Effect of Frailty on Depression among Patients with Late-life Depression: A Test of Anger, Anxiety, and Resilience as Mediators
Junhyung Kim1, Hyun-Ghang Jeong1, Moon-Soo Lee1,2, Chi-Un Pae3,4,5, Ashwin A. Patkar6, Sang Won Jeon7,8, Cheolmin Shin9, Changsu Han1
1Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
2Department of Life Sciences, Korea University, Seoul, Korea
3Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
4Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
5Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
6Department of Advance Psychiatry, Rush University Medical Center, Raleigh, NC, USA
7Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
8Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Korea
9Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
Correspondence to: Changsu Han
Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea
E-mail: hancs@korea.ac.kr
ORCID: https://orcid.org/0000-0002-4021-8907
Received: March 6, 2023; Revised: May 22, 2023; Accepted: May 25, 2023; Published online: September 6, 2023.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: While the association between depression and frailty in the elderly population has been investigated, the psychological factors that mediate such a relationship remain unknown. The identification of psychological factors in interventions for depression treatment in the elderly may assist in the treatment and care. We aimed to explore the mediating effects of anger, anxiety, and resilience on the link between frailty and depression symptoms in patients with late-life depression.
Methods: A sample of 203 older adults completed questionnaires that assessed depression, anger, resilience, and anxiety. To measure frailty, participants were evaluated using a self-rated health questionnaire, weight-adjusted waist index related to sarcopenia, and weight-adjusted handgrip strength to evaluate weakness. A mediation model was tested, hypothesizing that anger, anxiety, and resilience would partially mediate the strength of the frailty-depression link in the elderly.
Results: Only self-rated health showed a significant association with depressive symptoms in late-life depression. Our study demonstrated that frailty has both direct and indirect associations with depression, mediated by anger, resilience, and anxiety.
Conclusion: Given that anger, resilience, and anxiety influence the link between self-rated health and depression, interventions that lead to increased resilience and decreased anger and anxiety may be promising to reduce depressive symptoms in older adults with depression.
Keywords: Anxiety; Anger; Depression; Aged; Hand-grip strength; Frailty

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