Negative Life Events and Psychological Distress Among Rural Chinese Older Adults with Hypertension: A Moderated Mediation Model of Self-Efficacy and Social Capital

Background: Although negative life events have been linked to poorer mental health among older adults, how self-efficacy and social capital jointly relate to this association remains unclear among older adults with hypertension, who face additional demands of chronic disease management. We examined the mediating role of self-efficacy and the moderating role of social capital in the association between negative life events and psychological distress. Methods: This cross-sectional survey included 953 rural older adults with hypertension in Shandong, China. Negative life events in the preceding 12 months were self-reported. Psychological distress, self-efficacy, and social capital were measured using the Kessler Psychological Distress Scale (K10), General Self-Efficacy Scale (GSES), and Resource Generator Scale for China (RG-China), respectively. Hierarchical multiple linear regression and PROCESS Models 4 and 15 assessed mediation and moderated mediation using 5000 bootstrap resamples. Results: Negative life events were positively associated with psychological distress (β = 0.418). The indirect association through self-efficacy was 0.053 (95% CI: 0.035–0.073), accounting for 12.7% of the total association. Higher social capital was associated with a weaker positive association between negative life events and psychological distress (interaction β = −0.058) and a weaker negative association between self-efficacy and psychological distress (interaction β = 0.059). The index of moderated mediation was −0.012 (95% bootstrap CI: −0.023 to −0.001). Conclusions: Self-efficacy accounted for part of the association between negative life events and psychological distress, while social capital moderates both the direct and indirect associations. Social capital may be an important consideration in developing and evaluating future strategies to support psychological well-being and hypertension management among vulnerable older adults.