Wang WL, Liu JK, Sun YF, Liu XH, Ma YH, Gao XZ, Chen LM, Zhou ZH, Zhou HL. Interoception mediates the association between social support and sociability in patients with major depressive disorder. World J Psychiatry 2024; 14(10): 1484-1494 [DOI: 10.5498/wjp.v14.i10.1484]
Corresponding Author of This Article
Zhen-He Zhou, MD, PhD, President, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Nanjing Medical University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@nimu.edu.cn
Research Domain of This Article
Biology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen-Liang Wang, Xiao-Hong Liu, Yu-Hang Ma, Li-Min Chen, Department of Psychiatry, The Affiliated Mental Health Center of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Ji-Kang Liu, Yi-Fan Sun, Xue-Zheng Gao, Zhen-He Zhou, Department of Psychiatry, The Affiliated Mental Health Center of Nanjing Medical University, Wuxi 214151, Jiangsu Province, China
Hong-Liang Zhou, Department of Psychology, The Affiliated Hospital of Jiangnan University, Wuxi 214151, Jiangsu Province, China
Co-corresponding authors: Zhen-He Zhou and Hong-Liang Zhou.
Author contributions: Zhou ZH and Zhou HL designed the study; Wang WL analyzed the data, and wrote the manuscript; Liu JK and Ma YH collected the relevant data; Zhou ZH provided financial support; Gao XZ, Sun YF, Liu XH, and Chen LM provided technological support; Zhou ZH and Zhou HL edited the manuscript; and all authors have read and approved the final manuscript.
Supported bythe Wuxi Municipal Health Commission Major Project, No. 202107.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the affiliated mental health center of Jiangnan University, No. WXMHCIRB2022LLky010.
Informed consent statement: All participants enrolled into this study provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data used in this study can be available from the corresponding author at zhouzh@njmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-He Zhou, MD, PhD, President, Professor, Department of Psychiatry, The Affiliated Mental Health Center of Nanjing Medical University, No. 156 Qianrong Road, Wuxi 214151, Jiangsu Province, China. zhouzh@nimu.edu.cn
Received: July 4, 2024 Revised: August 20, 2024 Accepted: September 2, 2024 Published online: October 19, 2024 Processing time: 105 Days and 6.6 Hours
Abstract
BACKGROUND
Interoception dysfunction has an important impact on the onset and development of major depressive disorder (MDD). Social support serves as a protective factor against MDD, and sociability also plays a significant role in this condition. These interconnected constructs-social support and sociability-play pivotal roles in MDD. However, no research on the mechanisms underlying the associations between social support and sociability, particularly the potential role of interoception, have been reported.
AIM
To investigate the mediating effect of interoception between social support and social ability and to explore the independent role of social support in sociability.
METHODS
The participants included 292 patients with MDD and 257 healthy controls (HCs). The patient health questionnaire 9, the multidimensional assessment of interoception awareness, version 2 (MAIA-2), the social support rating scale (SSRS), and the Texas social behavior inventory (TSBI) were used to assess depression, interoception, social support, and sociability, respectively. A mediation analysis model for the eight dimensions of interoception (noticing, not distracting, not worrying, attention regulation, emotional awareness, self-regulation, body listening, and trust), social support, and sociability were established to evaluate the mediating effects.
RESULTS
A partial correlation analysis of eight dimensions of the MAIA-2, SSRS, and TSBI scores, with demographic data as control variables, revealed pairwise correlations between the SSRS score and both the MAIA-2 score and TSBI score. In the major depression (MD) group, the SSRS score had a positive direct effect on the TSBI score, while the scores for body listening, emotional awareness, self-regulation, and trust in the MAIA-2C had indirect effects on the TSBI score. In the HC group, the SSRS score had a positive direct effect on the TSBI score, and the scores for attention regulation, emotional awareness, self-regulation, and trust in the MAIA-2C had indirect effects on the TSBI score. The proportion of mediators in the MD group was lower than that in the HC group.
