.001). A significant indirect effect of social support via depression severity in relation to HTN control (a × b = –0.04[0.01]), bootstrap p = 0.0015, and 95% confidence interval (–0.07, –0.02), accounting for 11% of the effect of social support on HTN control. These findings imply that social support impacts HTN control directly and indirectly through depression. Intervention approaches such as primary care-based collaborative care models should address social support to achieve greater outcomes for depression and HTN management.