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Pain Res."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Gratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-\u03b1) on the relationship between gratitude and depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-\u03b1 and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Gratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-\u03b1. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Perceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2023.1140778","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T06:07:35Z","timestamp":1683266855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Exploring the relationship between gratitude and depression among older adults with chronic low back pain: a sequential mediation analysis"],"prefix":"10.3389","volume":"4","author":[{"given":"Melissa","family":"Makhoul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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