CONCLUSION
Interoceptive awareness is a mediating factor in the association between social support and sociability in both HCs and depressed patients. Training in interoceptive awareness might not only help improve emotional regulation in depressed patients but also enhance their social skills and support networks.
Core Tip: Interoception dysfunction is closely related to the development of major depression. Social support and sociability have a vital impact on depressed patients. Our study investigated the mediating effect of interoception between social support and social ability, explored the independent role of social support in sociability, and concluded that interoceptive awareness is a mediating factor between social support and sociability in both healthy controls and depressed patients. The mediating effect was lower in depressed patients than in healthy controls, which may be one of the reasons why patients with depression have reduced social skills.
Citation: Wang WL, Liu JK, Sun YF, Liu XH, Ma YH, Gao XZ, Chen LM, Zhou ZH, Zhou HL. Interoception mediates the association between social support and sociability in patients with major depressive disorder. World J Psychiatry 2024; 14(10): 1484-1494
Major depressive disorder (MDD) is a prevalent and serious mood disorder characterized by persistent feelings of sadness, loss of interest or pleasure, and diminished energy[1,2]. MDD is a significant health issue that requires public awareness and appropriate treatment. MDD profoundly impacts an individual’s quality of life[3]. The etiology of MDD is generally believed to result from a combination of multiple factors. Biological factors include imbalances in neurotransmitters, changes in hormone levels, and genetic predispositions[4]. Psychosocial factors, such as inadequate mechanisms for coping with chronic stress and experiencing significant life events or trauma, also play critical roles in the onset of depression[5].
As one of the biological factors of MDD, interoception plays an important role in the pathogenesis of this disorder[6]. Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a unique representation of the physiological condition of the body[7]. This internal sense is crucial for maintaining homeostasis, and its role in emotional and cognitive functions has been increasingly studied[8]. Research has shown that interoception has significant implications for MDD[9]. The ability to accurately perceive internal bodily states is closely linked to emotional awareness and regulation. Individuals with MDD often exhibit altered interoceptive accuracy, which refers to the ability to correctly perceive internal bodily sensations[10]. In patients with MDD, misinterpretation or heightened perception of bodily signals can lead to or worsen negative emotional states[11]. Neuroimaging studies have revealed that certain brain regions associated with interoceptive processing, such as the insular cortex and the anterior cingulate cortex, exhibit altered activity in individuals with MDD[12]. Interoceptive awareness, as a sense of one’s own inner self, can simultaneously coordinate brain reflexes and bodily secretions to maintain an individual’s homeostasis while encoding and integrating internal information of the body through a variety of neuronal or humoral channels[6]. Interoceptive awareness dysfunction is thought to be an integral component of MDD[13]. Consequently, interoceptive awareness might be critically important for the brain’s coding system, particularly for the integration and conversion of internal and exterior information. Interoceptive awareness is considered the foundation of motivation, emotion, social cognition, and self-awareness, and this has been increasingly confirmed by research[14].
Social support is an important psychological factor in the pathogenesis of MDD[15]. Social support refers to the physical and emotional comfort provided by friends, family, and others. The concept encompasses several forms, including emotional, informational, and instrumental support[16]. It is a critical factor in the onset, duration, and severity of MDD. In the context of MDD, the availability and quality of social support have been extensively studied because of their protective effects and therapeutic potential, and social support can be considered a protective factor against depression[17]. Increasing social support is a vital strategy in comprehensive treatment plans for depression, highlighting the importance of integrated approaches that consider both psychological and social factors in MDD treatment.
Sociability refers to an individual’s propensity to engage in social interactions and form relationships with others[18]. It includes both the desire and ability to interact socially, and it plays a significant role in MDD; moreover, the relationship between sociability and MDD is complex and involves various psychological, social, and biological factors that interact in nuanced ways[19]. MDD is often characterized by social withdrawal and a decreased desire for social interaction. MDD can lead to reduced sociability, and conversely, a lower level of sociability can increase the risk of developing MDD[20]. High levels of sociability are often associated with better MDD outcomes[21]. Increasing sociability can be an effective therapeutic strategy for managing MDD.
