{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:26:08Z","timestamp":1787199968031,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Zhejiang Provincial Natural Science","award":["Y23G030061"],"award-info":[{"award-number":["Y23G030061"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Sciences Foundation of China","doi-asserted-by":"crossref","award":["72004193"],"award-info":[{"award-number":["72004193"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with complex multimorbidity are prone to fall into the cycle of \u201cburden-management failure-deterioration\u201d under the overspending of resources due to the complex management burden of cross-system chronic diseases superimposed on frequent visits and polypharmacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate the relationship between treatment burden and holistic health status in older adults with complex multimorbidity, and to analyze the mediating effects of depressive symptoms and stress adaptation capacity on holistic health status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were recruited from nine healthcare facilities across three cities in Zhejiang Province, China. Data were collected with a sociodemographic questionnaire, the Treatment Burden Questionnaire, Stress Adaptation Scale, 9-item Patient Health Questionnaire, and Long-Term Conditions Questionnaire. Parallel mediating effect modeling was performed using the Lavaan package in R software, and the mediating effect between depressive symptoms and stress adaptation capacity was tested using the Bootstrap resampling method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 507 participants with complete data were included in the mediation analysis. Median (IQR) scores for treatment burden, holistic health status, depressive symptoms, and stress adaptation capacity were 25.0 (12.0\u201342.0), 78.0 (66.0\u201388.0), 3.0 (1.0\u20136.0), and 20.0 (18.0\u201325.0), respectively. Treatment burden had a significant direct negative effect on holistic health status (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f\u22120.263, 95% CI [\u22120.357, \u22120.168]), with a total effect of \u22120.449 (95% CI [\u22120.538, \u22120.360]). Further mediation analysis revealed that depressive symptoms (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f\u22120.095, 95% CI [\u22120.145, \u22120.047]) and stress adaptation capacity (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f\u22120.091, 95% CI [\u22120.138, \u22120.051]) partially mediated this relationship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stress adaptation and depressive symptoms partially mediated the relationship between treatment burden and holistic health status. Healthcare professionals can improve the overall health of patients by strengthening their stress adaptation capacity and intervening with depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1824738","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:15:33Z","timestamp":1787199333000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unraveling the pathway from treatment burden to holistic health status in older adults with complex multimorbidity: the mediating roles of stress adaptation and depressive symptoms"],"prefix":"10.3389","volume":"14","author":[{"given":"Yajun","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Fu","sequence":"additional","affiliation":[{"name":"Institute of Nursing Research, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huafang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, China"]},{"name":"Institute of Nursing Research, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101860","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis","volume":"57","author":"Chowdhury","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S2213-8587(22)00033-X","article-title":"Body-mass index and risk of obesity-related complex multimorbidity: 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