Fang J, Li LH, He MQ, Ji Y, Lu DY, Zhang LB, Yao JL. Mediating role of health literacy in the relationship between social isolation and psychological distress among pre-frail older adults. World J Psychiatry 2025; 15(1): 100953 [PMID: 39831020 DOI: 10.5498/wjp.v15.i1.100953]
Corresponding Author of This Article
Juan Fang, PhD, Lecturer, School of Medicine, Huzhou University, No. 759 East Erhuan Road, Huzhou 313000, Zhejiang Province, China. 02508@zjhu.edu.cn
Research Domain of This Article
Psychology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jan 19, 2025; 15(1): 100953 Published online Jan 19, 2025. doi: 10.5498/wjp.v15.i1.100953
Mediating role of health literacy in the relationship between social isolation and psychological distress among pre-frail older adults
Juan Fang, Li-Hui Li, Ming-Qian He, Yue Ji, Dong-Yan Lu, Li-Bing Zhang, Jin-Lan Yao
Juan Fang, Li-Hui Li, Ming-Qian He, Yue Ji, Dong-Yan Lu, Li-Bing Zhang, Jin-Lan Yao, School of Medicine, Huzhou University, Huzhou 313000, Zhejiang Province, China
Co-corresponding authors: Juan Fang and Jin-Lan Yao.
Author contributions: Fang J and Yao JL designed the study; Li LH, He MQ, and Ji Y acquired data; Lu DY and Zhang LB performed data analysis; Fang J drafted the manuscript; Yao JL revised the manuscript; All the authors have read and approved the final manuscript; As co-corresponding authors, Fang J and Yao JL have played equally indispensable roles in the study design, data interpretation, and manuscript preparation. Fang J applied for and obtained the funds for this research project. Fang J conceptualized and designed the whole project process. She searched the literature and drafted and submitted the manuscript. Yao JL was responsible for designing and supervising the whole project process and revising the manuscript. This collaboration between Fang J and Yao JL is crucial for the publication of this manuscript.
Supported by the Scientific Research Fund of Zhejiang Provincial Education Department, No. Y202351104; and Huzhou Science and Technology Plan Project, No. 2023GZ67.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Huzhou University (approval No. 2023-06-27).
Informed consent statement: All study participants provided informed written consent before enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest with any financial organization, corporation, or individual that can inappropriately influence this work.
Data sharing statement: The data presented in this study are available upon reasonable request from the corresponding author at 02508@zjhu.edu.cn.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan Fang, PhD, Lecturer, School of Medicine, Huzhou University, No. 759 East Erhuan Road, Huzhou 313000, Zhejiang Province, China. 02508@zjhu.edu.cn
Received: August 31, 2024 Revised: November 2, 2024 Accepted: November 26, 2024 Published online: January 19, 2025 Processing time: 109 Days and 0.6 Hours
Abstract
BACKGROUND
Frailty has become a significant public health issue. The recent increase in the number of frail older adults has led to increased attention being paid to psychological care services in communities. The social isolation of pre-frail older adults can impact their psychological distress.
AIM
To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty.
METHODS
This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over. Social isolation, health literacy, and psychological distress were comprehensively measured using the Lubben Social Network Scale-6, 12-item Short-Form Health Literacy Questionnaire, and the Kessler Psychological Distress Scale-10. Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool. Descriptive statistical analyses, correlation analyses, and bootstrap mediation tests were used to assess associations between the variables.
RESULTS
The results showed that social isolation had an effect on health literacy among pre-frail older adults (β = 0.240, P < 0.001), social isolation impact on psychological distress pre-frail older adults (β = -0.415, P < 0.001); health literacy was identified effect on psychological distress among pre-frail older persons (β = -0.307, P < 0.001). Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty, with a mediation effect of -0.074, accounting for 17.83% of the total effect.
CONCLUSION
Health literacy significantly affects the relationship between social isolation and psychological distress among pre-frail older adults. Apart from fostering social connections, improved health literacy measures should be considered.
Core Tip: Older adults' combined frailty and social isolation should be addressed to prevent adverse health outcomes. Social isolation is negatively associated with health literacy. Health literacy is associated with psychological distress in older adults. This study identified a mediating role of health literacy between social isolation and psychological distress among pre-frail older adults. It is significant to develop intervention programs to foster social connection as well as health literacy in the future for pre-frail older persons with psychological distress.