Social support and sociability are interconnected constructs that play pivotal roles in MDD. Sociability often facilitates the development and maintenance of a robust social network, which is a critical source of social support[22]. Individuals who are more sociable are likely to have broader and potentially more supportive networks[23]. Conversely, social support can increase sociability by increasing an individual’s confidence in social settings, thereby reinforcing their social engagement and interactions[24]. The presence of strong social support can mitigate the effects of stress and serve as a protective factor against MDD[25]. Sociability can contribute to this protective effect not only by expanding the quantity of social contacts but also by potentially improving the quality of these interactions. High-quality social interactions, which are often facilitated by greater sociability, can lead to improved mood, increased self-esteem, and greater life satisfaction[26]. It is important to consider the dynamic interaction between sociability and social support when designing studies or interventions. Sociability and social support are closely linked constructs that significantly influence MDD[27]. Their interplay is crucial for understanding the social dimensions of MDD and forms a foundation for developing effective interventions aimed at improving MDD outcomes. Increasing the social support available in multiple aspects has certain benefits for high-risk individuals with MDD[28]. Further exploration of how these factors influence each other and impact MDD can aid in the development of more nuanced and effective therapeutic strategies.
However, to the best of our knowledge, no studies have reported the mechanism underlying the associations between social support and sociability, particularly regarding the possible role of interoception in MDD. Elucidating these mechanism is helpful for identifying new intervention points and treatment targets to address this mutually damaging phenomenon in MDD. Based on previous findings[25-28], our study hypothesized that: (1) Social support directly influences sociability in MDD; (2) One or more dimensions of interoception influence sociability after being influenced by social support, acting as a mediator in the process by which social support is transformed into sociability in MDD; and (3) There are different mediating pathways between MDD patients and healthy individuals (HCs). The purpose of this study was to measure the mediating effect of interoception on the relationship between social support and sociability and to explore the independent role of social support in sociability in individuals with MDD.
MATERIALS AND METHODS
This observational study was conducted in accordance with the Helsinki Declaration and was approved by the Ethics Committee of the affiliated mental health center of Jiangnan University (No. WXMHCIRB2022LLky010). Signed informed consent was obtained from all participants before their inclusion in the study. The study was conducted from March 1st, 2023, to March 1st, 2024.
Participant recruitment and selection criteria
The participants included patients with MDD and HCs. The inclusion criteria for patients with MDD were as follows: (1) Met the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) major depressive criteria[29]; (2) Were aged 18-65 years; (3) Had no physical illness as determined by clinical evaluations and medical records; (4) Had no substance misuse or dependence; (5) Did not have suicidal thoughts or suicidal behavior; (6) Had no history of modified electroconvulsive therapy in the past 12 months; (7) Had no physical diseases, such as diabetes or coronary heart disease; and (8) Were not pregnant or breastfeeding. The inclusion criteria for HCs were as follows: (1) No history of mental illness; (2) Aged 18-65 years; and (3) Not pregnant or breastfeeding.
A total of 292 patients with MDD were recruited from the Department of Psychology at the Affiliated Mental Health Center of Jiangnan University, China, and 257 HCs were recruited from the local community through advertising.
Study design
The demographic characteristics of both patients with MDD and HCs were evaluated. Moreover, a cross-sectional observational study was conducted in which interoception, social support, sociability, and MDD severity were measured with the multidimensional assessment of interoception awareness, version 2 (MAIA-2)[30], the social support rating scale (SSRS)[31], the Texas social behavior inventory (TSBI)[32], and the patient health questionnaire 9 (PHQ-9)[33], respectively.
Measures
Demographic characteristics: The demographic characteristics of both patients with MDD and HCs were examined by an attending psychiatrist and an associate chief psychiatrist. These characteristics included sex, age, education, body mass index (BMI), annual household income, social media use, and physical activity level, all of which may affect interoception[34-38]. In terms of the demographic characteristics of the participants, depression was evaluated by the PHQ-9, and anxiety was assessed by the Hamilton anxiety scale[39].
