This study examined how restricted social participation mediates the relationship between chronic illness and psychological distress among community-dwelling older adults. Additionally, the use of the Internet for health care was tested as a moderator to examine whether the relationship between limited social participation and psychological distress differs. Using the multiple-group path analysis approach, 16,032 community-dwelling older adults (65+) from the National Health Interview Survey were analyzed. The findings show that 32.2% suffered from chronic illnesses that limited their daily activities, and 26% reported social participation restrictions to some degree. While having chronic illnesses was associated with greater psychological distress, the association was also through increased social participation restriction (mediation). Furthermore, differences in mediation were found between health information technology users and nonusers (moderated mediation). In contrast to the hypothesis, the adverse relationship between limited social participation and psychological distress was stronger among users, although chronic conditions were associated with greater social participation restrictions among nonusers. The findings suggest that with proper accommodations and interventions that aim to increase the social participation of community-dwelling older adults, the disadvantageous effects of chronic conditions on psychological distress could be ameliorated. Moreover, the importance of such interventions is greater among health information technology users.
Keywords: Social participation restriction; chronic illness; health information technology; psychological distress.