title: Mediating effect of decline in social activities on urinary incontinence and negative mood: Do sex and marital differences exist?
abstract: OBJECTIVE
  We tested the mediating effect of decline in social participation on urinary incontinence (UI) and negative mood in older adults by sex and marital status.
  
  
  METHODS
  We carried out secondary analysis of data collected from 5301 Chinese adults aged 60 years or older in Hong Kong who had completed an initial screening instrument for subsidized long-term care services in 2010. Path analysis within structural equation modeling was carried out.
  
  
  RESULTS
  Satisfactory model fit was obtained: male-married group (n = 1949, standardized root means squared residual [SRMR] = 0.034, robust root mean square error of approximation [R-RMSEA] = 0.045, robust comparative fit index [R-CFI] = 0.965), male-other group (n = 519, SRMR = 0.023, R-RMSEA = 0.011, R-CFI = 0.988), female-married group (n = 948, SRMR = 0.018, R-RMSEA = 0.002, R-CFI = 1.000) and female-other group (n = 2251, SRMR = 0.023, R-RMSEA = 0.048, R-CFI = 0.970). In the male-married subsample, UI had both a significant direct effect (β = 0.046) and significant indirect effect on mood through decline in social participation (β = 0.021); for the female-other subsample, UI (β = 0.058) and decline in social participation (β = 0.335) had significant direct effects on negative mood. Decline in social participation had a significant direct effect on negative mood in the male-other subsample (β = 0.306) and the female-married subsample (β = 0.325).
  
  
  CONCLUSIONS
  Decline in social participation mediated the relationship between UI and negative mood in married older men, but not male-other group or women. It is important to recognize these sex and marital status differences, and expand social participation opportunities for UI patients. Geriatr Gerontol Int 2017; 17: 1829-1836.
authors.affiliation: Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong.
authors.forename: Xue
authors.initials: X
authors.lastname: Bai
authors.affiliation: Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong.
authors.forename: Doris Yin Ping
authors.initials: DYP
authors.lastname: Leung
authors.affiliation: School of Nursing, Hong Kong Polytechnic University, Hong Kong.
authors.forename: Claudia Kam Yuk
authors.initials: CKY
authors.lastname: Lai
authors.affiliation: Department of Applied Social Sciences, City University of Hong Kong, Hong Kong.
authors.forename: Alice Ming Lin
authors.initials: AML
authors.lastname: Chong
authors.affiliation: School of Social Work, University of Southern California, California, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Chi
mesh_terms: D000339:Affect; D000368:Aged; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D017678:Sex Distribution; D058992:Social Participation / Q000523:psychology; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: negative mood; older adults; social participation; urinary incontinence