Interoception
The MAIA-2 was used to evaluate multiple dimensions of interoception related to body consciousness. MAIA-2 consists of 8 factors: (1) Noticing; (2) Not distracting; (3) Not worrying; (4) Attention regulation; (5) Emotional awareness; (6) Self-regulation; (7) Body listening; and (8) Trust. Items in the MAIA-2 were assessed with a 6-point Likert scale (0-5). The average score of all items on each scale was used as the score. A higher score indicates a greater ability of interoception body consciousness.
Social support
The SSRS was used to measure an individual’s level of social support. The scale consists of 10 items across three dimensions: 3 items for objective support, 4 items for subjective support, and 3 items for the utilization of social support. The scores are categorized into 3 levels, including low (≤ 22), moderate (23-44), and high (≥ 45) support levels.
Sociability
The TSBI is used to assess an individual’s sense of self-worth and sociability. The original scale is divided into two independent 16-item scales (scale A and scale B). In this study, scales A and B were selected as measurements of sociability. A high score indicates a high level of social self-esteem and sociability.
Major depressive severity
The PHQ-9 was used to assess the severity of MDD. The PHQ-9 is a standard screening tool for mood, anxiety, and other mental disorders. Based on the depressive symptoms outlined in the DSM-4, 9 items to assess the feelings of individuals over the past 2 weeks. A higher PHQ-9 score indicates greater severity of MDD.
Statistical analysis
Statistical package for the social sciences (International Business Machines Corporation) version 26.0 was used to conduct a partial correlation analysis on the eight dimensions of social support, interoception, and sociability, with demographic data as control variables. The “mediation” package in R studio (https://www.R-project.org/) was used to conduct causal mediation analysis. A bootstrap test (5000) for validity verification was used to estimate the total, indirect, and direct effects of social support on sociability through different mediators of interoception.
RESULTS
Demographic data of the participants
As shown in Table 1, there were no significant differences in sex, weight, height, or physical activity between the MDD group and the HC group. However, there were significant differences in age, education, BMI, annual household income, depression state, anxiety state, and social media usage between the two groups.
Correlation analysis of social support, sociability, and interoception
We conducted a partial correlation analysis on eight dimension sores of MAIA-2, SSRS scores, and TSBI scores, with demographic data used as control variables. Figure 1 illustrate the correlations among the SSRS score, MAIA-2 score, and TSBI scores in the MDD and HC groups. In the MDD group, the MAIA-2 scores for five dimensions-attention regulation, emotional awareness, self-regulation, body listening, and trust-were positively correlated with the SSRS score and TSBI score. In the HC group, MAIA-2 scores for four dimensions attention regulation, emotional awareness, self-regulation, and trust-were positively correlated with the TSBI score. Additionally, scores for six MAIA-2 dimensions-noticing, attention regulation, emotional awareness, self-regulation, body listening, and trust-were positively correlated with the TSBI score, while scores for one MAIA-2 dimension-not distracting-were negatively correlated with the TSBI score. There was a pairwise correlation between the SSRS scores and both the MAIA-2 and TSBI scores, suggesting that the MAIA-2 score may act as a mediating variable.
Figure 1 Pearson’s correlation matrix.
A: Pearson’s correlation matrix of major depressive group; B: Pearson’s correlation matrix of healthy control group. aP < 0.05; bP < 0.01. SSRS: Social support rating scale; TSBI: Texas social behavior inventory.
Analysis of mediating effects
The bootstrap method was used to evaluate the mediation analysis model of interoception, with the sample size was set to 5000. In the MDD group, the SSRS score was the independent variable; the TSBI score was the dependent variable; and emotional awareness, self-regulation, body listening, and trust scores from the MAIA-2 were the mediating variables. In the HC group, the SSRS score was the independent variable, the TSBI score was the dependent variable, and attention regulation, emotional awareness, self-regulation, and trust scores from the MAIA-2 were the mediating variables. Table 2 and Figure 2A-D show the direct, indirect, and total effects of the model for the analysis the mediating roles of body listening, trust, emotional awareness, and self-regulation scores from the MAIA-2 in the MDD group. In the MDD group, the SSRS scores had a positive direct effect on the TSBI score, while the scores for body listening, emotional awareness, self-regulation, and trust in the MAIA-2C had an indirect effect on the TSBI score. This suggests that emotional awareness, self-regulation, body listening, and trust scores in the MAIA-2C play a partial mediating role between social support and sociability.
