Work

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

Year: 2026

Type: article

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.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1973096