{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:43Z","timestamp":1785732403913,"version":"3.56.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"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. Public Health"],"abstract":"\n Background<\/jats:title>\n Treatment burden is associated with health-related quality of life (HRQoL) in multimorbidity, but its psychological and social correlates in older adults remain unclear. This study examined whether personal mastery was statistically linked to the association between treatment burden and HRQoL and whether social support moderated the association between treatment burden and personal mastery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional survey was conducted among 470 outpatients aged 60\u202fyears and older with multimorbidity in Jiangsu Province, China. Treatment burden, personal mastery, social support, and HRQoL were assessed using validated scales. Pearson correlations and PROCESS Model 7 with 5,000 bootstrap resamples were used, adjusting for age, BMI, sex, income, and education.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Treatment burden was negatively associated with personal mastery (\n b<\/jats:italic>\n \u202f=\u202f\u22120.1185,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), and the treatment burden\u202f\u00d7\u202fsocial support interaction was significant (\n b<\/jats:italic>\n \u202f=\u202f0.0056,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Personal mastery was positively associated with PCS (\n b<\/jats:italic>\n \u202f=\u202f0.4064,\n p<\/jats:italic>\n \u202f=\u202f0.005) and MCS (\n b<\/jats:italic>\n \u202f=\u202f0.3894,\n p<\/jats:italic>\n \u202f=\u202f0.028). Treatment burden showed a negative direct association with PCS (\n b<\/jats:italic>\n \u202f=\u202f\u22120.1417,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) but a positive direct association with MCS (\n b<\/jats:italic>\n \u202f=\u202f0.3639,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The indices of moderated mediation were significant for PCS (index\u202f=\u202f0.0023, 95% CI [0.0006, 0.0042]) and MCS (index\u202f=\u202f0.0022, 95% CI [0.0002, 0.0047]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Greater treatment burden was associated with poorer physical HRQoL and showed negative indirect associations with physical and mental HRQoL through lower personal mastery. These indirect associations were weaker at higher social support.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1859774","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:11Z","timestamp":1785731171000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between treatment burden and quality of life in older adults with multimorbidity: the mediating role of personal mastery and the moderating role of social support\u2014a cross-sectional study in China"],"prefix":"10.3389","volume":"14","author":[{"given":"Yanmin","family":"Weng","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Nursing, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengcheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Jiangsu Longtan Prison","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuerui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"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":"e0322042","DOI":"10.1371\/journal.pone.0322042","article-title":"Prevalence of multimorbidity and its relationship with socioeconomic status among Chinese older adults over time","volume":"20","author":"Liu","year":"2025","journal-title":"PLoS One"},{"key":"ref3","year":"2021"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"100903","DOI":"10.1016\/j.arr.2019.04.005","article-title":"Multimorbidity and quality of life: systematic literature review and meta-analysis","volume":"53","author":"Makovski","year":"2019","journal-title":"Ageing Res Rev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/s12875-024-02586-z","article-title":"Treatment burden in multimorbidity: an integrative review","volume":"25","author":"Lee","year":"2024","journal-title":"BMC Prim Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e59","DOI":"10.3399\/BJGP.2022.0066","article-title":"Influence of health-system change on treatment burden: a systematic review","volume":"73","author":"Matthews","year":"2023","journal-title":"Br J Gen Pract"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2","DOI":"10.2307\/2136319","article-title":"The structure of coping","volume":"19","author":"Pearlin","year":"1978","journal-title":"J Health Soc Behav"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1037\/0022-3514.74.3.763","article-title":"The sense of control as a moderator of social class differences in health and well-being","volume":"74","author":"Lachman","year":"1998","journal-title":"J Pers Soc Psychol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1016\/j.jclinepi.2012.05.005","article-title":"Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice","volume":"65","author":"Shippee","year":"2012","journal-title":"J Clin Epidemiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol Bull"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1186\/s12889-023-15837-y","article-title":"The effect of informal social support on the health of Chinese older adults: a cross-sectional study","volume":"23","author":"Yang","year":"2023","journal-title":"BMC Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1093\/scan\/nsv071","article-title":"Social support, stress and the aging brain","volume":"11","author":"Sherman","year":"2016","journal-title":"Soc Cogn Affect Neurosci"},{"key":"ref13","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/1741-7015-12-109","article-title":"Adaptation and validation of the treatment burden questionnaire (TBQ) in English using an internet