Figure 2 The bootstrap method was used to evaluate the mediation analysis model of interoception, with the sample size was set to 5000.
A: Social support was used as independent variable, sociability as dependent variable, and body listening as mediating variable; B: Social support was used as independent variable, sociability as dependent variable, and trust as mediating variable; C: Social support was used as independent variable, sociability as dependent variable, and emotional awareness as mediating variable; D: Social support was used as independent variable, sociability as dependent variable, and self-regulation as mediating variable; E: Social support was used as independent variable, sociability as dependent variable, and attention regulation as mediating variable; F: Social support was used as independent variable, sociability as dependent variable, and emotional awareness as mediating variable; G: Social support was used as independent variable, sociability as dependent variable, and self-regulation as mediating variable; H: Social support was used as independent variable, sociability as dependent variable, and trust as mediating variable. aP < 0.05; bP < 0.01.
Table 2 Analysis of mediating effect in major depression group.
Independent variable
Mediator
Total effect
Indirect effect
Direct effect
Proportion mediated (%) (95%CI)
95%CI
P value
95%CI
P value
95%CI
P value
SSRS scores
Noticing
0.77 (0.55 to 0.97)
< 0.001
0.00 (-0.01 to 0.03)
0.820
0.77 (0.55 to 0.97)
< 0.001
0.1 (-2.0 to 3.2)
Not-distracting
0.77 (0.55 to 0.97)
< 0.001
0.00 (-0.02 to 0.02)
0.821
0.77 (0.56 to 0.97)
< 0.001
-0.1 (-3.2 to 2.1)
Not-worrying
0.77 (0.55 to 0.98)
< 0.001
0.01 (-0.01 to 0.04)
0.501
0.76 (0.55 to 0.97)
< 0.001
0.7 (-1.5 to 4.8)
Attention regulation
0.77 (0.56 to 0.98)
< 0.001
0.04 (-0.00 to 0.10)
0.084
0.73 (0.52 to 0.93)
< 0.001
5.0 (-0.6 to 12.7)
Emotional awareness
0.77 (0.55 to 0.98)
< 0.001
0.03 (0.00 to 0.08)
0.036
0.73 (0.52 to 0.94)
< 0.001
3.9 (0.2 to 11.1)
Self-regulation
0.77 (0.56 to 0.98)
< 0.001
0.08 (0.02 to 0.15)
0.008
0.69 (0.48 to 0.89)
< 0.001
9.6 (2.6 to 19.4)
Body listening
0.77 (0.56 to 0.98)
< 0.001
0.06 (0.01 to 0.12)
0.016
0.71 (0.50 to 0.91)
< 0.001
7.0 (1.3 to 15.5)
Trust
0.77 (0.55 to 0.97)
< 0.001
0.06 (0.01 to 0.13)
0.008
0.70 (0.48 to 0.91)
< 0.001
7.8 (1.8 to 16.8)
Table 3 and Figure 2E-H show the direct, indirect, and total effects of the model for analyzing the mediating role of attention regulation, emotional awareness, self-regulation, and trust scores from the MAIA-2 in the HC group. In the HC group, the SSRS score had a positive direct effect on the TSBI score, and the scores for attention regulation, emotional awareness, self-regulation, and trust from MAIA-2C had an indirect effect on the TSBI score. This suggests that emotional awareness, self-regulation, attention regulation, and trust scores in the MAIA-2C play a partial mediating role between social support and sociability.
Table 3 Analysis of mediating effect in health control group.
