{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:06:29Z","timestamp":1784700389433,"version":"3.55.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Population aging has intensified concerns regarding mental health in older adults. Multimorbidity is highly prevalent in late life and is strongly associated with both somatic pain and depressive symptoms. Somatic pain and abnormal sleep duration are common in older adults and may mediate the relationship between chronic disease burden and depression. However, the potential chain mediating roles of somatic pain and sleep duration between chronic disease count and depressive symptoms remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine whether somatic pain and sleep duration independently and sequentially mediate the association between chronic disease count and depressive symptoms in older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 213 older adult patients who visited the First People\u2019s Hospital of Zunyi from March 2020 to March 2024 were selected as the research subjects. Data were collected using a general information questionnaire, the Chronic Disease Checklist, the Short-Form McGill Pain Questionnaire (SF-MPQ), and the 10-item Short-Form Center for Epidemiological Studies Depression Scale (CES-D-10). SPSS 26.0 and PROCESS 4.1 macro program were used for correlation analysis, regression analysis, and bootstrap mediation effect test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The depression detection rate was 40.38%. Chronic disease count, sleep duration, somatic pain, and depressive symptoms were significantly correlated (all P &amp;lt; 0.01). After covariate adjustment, chronic disease count had a significant direct effect on depressive symptoms (\u03b2=0.164, 95% CI: 0.056\u20130.273). The independent mediating effects of somatic pain (effect=0.122, 95% CI: 0.057\u20130.187) and sleep duration (effect=0.054, 95% CI: 0.021\u20130.096), as well as the chain mediating effect of \u201csomatic pain \u2192 sleep duration\u201d (effect=0.018, 95% CI: 0.006\u20130.037), were all significant. The total indirect effect accounted for 54.17% of the total effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Somatic pain and sleep duration independently and sequentially mediate the association between chronic disease count and depressive symptoms in older adults. Integrated strategies targeting multimorbidity control, pain management, and sleep regulation may help reduce depression risk. However, the chain-mediated effect was small in magnitude, suggesting that direct interventions targeting pain and sleep may offer more clinically meaningful benefits than long-chain approaches. Given the cross-sectional design, causal directions cannot be inferred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1821807","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:52:42Z","timestamp":1784699562000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chain mediating effect of somatic pain and sleep duration between chronic disease count and depressive symptoms in older adults"],"prefix":"10.3389","volume":"17","author":[{"given":"Lan","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Pain, The First People\u2019s Hospital of Zunyi","place":["Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(20)30127-3","article-title":"Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data","volume":"8","author":"Zhao","year":"2020","journal-title":"Lancet Global Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.1186\/s12889-022-14695-4","article-title":"Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Public Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcle.2021.09.026","article-title":"Influence of comorbidities on pain intensity in patients with chronic low back pain","volume":"159","author":"Cruz","year":"2022","journal-title":"Med Cl\u00ednica (English Edition)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnad148","article-title":"A network analysis of pain intensity and pain-related measures of physical, emotional, and social functioning in US military service members with chronic pain","volume":"25","author":"Wi","year":"2024","journal-title":"Pain Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2023.01.015","article-title":"A pathway model of chronic pain and frailty in older Chinese cancer patients: The mediating effect of sleep","volume":"50","author":"Zhang","year":"2023","journal-title":"Geriatric Nurs"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2018.05.006","article-title":"Pain and severe sleep disturbance in the general population: Primary data and meta-analysis from 240,820 people across 45 low-and middle-income countries","volume":"53","author":"Stubbs","year":"2018","journal-title":"Gen Hosp Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-13-3585-3_12","article-title":"Hypothalamic-pituitary-adrenal (HPA) axis and aging","volume":"4","author":"Gupta","year":"2014","journal-title":"Compr Physiol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2019.12.002","article-title":"Depression and sleep: what has the treatment research revealed and could the HPA axis be a potential mechanism","volume":"34","author":"Asarnow","year":"2020","journal-title":"Curr Opin Psychol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/00019442-200505000-00002","article-title":"Aging and the role of the HPA axis and rhythm in sleep and memory-consolidation","volume":"13","author":"Buckley","year":"2005","journal-title":"Am J Geriatric Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.12871\/000298292014236","article-title":"REM sleep alteration and depression","volume":"152","author":"Kimura","year":"2014","journal-title":"Arch Ital Biol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2174\/1570159x21666230811141557","article-title":"The HPA axis as target for depression","volume":"22","author":"Menke","year":"2024","journal-title":"Curr Neuropharmacol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00393-7","article-title":"Chronic pain: an update on burden, best practices, and new advances","volume":"397","author":"Cohen","year":"2021","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.puhe.2021.06.023","article-title":"The relationship between depressive symptoms and activity of daily living disability among the elderly: results from the China Health and Retirement Longitudinal Study (CHARLS)","volume":"198","author":"Feng","year":"2021","journal-title":"Public Health"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3399\/bjgpo.2024.0147","article-title":"Chronic pain: prevalence, demographic inequalities, and healthcare utilisation. 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