Depression Mediates the Association Between Burden and Quality of Life in Informal Caregivers of Stroke Survivors: Meta-analytic Structural Equation Modeling.

OBJECTIVE: This study aims to use Meta-analytical structural equation modeling (MASEM) to clarify the relationship between burden, depression, and quality of life in informal caregivers of stroke survivors. DATA SOURCES: The databases of PubMed, Cochrane Library, Embase, China Knowledge Resource Integrated Database, Wan Fang Database, and Chinese Biomedical Database were comprehensively searched before January 16, 2023. STUDY SELECTION: Two researchers performed an independent initial search by using a unified search strategy. Observational studies investigating the relation between burden, depression, and quality of life in informal caregivers of stroke survivors were included. The studies that met the inclusion criteria were appraised by "Quality Assessment and Validity Tool for Correlational Studies". DATA EXTRACTION: PRISMA guidelines were used for this study. Data extraction was performed independently by 2 researchers. The following data were extracted: study author, year of publication, country, language, sample size, age, sex (%women), the caregivers' relation with stroke survivor, measures, type of outcome reported in the study, study design, and main conclusion. DATA SYNTHESIS: The analysis included 18 articles that reported 23 effect sizes (N=3284). The MASEM findings showed that caregiver burden was positively associated with caregiver depression (ß=0.474, 95% CI [0.398, 0.550]), caregiver depression was negatively associated with caregiver quality of life (ß=-0.316, 95% CI [-0.545, -0.087]). Furthermore, the association between caregiver burden and quality of life was completely mediated by caregiver depression (ß=-0.150, 95% CI [-0.271, -0.041]). CONCLUSIONS: Using the MASEM approach, we observed that caregiver depression completely mediated the relation between burden and quality of life in informal caregivers of stroke survivors. Although the results did not allow for causal inference, this result suggested that for burdened stroke survivors' informal caregivers efforts should be made to their mental health to eliminate the internal barriers, then eventually improve their quality of life.

Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function.

BACKGROUND: Numerous studies have explored the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults. However, the results of these studies were not consistent. Therefore, the in-depth excavation of the complex relationship mechanism between these four variables is limited. This study aims to explore whether depression and cognitive function act as the multiple mediators between social participation and life satisfaction in community-dwelling older adults. METHODS: This study used the meta-analytic structural equation modeling (MASEM) approach. Six databases were comprehensively searched to investigate the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults from inception to March 1, 2023. RESULTS: The analysis included 50 articles that reported 66 effect sizes (N = 161,854). The MASEM found the relationship between social participation and life satisfaction was mediated by depression [ß = 0.085, 95 % CI (0.053, 0.126)] and by cognitive function [ß = 0.015, 95 % CI (0.002, 0.033)], respectively. Depression and cognitive function also played multiple mediating roles between social participation and life satisfaction in community-dwelling older adults [ß = 0.005, 95 % CI (0.001, 0.012)]. CONCLUSIONS: There was not only a direct association between social participation and life satisfaction, but also an association through multiple mediating roles of depression and cognitive function in community-dwelling older adults. In the process of using diverse interventions to promote social participation in community-dwelling older adults, more attention should be paid to their psychological status and cognitive function to eliminate intrinsic barriers so as to improve life satisfaction effectively.

Mediating effect of post-stroke depression between activities of daily living and health-related quality of life: meta-analytic structural equation modeling.

BACKGROUND: Stroke survivors face various problems that affect their health-related quality of life (HRQoL). Reduced activities of daily living (ADL) may contribute to post-stroke depression (PSD) and low HRQoL, and depression might be associated with low HRQoL. However, these relationships are not well known. This study aimed to analyze correlations among ADL, PSD, and HRQoL in stroke survivors and further explore the mediating role of PSD between ADL and HRQoL. METHODS: This study utilized meta-analytic structural equation modeling (MASEM) on systematically searched articles from six electronic databases, namely PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (China), Wanfang database (China), and SinoMed (China), from inception up to July 31, 2021. Two researchers independently assessed study eligibility, and data from the eligible studies were encoded and assessed for quality. MASEM was utilized to examine correlations among ADL, PSD, and HRQoL, with an estimation of a pooled correlation matrix under a random-effects model. The matrix was directly fitted to a structural equation model using webMASEM. RESULTS: In total, 8580 articles were screened, and data from 27 studies involving 33 effect sizes were used in the MASEM analysis. Correlations among the three variables were significant (both P < 0.01). Furthermore, PSD partially mediated the correlation between ADL and HRQoL (ß = 0.24, 95% confidence interval 0.15-0.30). CONCLUSIONS: The findings suggest that both decreased ADL and PSD may reduce HRQoL, while a decrease in ADL tends to cause depression after stroke. Therefore, ADL and PSD reductions should be improved to achieve better HRQoL of stroke survivors. Future studies should continue to discuss other factors affecting HRQoL to achieve optimal recovery in stroke survivors.

The mediating effect of post-stroke depression between social support and quality of life among stroke survivors: A meta-analytic structural equation modeling.

OBJECTIVES: The aim was to confirm the relationship between social support (SS), post-stroke depression (PSD), and quality of life (QOL) and determine the mediating effect of PSD in stroke survivors. Additionally, we tested the impact of economic development level (in developed or developing countries) on the relationship between SS, PSD, and QOL. METHODS: This study utilized meta-analytic structural equation modeling on systematically searched articles from PubMed, MEDLINE, Cochrane Library, Scopus, PsycINFO, Web of Science, China National Knowledge Infrastructure, and WanFang data published from inception to February 2022. Collect the sample size (n) of each study and the associations of observed variables, and conduct meta-analysis path analysis using AMOS 23.0 to assess the relationships. Concurrently, the effects of the national economic development level were extracted for moderator analysis. RESULTS: A total of 28 studies (N = 3967) were included for analysis. SS and PSD were significant predictors of QOL (both p < 0.01). PSD mediated the relationship between SS and QOL (ß = 0.31; 95% confidence interval 0.273-0.345; p < 0.01). Furthermore, in developed countries, SS was not statistically correlated with PSD (p = 0.811) compared to developing countries. CONCLUSIONS: Improving SS may help improve the QOL of stroke patients. PSD should be addressed using a comprehensive approach that includes interventions to enhance the QOL. Additionally, people have different psychological reactions to SS at different stages of economic development; thus, further research is needed to develop different measurement standards for patients according to the country's level of economic development.