Independent variable
Mediator
Total effect
Indirect effect
Direct effect
Proportion mediated (%) (95%CI)
95%CI
P value
95%CI
P value
95%CI
P value
SSRS scores
Noticing
0.52 (0.34 to 0.72)
< 0.001
0.00 (-0.02 to 0.03)
0.841
0.52 (0.33 to 0.72)
< 0.001
0.3 (-4.7 to 6.3)
Not-distracting
0.52 (0.32 to 0.72)
< 0.001
0.02 (-0.01 to 0.07)
0.228
0.49 (0.30 to 0.69)
< 0.001
4.0 (-2.8 to 13.7)
Not-worrying
0.52 (0.32 to 0.72)
< 0.001
0.00 (-0.03 to 0.01)
0.660
0.52 (0.33 to 0.73)
< 0.001
-0.6 (-6.4 to 2.1)
Attention regulation
0.52 (0.34 to 0.72)
< 0.001
0.07 (0.00 to 0.16)
0.048
0.45 (0.27 to 0.64)
< 0.001
13.7 (0.3 to 29.3)
Emotional awareness
0.52 (0.34 to 0.72)
< 0.001
0.05 (0.00 to 0.12)
0.048
0.47 (0.28 to 0.67)
< 0.001
9.6 (0.5 to 22.5)
Self-regulation
0.52 (0.34 to 0.72)
< 0.001
0.08 (0.01 to 0.17)
0.036
0.44 (0.26 to 0.63)
< 0.001
15.6 (2.8 to 31.8)
Body listening
0.52 (0.34 to 0.72)
< 0.001
0.05 (-0.02 to 0.13)
0.201
0.48 (0.30 to 0.67)
< 0.001
8.5 (-4.6 to 22.5)
Trust
0.52 (0.34 to 0.72)
< 0.001
0.10 (0.03 to 0.19)
0.004
0.42 (0.24 to 0.61)
< 0.001
19.1 (7.1 to 37.0)
The proportion of mediators in the MDD group was lower than that in the HC group.
DISCUSSION
This study is the first to investigate the association between social support and sociability via mediation analysis with interoception as a mediator in MDD patients. Our study showed that, based on a partial correlation analysis of eight dimensions of the MAIA-2, SSRS score, and TSBI scores, with demographic data as control variables, there are pairwise correlations among social support, interoception and sociability, suggesting that interoception can act as a mediating variable. In both the MDD and HC groups, social support had a positive direct effect on sociability, and interoception had a positive indirect effect on sociability. The dimensions of interoception that mediated these effects varied between the two groups; attention regulation, emotional awareness, and self-regulation were mediators in both depressed patients and HCs, but the proportion of mediators was lower in the MDD group than in the HC group. Importantly, interoceptive awareness has a mediating effect on the association between social support and sociability in MDD patients.
A recent study indicated that social support plays a pivotal role in the etiology and progression of MDD, acting as a buffer against stress and promoting resilience; this protective effect is particularly significant in the context of sociability, where social interactions can influence mood and cognitive functions[15]. Research also suggests that reduced sociability is both a precursor to and a consequence of MDD[40]. A previous study suggested that interoception plays a vital role in MDD by affecting individuals’ awareness and responsiveness to their emotional states and that distorted interoceptive accuracy can lead to maladaptive emotional responses and heightened vulnerability to depression[41]. Our results are consistent with these findings, showing that social support acts as a buffer against stress and promotes resilience in the pathogenesis of MDD and that social ability can predict the onset and outcome of depression. Impaired interoceptive accuracy can lead to poor emotional responses and increased susceptibility to depression.
The relationships among interoception, social support, and sociability in MDD patients provide complex but insightful information for understanding the multifaceted nature of this psychiatric condition. Social support in individuals with MDD can be influenced by their interoceptive awareness[42]. Enhanced interoceptive skills may enable individuals to better perceive and articulate their emotional needs, thereby facilitating more effective social support. Conversely, poor interoceptive awareness may hinder individuals from seeking or utilizing support from their social network[43]. Sociability, or the tendency to seek and enjoy social interactions, can also be influenced by one’s interoceptive ability. Individuals with accurate interoception may be more adept at managing social interactions, which can lead to increased sociability and better social functioning. This relationship suggests that interoceptive awareness could mediate the link between sociability and depression[44]. In this study, we investigated the mechanism by which social support influences social ability in patients with depression and explored the mediating role of interoception in this process. Our study confirmed that interoceptive awareness mediates the association between social support and sociability in MDD patients. The results of this study may provide new therapeutic targets and intervention pathways for the treatment of depression. For example, improving interoception through methods such as vagus nerve stimulation, respiratory-gated auricular vagal afferent nerve stimulation, mindfulness training, or higher-order neural networks engagement may lead to improvements in MDD[7].
