Chain mediation effects of depressive symptoms and nutritional risk between social support and oral frailty in patients with coronary heart disease

Bibliographic Data

ID22433462
AuthorsYufeng Wang (0000-0002-0833-6727, Hunan Normal University), QingQiu Gan (0000-0002-1731-2866, Hunan Normal University), Juan Zhang (0000-0003-3613-6332, Hunan Normal University), Meiyi Tao (Hunan Normal University)
Year2026
Volume14
Publication date2026-07-14
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1880497
OpenAlexW7168285397
LanguageEN
References cited47

Introduction Oral frailty among coronary heart disease (CHD) patients is prevalent and harmful. CHD patients have encountered serious physical and psychological health issues. Social support is a crucial protective factor in chronic disease management. There is a paucity of evidence regarding the specific association among CHD patients. Depressive symptoms and nutritional risk have been demonstrated to be associated with oral frailty, but the mediating role between them under the influence of social support remains to be further explored. This study aimed to investigate the chain mediating effect of depressive symptoms and nutritional risk between social support and oral frailty among CHD patients. Methods This is a cross-sectional study involving 500 hospitalized CHD patients, conducted from September 2025 to January 2026. The assessment tools used included a demographic characteristics, the Social Support Rating Scale (SSRS), the PHQ-9 Depression Screening Scale (PHQ-9), the Nutritional Risk Screening 2002(NRS 2002), and the Oral Frailty Index-8 (OFI-8). Pearson correlation analysis was used to examine relationships among variables, and the Bootstrap method (with 5,000 repeated samples) was employed to test for mediating effects. Results The prevalence of oral frailty among CHD patients was 57.60%. The mean scores for social support, depressive symptoms, nutritional risk, and oral frailty were (37.67 ± 8.15), (13.41 ± 3.47), (1.12 ± 1.13), and (4.80 ± 2.86), respectively. Correlation analysis revealed that oral frailty was negatively correlated with social support and positively correlated with depressive symptoms and nutritional risk. Mediation analysis indicated that social support not only directly influences oral frailty but also indirectly influenced it through depressive symptoms, nutritional risk, and the chain path between depressive symptom and nutritional risk; the chain mediation effect accounted for 15.57% of the total effect. After adjusting for covariate, the mediation effects remained statistically significant. Discussion The study showed that social support can predict oral frailty through depressive symptoms and nutritional risk. It is recommended that healthcare professionals provide comprehensive interventions to enhance social support for CHD patients and actively manage their depressive symptoms and nutritional risks to prevent the progression of oral frailty.

Coronary heart disease · Depressive symptoms · Disease · Mediation · Risk factor · Social support · Cardiac Health and Mental Health · Dental Health and Care Utilization · Frailty in Older Adults

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