platform","volume":"12","author":"Tran","year":"2014","journal-title":"BMC Med"},{"key":"ref15","first-page":"1275","article-title":"Chinese translation and reliability and validity testing of the treatment burden questionnaire","volume":"28","author":"Sun","year":"2022","journal-title":"Chin J Mod Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"404","DOI":"10.3109\/11038128.2013.838999","article-title":"Psychometric properties of the mastery scale-Chinese version: applying classical test theory and Rasch analysis","volume":"20","author":"Chen","year":"2013","journal-title":"Scand J Occup Ther"},{"key":"ref17","first-page":"98","article-title":"The theoretical basis and research application of the social support rating scale","volume":"4","author":"Xiao","year":"1994","journal-title":"J Clin Psychiatry"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"4262","DOI":"10.12114\/j.issn.1007-9572.2018.34.020","article-title":"Reliability and validity of the Chinese version of SF-12v2 among the elderly with community home-based care","volume":"21","author":"Su","year":"2018","journal-title":"Chin Gen Pract"},{"key":"ref20","author":"Hayes","year":"2026"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12955-025-02366-y","article-title":"Perceived treatment burden and health-related quality of life in association with healthcare utilisation among patients attending multiple outpatient clinics","volume":"23","author":"Bell","year":"2025","journal-title":"Health Qual Life Outcomes"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e381","DOI":"10.3399\/BJGP.2020.0883","article-title":"Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure","volume":"71","author":"Morris","year":"2021","journal-title":"Br J Gen Pract"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1521189","DOI":"10.3389\/fmed.2025.1521189","article-title":"Relationship between multimorbidity treatment burden and chronic disease self-efficacy in the elderly population of China","volume":"12","author":"Guo","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3215","DOI":"10.1007\/s40520-023-02613-6","article-title":"Effects of declines in personal mastery on self-perceived mobility, physical function, cognitive function, and depressive symptoms: a 6-year follow-up study from the Social Environment and Biomarkers of Aging Study","volume":"35","author":"Shen","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"106612","DOI":"10.1016\/j.ypmed.2021.106612","article-title":"The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: an outcome-wide approach","volume":"149","author":"Hong","year":"2021","journal-title":"Prev Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s12955-024-02309-z","article-title":"Impacts of chronic diseases and multimorbidity on health-related quality of life among community-dwelling elderly individuals in economically developed China: evidence from cross-sectional survey across three urban centers","volume":"22","author":"Liang","year":"2024","journal-title":"Health Qual Life Outcomes"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1007\/s11136-024-03608-0","article-title":"Multimorbidity patterns and health-related quality of life among community-dwelling older adults: evidence from a rural town in Suzhou, China","volume":"33","author":"Lu","year":"2024","journal-title":"Qual Life Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e2030090","DOI":"10.1001\/jamanetworkopen.2020.30090","article-title":"Evaluation of peer-to-peer support and health care utilization among community-dwelling older adults","volume":"3","author":"Jacobs","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e2544315","DOI":"10.1001\/jamanetworkopen.2025.44315","article-title":"Family caregiver experiences coordinating care of older adults","volume":"8","author":"Wolff","year":"2025","journal-title":"JAMA Netw Open"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"914707","DOI":"10.3389\/fpubh.2022.914707","article-title":"The impact of social support on the quality of life among older adults in China: an empirical study based on the 2020 CFPS","volume":"10","author":"Shen","year":"2022","journal-title":"Front Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1007\/s11136-024-03867-x","article-title":"Response shift results of quantitative research using patient-reported outcome measures: a meta-regression analysis","volume":"34","author":"Sawatzky","year":"2025","journal-title":"Qual Life Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5334\/ijic.9018","article-title":"Inter-organizational coordination to improve patient outcomes in multimorbid older patients following hospital discharge: a systematic review","volume":"25","author":"Linder","year":"2025","journal-title":"Int J Integr Care"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"6373","DOI":"10.2147\/JMDH.S548950","article-title":"Effectiveness of community nurse-led intervention in managing older adults with multimorbidity: a systematic review of randomized controlled trials","volume":"18","author":"Rahmat","year":"2025","journal-title":"J Multidiscip Healthc"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.soard.2019.10.020","article-title":"A test of the stress-buffering hypothesis of social support among bariatric surgery patients","volume":"16","author":"Ahlich","year":"2020","journal-title":"Surg Obes Relat Dis"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1859774\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:26:14Z","timestamp":1785731174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1859774\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":34,"alternative-id":["10.3389\/fpubh.2026.1859774"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1859774","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1859774"}}