There are two limitations in this study. First, this study is incomplete in that it uses interoceptive awareness to represent the characteristics of interoception. Future studies should incorporate other interoceptive dimensions, such as interoceptive neural circuits, to fully capture the characteristics of interoception. Second, because this is a cross-sectional study, the findings are preliminary. Future research should consider longitudinal and experimental designs to explore these relationships in depth and further confirm the potential mediating role of interoception between sociability and the efficacy of social support in alleviating depressive symptoms.
CONCLUSION
In conclusion, our study confirms that interoceptive awareness is a mediating factor in the association between social support and sociability in both HCs and depressed patients. Additionally, the mediating effect was lower in depressed patients than in HCs, which may explain why patients with depression often have reduced social skills. Understanding the interactions among interoception, social support, and sociability in the context of MDD could inform the development of targeted therapeutic interventions. Training in interoceptive awareness might not only help improve emotional regulation in depressed patients but also enhance their social skills and support networks.
ACKNOWLEDGEMENTS
We are grateful to all the people who took part in this study.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade C
Scientific Significance: Grade C
P-Reviewer: Francia L S-Editor: Fan M L-Editor: A P-Editor: Wang WB
Lu J, Xu X, Huang Y, Li T, Ma C, Xu G, Yin H, Xu X, Ma Y, Wang L, Huang Z, Yan Y, Wang B, Xiao S, Zhou L, Li L, Zhang Y, Chen H, Zhang T, Yan J, Ding H, Yu Y, Kou C, Shen Z, Jiang L, Wang Z, Sun X, Xu Y, He Y, Guo W, Jiang L, Li S, Pan W, Wu Y, Li G, Jia F, Shi J, Shen Z, Zhang N. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study.Lancet Psychiatry. 2021;8:981-990.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 292][Cited by in F6Publishing: 283][Article Influence: 94.3][Reference Citation Analysis (0)]
Zhou H, Zou H, Dai Z, Zhao S, Hua L, Xia Y, Han Y, Yan R, Tang H, Huang Y, Du Y, Wang X, Yao Z, Lu Q. Interoception Dysfunction Contributes to the Negative Emotional Bias in Major Depressive Disorder.Front Psychiatry. 2022;13:874859.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 2][Reference Citation Analysis (0)]
Khalsa SS, Adolphs R, Cameron OG, Critchley HD, Davenport PW, Feinstein JS, Feusner JD, Garfinkel SN, Lane RD, Mehling WE, Meuret AE, Nemeroff CB, Oppenheimer S, Petzschner FH, Pollatos O, Rhudy JL, Schramm LP, Simmons WK, Stein MB, Stephan KE, Van den Bergh O, Van Diest I, von Leupoldt A, Paulus MP; Interoception Summit 2016 participants. Interoception and Mental Health: A Roadmap.Biol Psychiatry Cogn Neurosci Neuroimaging. 2018;3:501-513.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 380][Cited by in F6Publishing: 419][Article Influence: 69.8][Reference Citation Analysis (0)]
Bralten J, Mota NR, Klemann CJHM, De Witte W, Laing E, Collier DA, de Kluiver H, Bauduin SEEC, Arango C, Ayuso-Mateos JL, Fabbri C, Kas MJ, van der Wee N, Penninx BWJH, Serretti A, Franke B, Poelmans G. Genetic underpinnings of sociability in the general population.Neuropsychopharmacology. 2021;46:1627-1634.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 14][Cited by in F6Publishing: 18][Article Influence: 6.0][Reference Citation Analysis (0)]
