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Open Access Research article

Depressive mood mediates the influence of social support on health-related quality of life in elderly, multimorbid patients

Felix S Wicke1, Corina Güthlin1, Karola Mergenthal1, Jochen Gensichen2, Christin Löffler3, Horst Bickel4, Wolfgang Maier5, Steffi G Riedel-Heller6, Siegfried Weyerer7, Birgitt Wiese8, Hans-Helmut König9, Gerhard Schön10, Heike Hansen11, Hendrik van den Bussche11, Martin Scherer11 and Anne Dahlhaus1*

Author Affiliations

1 Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany

2 Department of General Practice, Jena University Hospital, Jena, Germany

3 Institute of General Practice, Rostock University Medical Center, Rostock, Germany

4 Department of Psychiatry, Technical University of Munich, Munich, Germany

5 Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany

6 Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

7 Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

8 Institute for Biometry, Hannover Medical School, Hannover, Germany

9 Department of Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

10 Department of Medical Biometry and Epidemiology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany

11 Department of Primary Medical Care, Hamburg-Eppendorf University Medical Center, Hamburg, Germany

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BMC Family Practice 2014, 15:62  doi:10.1186/1471-2296-15-62

Published: 8 April 2014



It is not well established how psychosocial factors like social support and depression affect health-related quality of life in multimorbid and elderly patients. We investigated whether depressive mood mediates the influence of social support on health-related quality of life.


Cross-sectional data of 3,189 multimorbid patients from the baseline assessment of the German MultiCare cohort study were used. Mediation was tested using the approach described by Baron and Kenny based on multiple linear regression, and controlling for socioeconomic variables and burden of multimorbidity.


Mediation analyses confirmed that depressive mood mediates the influence of social support on health-related quality of life (Sobel’s p < 0.001). Multiple linear regression showed that the influence of depressive mood (β = −0.341, p < 0.01) on health-related quality of life is greater than the influence of multimorbidity (β = −0.234, p < 0.01).


Social support influences health-related quality of life, but this association is strongly mediated by depressive mood. Depression should be taken into consideration in research on multimorbidity, and clinicians should be aware of its importance when caring for multimorbid patients.

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Multimorbidity; Chronic medical conditions; Coping; Primary care; Family practice; Social support; Health-related quality of life; Depression; Elderly patients