Multimorbidity is significantly associated with poorer mental health among older adults in China, and family support—but not social support—significantly moderates this relationship, with the negative association between multimorbidity and mental health becoming progressively stronger as family support increases.
Key Findings
Results
Chronic disease multimorbidity is significantly associated with poorer mental health among older adults in China.
Data were drawn from the 2020 China Longitudinal Aging Social Survey (CLASS), a nationally representative cross-sectional dataset.
Multimorbidity was based on self-reported chronic disease diagnoses.
Multivariate regression models were used to estimate the direct association between multimorbidity and mental health outcomes.
The negative association between multimorbidity and mental health was statistically significant in the primary models.
Results
Both social support and family support are positively associated with better mental health among older adults, but only family support significantly moderates the association between multimorbidity and mental health.
Interaction terms between support measures and multimorbidity were incorporated into multivariate regression models.
The interaction term for family support and multimorbidity was statistically significant.
The interaction term for social support and multimorbidity was not statistically significant.
The direct positive association of both family and social support with mental health was confirmed independently of their moderating roles.
Results
Marginal effects analysis reveals that the negative association between multimorbidity and mental health becomes progressively stronger as the level of family support increases.
This counterintuitive finding suggests that higher family support does not buffer but rather amplifies the mental health burden associated with multimorbidity.
Marginal effects were estimated across the distribution of family support levels.
The strengthening of the negative association with increasing family support was a consistent pattern in the marginal effects analysis.
This pattern may reflect increased awareness of illness burden or heightened psychological distress related to dependency among those with more family support.
Results
The direct association between family support and mental health follows a U-shaped pattern across age groups in subgroup analysis.
Subgroup analysis was conducted across different age groups of older adults.
The U-shaped pattern indicates that the mental health benefits of family support vary non-linearly with age.
The moderating effect of family support on the multimorbidity–mental health relationship gradually weakens with advancing age.
The moderating effect of family support becomes statistically insignificant among adults aged 80 years and above.
Conclusions
The study highlights the need to integrate family-centered approaches into geriatric care and mental health interventions for older adults living with multimorbidity.
Findings contribute to understanding the role of interpersonal resources in later life.
The differential moderating roles of family versus social support suggest that intervention design should distinguish between these support types.
Age-specific patterns in the moderating effect of family support point to the need for tailored approaches across different age subgroups of older adults.
The study used the 2020 CLASS dataset, which is nationally representative of the Chinese older adult population.
What This Means
This research suggests that having multiple chronic diseases at the same time (called multimorbidity) is linked to worse mental health among older adults in China. Using a large, nationally representative survey of Chinese older adults conducted in 2020, the researchers found that both family support (such as help and care from relatives) and social support (such as community connections) were independently associated with better mental health. However, only family support changed the way that multimorbidity affected mental health—social support did not play this moderating role.
A particularly surprising finding was that the mental health burden of multimorbidity actually grew stronger—not weaker—as family support increased. This means that older adults with more family support who also had multiple chronic conditions reported worse mental health than those with less family support in the same situation. The researchers also found that among the oldest adults (aged 80 and above), family support no longer significantly changed the relationship between multimorbidity and mental health at all. Among younger older adults, family support showed a U-shaped pattern in its direct effect on mental health across age groups.
These findings matter because they suggest that simply having more family support does not automatically protect older adults with multiple chronic conditions from mental health difficulties—and may even be associated with greater psychological distress, possibly due to feelings of dependency or heightened awareness of illness. This research suggests that healthcare systems and policymakers in aging societies like China should consider family dynamics carefully when designing mental health interventions for older adults with multiple chronic diseases, rather than assuming that more family involvement is always better.
Zong L, Zhou K. (2026). Chronic disease multimorbidity and mental health among older adults in China: The moderating roles of family and social support.. PloS one. https://doi.org/10.1371/journal.pone.0357259