Wu R, Jiang X, Wu X, Pang J, Tang Y, Ren Z, Yang F, Yang S, Wei W. Interspecific differences in sociability, social novelty preference, anxiety- and depression-like behaviors between Brandt's voles and C57BL/6J mice.Behav Processes. 2022;197:104624.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Naami A, Zargar Y, Davoodi I, Farnia V, Salemi S, Tatari F, Khanegi M. Comparison of trauma-focused cognitive-behavioral therapy and theory of mind on increasing social competence among abused children.J Educ Health Promot. 2020;9:81.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 1][Reference Citation Analysis (0)]
Wickramaratne PJ, Yangchen T, Lepow L, Patra BG, Glicksburg B, Talati A, Adekkanattu P, Ryu E, Biernacka JM, Charney A, Mann JJ, Pathak J, Olfson M, Weissman MM. Social connectedness as a determinant of mental health: A scoping review.PLoS One. 2022;17:e0275004.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 29][Cited by in F6Publishing: 37][Article Influence: 18.5][Reference Citation Analysis (0)]
Świtaj P, Grygiel P, Chrostek A, Anczewska M. Disentangling the relationships between interpersonal competence, social network, social support and the experience of being stigmatized among people with psychotic disorders: A path modeling approach.Schizophr Res. 2021;228:305-310.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 3][Cited by in F6Publishing: 3][Article Influence: 1.0][Reference Citation Analysis (0)]
Bicks LK, Yamamuro K, Flanigan ME, Kim JM, Kato D, Lucas EK, Koike H, Peng MS, Brady DM, Chandrasekaran S, Norman KJ, Smith MR, Clem RL, Russo SJ, Akbarian S, Morishita H. Prefrontal parvalbumin interneurons require juvenile social experience to establish adult social behavior.Nat Commun. 2020;11:1003.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 95][Cited by in F6Publishing: 88][Article Influence: 22.0][Reference Citation Analysis (0)]
Leclercq S, Le Roy T, Furgiuele S, Coste V, Bindels LB, Leyrolle Q, Neyrinck AM, Quoilin C, Amadieu C, Petit G, Dricot L, Tagliatti V, Cani PD, Verbeke K, Colet JM, Stärkel P, de Timary P, Delzenne NM. Gut Microbiota-Induced Changes in β-Hydroxybutyrate Metabolism Are Linked to Altered Sociability and Depression in Alcohol Use Disorder.Cell Rep. 2020;33:108238.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 38][Cited by in F6Publishing: 94][Article Influence: 31.3][Reference Citation Analysis (0)]
Choi KW, Lee YH, Liu Z, Fatori D, Bauermeister JR, Luh RA, Clark CR, Brunoni AR, Bauermeister S, Smoller JW. Social support and depression during a global crisis.Nat Mental Health. 2023;1:428-435.
[PubMed] [DOI][Cited in This Article: ]
Wakimizu R, Wang T. Parenting Stress of Chinese Mothers Living and Child-Rearing in Japan and Related Factors.OJN. 2022;12:181-198.
[PubMed] [DOI][Cited in This Article: ]
Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.BMJ. 2019;365:l1476.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 632][Cited by in F6Publishing: 771][Article Influence: 154.2][Reference Citation Analysis (0)]
Gajperia C, McBride J, Treasure J, Cardi V, Brewer R. Recognition of others' interoceptive states in those with and without eating disorders.BMC Psychiatry. 2024;24:169.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Shizuma H, Abe T, Kanbara K, Amaya Y, Mizuno Y, Saka-Kochi Y, Fukunaga M. Interoception and alexithymia are related to differences between the self-reported and the objectively measured physical activity in patients with chronic musculoskeletal pain.J Psychosom Res. 2021;140:110324.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 3][Cited by in F6Publishing: 3][Article Influence: 1.0][Reference Citation Analysis (0)]
Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms.Perspect Biol Med. 2003;46:S39-S52.
[PubMed] [DOI][Cited in This Article: ]
