The association of positive and negative affect with care dependence in elderly patients with senile cataract: the mediating role of self-regulatory fatigue

Senile cataract is a leading cause of visual impairment in older adults worldwide, yet the psychological mechanisms (particularly the role of self-regulatory fatigue) through which affective states influence care dependence in this population remain poorly understood. A cross-sectional survey was conducted in the Ophthalmology Outpatient Department of the Affiliated Hospital of Guizhou Medical University from January to May 2025. Positive and negative affect were assessed using the Chinese-revised Positive and Negative Affect Schedule Short (PANAS), self-regulatory fatigue using the Self-Regulatory Fatigue Scale (SRF-S), and care dependency using the Care Dependency Scale (CDS). Correlation analyses were conducted, and a path analysis using structural equation modeling was performed to evaluate direct and indirect effects while adjusting for the visual acuity of the affected eye, age, gender, monthly per capita income, and marital status. The study included 452 participants. The parsimonious path analysis showed that positive affect was positively associated with the CDS score (standardized β = 0.324, P < 0.001; higher CDS scores indicate greater independence/lower care dependence) and negatively associated with self-regulatory fatigue (standardized β = - 0.367, P < 0.001). In contrast, negative affect was negatively associated with the CDS score (standardized β = - 0.139, P = 0.004), indicating greater care dependence, and positively associated with self-regulatory fatigue (standardized β = 0.543, P < 0.001). Self-regulatory fatigue was negatively associated with the CDS score (standardized β = - 0.184, P = 0.001), also indicating greater care dependence. Bootstrap analysis confirmed significant indirect effects of positive affect (standardized β = 0.068, 95% CI 0.028-0.109, P = 0.003) and negative affect (standardized β = - 0.099, 95% CI - 0.152 to - 0.043, P = 0.002) on the CDS score through self-regulatory fatigue. These findings highlight associations between emotional and self-regulatory states and care dependence (as reflected in the CDS score) in elderly cataract patients.