The relationship between the number of chronic conditions and depressive symptoms in older adults with multimorbidity: the chain mediating role of psychological resilience and sleep quality
4 affiliations
- 1School of Management, Shandong Second Medical University
- 2Health Management Research Center of Shandong Second Medical University
- 3School of Public Health, Shandong Second Medical University
- 4Affiliated Hospital of Shandong Second Medical University
Abstract
Introduction: Depression represents a significant global public health challenge for older adults. The relationship between multimorbidity and depressive symptoms has been frequently studied. However, how the number of chronic conditions affects depressive symptoms in older adults with multimorbidity remains unclear. This study aimed to examine the relationship between the number of chronic conditions and depressive symptoms in older adults with multimorbidity, and to investigate the mediating roles of psychological resilience and sleep quality in this relationship.
Methods: This study utilized cross-sectional survey data collected from two Chinese provinces between October 2024 and January 2025, involving 1,759 older adults with multimorbidity. Statistical analysis was performed using SPSS 21.0, with Spearman correlation analysis employed to explore associations between key variables. Furthermore, linear regression analysis using Model 6 in the PROCESS 4.2 macro was conducted to assess the relationship between the number of chronic conditions and depressive symptoms and to examine the chain-mediating effects of psychological resilience and sleep quality in this relationship.
Results: Among older adults with multimorbidity, the number of chronic conditions was significantly associated with depressive symptoms ( β = 0.094, 95% CI: 0.059, 0.130). Psychological resilience ( β = 0.064, 95% CI: 0.042, 0.086) and sleep quality ( β = 0.044, 95% CI: 0.030, 0.060) each mediated the relationship between the number of chronic conditions and depressive symptoms, accounting for 30.05 and 20.66% of the total effect, respectively. Additionally, a chain-mediating effect involving both psychological resilience and sleep quality was observed ( β = 0.011, 95% CI: 0.007, 0.015), contributing 5.16% to the total effect.
Conclusion: This study found that psychological resilience and sleep quality mediated the association between the number of chronic conditions and depressive symptoms in older adults with multimorbidity. In health management practice, greater attention could be given to the assessment of psychological resilience and sleep quality, together with psychological support and sleep health management, to support the comprehensive management of depressive symptoms. Due to the cross-sectional design, causal direction and temporal ordering cannot be inferred.
Related
- Emotion Regulation Difficulties and Rumination as Serial Mediators in the Relationship Between Psychological Resilience and Loneliness
- Suicidal ideation, depressive experiences, and resilience among adolescents living with HIV in rural Ghana: a qualitative exploration of psychological experiences and coping
- Dose-Response Relationship Between Triglyceride Glucose-Waist Height Ratio Index and Cardiometabolic Multimorbidity Among Chinese Middle-Aged and Older People.
- Baseline depressive-symptom severity and divergent psychological trajectories during GIP and/or GLP-1 receptor agonist therapy: a prospective ecological momentary assessment study
- Frailty mediates the association between sleep duration and physical, psychological, and cognitive multimorbidity in Chinese middle-aged and older adults
BibTeX
@article{xu2026relationship,
title = {{The relationship between the number of chronic conditions and depressive symptoms in older adults with multimorbidity: the chain mediating role of psychological resilience and sleep quality}},
author = {Mengyuan Xu and Yingxin Duan and Zhiqiang Feng and Haoqi Li and Xiuming Sun and Jianing Yue and Jinkun Wang and Xianglan Zhuge and Xianqi Zhang and Shanju Hu and Fangfang Chen and Zhongming Chen},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1973096},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1973096/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The relationship between the number of chronic conditions and depressive symptoms in older adults with multimorbidity: the chain mediating role of psychological resilience and sleep quality
AU - Mengyuan Xu
AU - Yingxin Duan
AU - Zhiqiang Feng
AU - Haoqi Li
AU - Xiuming Sun
AU - Jianing Yue
AU - Jinkun Wang
AU - Xianglan Zhuge
AU - Xianqi Zhang
AU - Shanju Hu
AU - Fangfang Chen
AU - Zhongming Chen
PY - 2026
DA - 2026/10/22
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1973096
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1973096/full
AB - Introduction: Depression represents a significant global public health challenge for older adults. The relationship between multimorbidity and depressive symptoms has been frequently studied. However, how the number of chronic conditions affects depressive symptoms in older adults with multimorbidity remains unclear. This study aimed to examine the relationship between the number of chronic conditions and depressive symptoms in older adults with multimorbidity, and to investigate the mediating roles of psychological resilience and sleep quality in this relationship. Methods: This study utilized cross-sectional survey data collected from two Chinese provinces between October 2024 and January 2025, involving 1,759 older adults with multimorbidity. Statistical analysis was performed using SPSS 21.0, with Spearman correlation analysis employed to explore associations between key variables. Furthermore, linear regression analysis using Model 6 in the PROCESS 4.2 macro was conducted to assess the relationship between the number of chronic conditions and depressive symptoms and to examine the chain-mediating effects of psychological resilience and sleep quality in this relationship. Results: Among older adults with multimorbidity, the number of chronic conditions was significantly associated with depressive symptoms ( β = 0.094, 95% CI: 0.059, 0.130). Psychological resilience ( β = 0.064, 95% CI: 0.042, 0.086) and sleep quality ( β = 0.044, 95% CI: 0.030, 0.060) each mediated the relationship between the number of chronic conditions and depressive symptoms, accounting for 30.05 and 20.66% of the total effect, respectively. Additionally, a chain-mediating effect involving both psychological resilience and sleep quality was observed ( β = 0.011, 95% CI: 0.007, 0.015), contributing 5.16% to the total effect. Conclusion: This study found that psychological resilience and sleep quality mediated the association between the number of chronic conditions and depressive symptoms in older adults with multimorbidity. In health management practice, greater attention could be given to the assessment of psychological resilience and sleep quality, together with psychological support and sleep health management, to support the comprehensive management of depressive symptoms. Due to the cross-sectional design, causal direction and temporal ordering cannot be inferred.
SN - 2296-2565
ER -