Functional Social Support as a Mediator of the Association Between Anxiety and Executive Function: A Moderated Mediation Analysis of the Canadian Longitudinal Study on Aging

Abstract

Background: Anxiety in older adulthood may adversely affect executive function, a cognitive domain essential for adaptability and independence. Functional social support (FSS), the perception that others will provide help, care, or comfort when needed, may partially explain the link between anxiety and executive function. This link may differ by age or sex.

Objective: To examine whether FSS mediates the association between anxiety (self-reported clinical diagnosis of anxiety or anxiety symptoms) and executive function in middle-aged and older adults, stratified by age and sex.

Methods: Analyses included 6,719 community-dwelling adults aged 45 to 85 years at baseline, drawn from the Comprehensive cohort of the Canadian Longitudinal Study on Aging. Data were collected over three waves spanning six years. Clinical history of an anxiety disorder (yes/no) and anxiety symptoms (four items from the Kessler Psychological Distress Scale) were self-reported at baseline (T0). Three-year (T1) FSS was self-reported using the Medical Outcomes Study-Social Support Survey. Six-year (T2) executive function was obtained by standardizing and combining scores from five neuropsychological tests. Conditional process analysis with percentile bootstrapping was used to estimate mediation across levels of age and sex, adjusted for relevant covariates and antecedent measures of FSS (T0) and executive function (T0, T1).

Results: FSS did not significantly mediate the association between either anxiety measure (clinical anxiety or anxiety symptoms) and executive function for any age or sex subgroup (bs = -0.0043 to 0.0103, p > .05).

Discussion: While social support has known benefits for cognition, the results suggest that the provision of FSS as a strategy to mitigate the impact of anxiety on executive function may not be needed in healthy middle-aged and older men and women. To promote the cognitive health of aging Canadians, interventions may be better directed to targeting other pathways linking anxiety to cognitive decline.