Loneliness and depression in older adults with multimorbidity: the role of self-efficacy and social support

Introduction: As relatively little is known about self-efficacy and social support in individuals aged 65 years and older and whether they are facing a decline in life due to multimorbidity and previous COVID-19 infection, this study investigated hypotheses based on Social Cognitive Theory. Methods: It was tested whether depressive symptoms in multimorbid patients who were hospitalized for COVID-19 infection, and recover post infection during their hospital stay, do not differ from those of multimorbid patients hospitalized for other conditions. Furthermore, we tested whether depressive symptoms are associated with increased loneliness scores, low self-efficacy beliefs, and poorly perceived social support. Additionally, it was investigated whether self-efficacy is a mediator variable, and social support is a moderator variable between loneliness and depression. N = 135 patients with or without previous COVID-19 infection (mean age 64.76) were recruited. Paper questionnaires were collected at the time of inpatient hospital admission in the year 2021 and in a cross-sectional study design. The study compared n = 45 multimorbid patients who survived COVID-19 infection with those n = 90 who were not infected before. Results: No significant difference in depressive symptomology between these two groups revealed [t₍₁₃₃₎ = 130, p = 0.90, d = 0.024); F_{(3, 122)} = 0.255, p = 0.86]. The study found a positive correlation between loneliness and anxiety and depression in both groups (r_depression = 0.419 and r_anxiety = 0.496). Self-efficacy mediated the relation between loneliness and depression. The completely standardized indirect effect was β = 0.111, percentile Bootstrap 95% CI 0.027–0.201. Discussion: The research findings suggest the importance of self-efficacy, and loneliness in the development of depressive symptoms, and have several practical implications for improving the mental health of multimorbid patients: Prospectively, treatment should not only focus on physical and cognitive health, but also on promoting self-efficacy and perceived social support, as well as address loneliness with psychoeducational interventions. Replication of the findings and conducting interventional research also employing lifestyle components should follow up, as this study tested associations but no causal relationships.