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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...

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Detalles Bibliográficos
Autores principales: Fan, Si, Wang, Qianning, Zheng, Feiyang, Wu, Yuanyang, Yu, Tiantian, Wang, Yanting, Zhang, Xinping, Zhang, Dexing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2023
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.
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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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