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Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study
BACKGROUND: Chronic pain, sleep disorders, and depression are major global health concerns. Recent studies have revealed a strong link between sleep disorders and pain, and each of them is bidirectionally correlated with depressive symptoms, suggesting a complex relationship between these conditions...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413249/ https://www.ncbi.nlm.nih.gov/pubmed/37494109 http://dx.doi.org/10.2196/48032 |
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author | Fan, Si Wang, Qianning Zheng, Feiyang Wu, Yuanyang Yu, Tiantian Wang, Yanting Zhang, Xinping Zhang, Dexing |
author_facet | Fan, Si Wang, Qianning Zheng, Feiyang Wu, Yuanyang Yu, Tiantian Wang, Yanting Zhang, Xinping Zhang, Dexing |
author_sort | Fan, Si |
collection | PubMed |
description | BACKGROUND: Chronic pain, sleep disorders, and depression are major global health concerns. Recent studies have revealed a strong link between sleep disorders and pain, and each of them is bidirectionally correlated with depressive symptoms, suggesting a complex relationship between these conditions. Social participation has been identified as a potential moderator in this complex relationship, with implications for treatment. However, the complex interplay among sleep disorders, pain, depressive symptoms, and social participation in middle- and old-aged Asians remains unclear. OBJECTIVE: This study aimed to examine the bidirectional relationship between sleep disorders and pain in middle- and old-aged Chinese and measure the role of depression as a mediator and social participation as a moderator in this bidirectional relationship through a dynamic cohort study. METHODS: We used data from the China Health and Retirement Longitudinal Study across 5 years and included a total of 7998 middle- and old-aged people (≥45 years old) with complete data in 2011 (T1), 2015 (T2), and 2018 (T3). The cross-lag model was used to assess the interplay among sleep disorders, pain, depressive symptoms, and social participation. Depressive symptoms were assessed by the 10-item Centre for Epidemiological Studies Depression scale. Sleep disorders were assessed by a single-item sleep quality scale and nighttime sleep duration. The pain score was the sum of all pain locations reported. Social participation was measured using self-reported activity. RESULTS: Our results showed significant cross-lagged effects of previous sleep disorders on subsequent pain at T2 (β=.141; P<.001) and T3 (β=.117; P<.001) and previous pain on subsequent poor sleep at T2 (β=.080; P<.001) and T3 (β=.093; P<.001). The indirect effects of previous sleep disorders on pain through depressive symptoms (β=.020; SE 0.004; P<.001; effect size 21.98%), as well as previous pain on sleep disorders through depressive symptoms (β=.012; SE 0.002; P<.001; effect size 20.69%), were significant across the 3 time intervals. Among participants with high levels of social participation, there were no statistically significant effects of previous sleep disorders on subsequent pain at T2 (β=.048; P=.15) and T3 (β=.085; P=.02), nor were there statistically significant effects of previous pain on subsequent sleep disorders at T2 (β=.037; P=.15) and T3 (β=.039; P=.24). Additionally, the mediating effects of depressive symptoms on the sleep disorders-to-pain pathway (P=.14) and the pain-to-sleep disorders pathway (P=.02) were no longer statistically significant. CONCLUSIONS: There is a bidirectional relationship between sleep disorders and pain in middle- and old-aged Asians; depression plays a longitudinal mediating role in the bidirectional relationship between them; and social participation moderates the bidirectional relationship between them directly and indirectly by affecting depression. Future interventions may consider the complex relationship between these conditions and adopt a comprehensive treatment regime. |
format | Online Article Text |
id | pubmed-10413249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-104132492023-08-11 Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study Fan, Si Wang, Qianning Zheng, Feiyang Wu, Yuanyang Yu, Tiantian Wang, Yanting Zhang, Xinping Zhang, Dexing JMIR Public Health Surveill Original Paper BACKGROUND: Chronic pain, sleep disorders, and depression are major global health concerns. Recent studies have revealed a strong link between sleep disorders and pain, and each of them is bidirectionally correlated with depressive symptoms, suggesting a complex relationship between these conditions. Social participation has been identified as a potential moderator in this complex relationship, with implications for treatment. However, the complex interplay among sleep disorders, pain, depressive symptoms, and social participation in middle- and old-aged Asians remains unclear. OBJECTIVE: This study aimed to examine the bidirectional relationship between sleep disorders and pain in middle- and old-aged Chinese and measure the role of depression as a mediator and social participation as a moderator in this bidirectional relationship through a dynamic cohort study. METHODS: We used data from the China Health and Retirement Longitudinal Study across 5 years and included a total of 7998 middle- and old-aged people (≥45 years old) with complete data in 2011 (T1), 2015 (T2), and 2018 (T3). The cross-lag model was used to assess the interplay among sleep disorders, pain, depressive symptoms, and social participation. Depressive symptoms were assessed by the 10-item Centre for Epidemiological Studies Depression scale. Sleep disorders were assessed by a single-item sleep quality scale and nighttime sleep duration. The pain score was the sum of all pain locations reported. Social participation was measured using self-reported activity. RESULTS: Our results showed significant cross-lagged effects of previous sleep disorders on subsequent pain at T2 (β=.141; P<.001) and T3 (β=.117; P<.001) and previous pain on subsequent poor sleep at T2 (β=.080; P<.001) and T3 (β=.093; P<.001). The indirect effects of previous sleep disorders on pain through depressive symptoms (β=.020; SE 0.004; P<.001; effect size 21.98%), as well as previous pain on sleep disorders through depressive symptoms (β=.012; SE 0.002; P<.001; effect size 20.69%), were significant across the 3 time intervals. Among participants with high levels of social participation, there were no statistically significant effects of previous sleep disorders on subsequent pain at T2 (β=.048; P=.15) and T3 (β=.085; P=.02), nor were there statistically significant effects of previous pain on subsequent sleep disorders at T2 (β=.037; P=.15) and T3 (β=.039; P=.24). Additionally, the mediating effects of depressive symptoms on the sleep disorders-to-pain pathway (P=.14) and the pain-to-sleep disorders pathway (P=.02) were no longer statistically significant. CONCLUSIONS: There is a bidirectional relationship between sleep disorders and pain in middle- and old-aged Asians; depression plays a longitudinal mediating role in the bidirectional relationship between them; and social participation moderates the bidirectional relationship between them directly and indirectly by affecting depression. Future interventions may consider the complex relationship between these conditions and adopt a comprehensive treatment regime. JMIR Publications 2023-07-26 /pmc/articles/PMC10413249/ /pubmed/37494109 http://dx.doi.org/10.2196/48032 Text en ©Si Fan, Qianning Wang, Feiyang Zheng, Yuanyang Wu, Tiantian Yu, Yanting Wang, Xinping Zhang, Dexing Zhang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.07.2023. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Fan, Si Wang, Qianning Zheng, Feiyang Wu, Yuanyang Yu, Tiantian Wang, Yanting Zhang, Xinping Zhang, Dexing Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title | Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title_full | Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title_fullStr | Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title_full_unstemmed | Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title_short | Depression as a Mediator and Social Participation as a Moderator in the Bidirectional Relationship Between Sleep Disorders and Pain: Dynamic Cohort Study |
title_sort | depression as a mediator and social participation as a moderator in the bidirectional relationship between sleep disorders and pain: dynamic cohort study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413249/ https://www.ncbi.nlm.nih.gov/pubmed/37494109 http://dx.doi.org/10.2196/48032 |
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