The Paradox of Care: Family Support and Its Complex Role in the Depression and Anxiety Comorbidity Among Older Adults With Chronic Kidney Disease.

Background: With global ageing trends, the well-being of older adults is a growing concern. Chronic kidney disease (CKD) is a common ailment among older adults, often accompanied by mental distress such as depression and anxiety. This study investigates how family support impacts the comorbidity of depression and anxiety in older adults, comparing healthy individuals with those afflicted by CKD.

Methods: We recruited 228 healthy older adults and 89 with CKD. Using the Multidimensional Scale of Perceived Social Support (MSPSS), the Centre for Epidemiologic Studies Depression (CES-D) scale and the Self-Rating Anxiety Scale (SAS), we measured family support levels and the severity of depression and anxiety. The Bayesian Information Criterion (BIC) based hierarchical Least Absolute Shrinkage and Selection Operator (LASSO) regression method was used to estimate the moderated network models. Two separate moderated network models for the CKD and healthy groups were constructed to assess the differential effects of family support.

Results: Older adults with CKD experience significantly more severe depression (t = 6.39, p < 0.001), anxiety (t = 7.23, p < 0.001) and perceive less family support than their healthy counterparts (t = 5.03, p < 0.001). For healthy older adults, family support alleviates comorbidity by reducing the impact of peer rejection on mental disintegration symptoms (β = -0.02, p < 0.01). In CKD-affected older adults, family support mitigates comorbidity by lessening the effect of unfounded fear on guilt (β = -0.07, p < 0.01). However, among older individuals with CKD, family support may exacerbate comorbidity by intensifying the impact of frequent urination on feelings of life despair (β = 0.09, p < 0.05).

Conclusions: These results contribute to the understanding of mental health in the older population and inform clinical practices and policies to enhance home care measures for older adults, particularly those with CKD. As caregivers help older adults with CKD deal with physical problems that may bring shame (e.g., urinary problems), care should be taken to protect the older adult's privacy and self-esteem and not to show excessive concern for these problems.