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BMC Geriatrics
Published in: BMC Geriatrics 1/2023

Open Access 01-12-2023 | Mood Disorders | Research

Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression

Authors: Jiashuang Xu, Lin Zhang, Hong Sun, Ziyun Gao, Meiding Wang, Mengya Hu, Qiqi Ji, Leilei Guo

Published in: BMC Geriatrics | Issue 1/2023

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Abstract

Background

The present study is intended to examine the multiple mediating roles of sleep quality and depression in the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases.

Methods

From October 2, 2021, to February 27, 2022, a questionnaire survey was conducted using a multistage stratified sampling method among 339 middle-aged and older adults (45 years and over) hospitalized with chronic diseases. These participants were recruited from a hospital in Zhejiang Province, China. The questionnaire included the Aged Cumulative Disease Rating Scale, the Psychological Resilience Scale, the Pittsburgh Sleep Quality Index Scale, the Depression Scale, and the Quality-of-Life Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between psychological resilience and quality of life. Amos 24.0 was used to analyze the multiple mediated effects of sleep quality and depression.

Results

Psychological resilience exerted a remarkable direct effect on the quality of life in middle-aged and older adults hospitalized with chronic diseases (β = 0.239, 95% CI = 0.125–0.354), which represented 52.98% of the total effect. Through three significantly mediated pathways indirectly affect the quality of life: (1) through the sleep quality pathway (β = 0.115, 95% CI = 0.056–0.201), which represented 25.39% of the total effect; (2) through the depression pathway (β = 0. 060, 95% CI = 0.023–0.114), which represented 13.24% of the total effect; and (3) through both the sleep quality and depression pathway (β = 0. 038, 95% CI = 0.019–0.074), which represented 8.39% of the total effect. The total mediating effect was 47.02%.

Conclusions

Sleep quality and depression mediate the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. Therefore, healthcare professionals and stakeholders should be concerned about the sleep status and mental health of middle-aged and older adults hospitalized with chronic diseases, strengthen their attention to psychological resilience, and provide interventions and treatment measures for hospitalized patients who have sleep problems and depressive tendencies.
Literature
1.
Zhang T, Liu C, Ni Z. Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations. Int J Environ Res Public Health. 2019;16(14):2592.PubMedPubMedCentralCrossRef
2.
Miao W, Zhang X, Shi B, Tian W, Wu B, Lai Y, Li Y, Huang Z, Xia Q, Yang H, et al. Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China. BMC Med Res Methodol. 2022;22(1):151.PubMedPubMedCentralCrossRef
3.
He L, La Y, Yan Y, Wang Y, Cao X, Cai Y, Li S, Qin M, Feng Q. The prevalence and burden of four major chronic diseases in the Shanxi Province of Northern China. Front Public Health. 2022;10:985192.PubMedPubMedCentralCrossRef
4.
Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open. 2018;8(3):e019901.PubMedPubMedCentralCrossRef
5.
Rodrigues LP, Vissoci JRN, França DG, Caruzzo NM, Batista SRR, de Oliveira C, Nunes BP, Silveira EA. Multimorbidity patterns and hospitalisation occurrence in adults and older adults aged 50 years or over. Sci Rep. 2022;12(1):11643.PubMedPubMedCentralCrossRef
6.
Helvik A-S, Engedal K, Selbæk G. Change in quality of life of medically hospitalized patients – A one-year follow-up study. Aging Ment Health. 2013;17(1):66–76.PubMedCrossRef
7.
Margis R, Donis KC, Schonwald SV, Rieder CRM. WHOQOL-OLD assessment of quality of life in elderly patients with Parkinson’s disease: influence of sleep and depressive symptoms. Rev Bras Psiquiatr. 2010;32(2):125–31.PubMedCrossRef
8.
Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019;53:100903.PubMedCrossRef
9.
Ye ZJ, Qiu HZ, Li PF, Liang MZ, Zhu YF, Zeng Z, Hu GY, Wang SN, Quan XM. Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon-rectal cancer diagnoses: the role of psychological resilience. Psychooncology. 2017;26(6):829–35.PubMedCrossRef
10.
Troy AS, Willroth EC, Shallcross AJ, Giuliani NR, Gross JJ, Mauss IB. Psychological Resilience: An Affect-Regulation Framework. Annu Rev Psychol. 2023;74(1):547–76.PubMedCrossRef
11.
Zou G, Li Y, Xu R, Li P. Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer. J Clin Nurs. 2018;27(7–8):e1412–8.PubMed
12.
Isokääntä S, Honkalampi K, Kokki H, Sintonen H, Kokki M. Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy. BMC Pulmonary Medicine. 2021;21(1):144.PubMedPubMedCentralCrossRef
13.
Sehgal P, Ungaro RC, Foltz C, Iacoviello B, Dubinsky MC, Keefer L. High Levels of Psychological Resilience Associated With Less Disease Activity, Better Quality of Life, and Fewer Surgeries in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2021;27(6):791–6.PubMedCrossRef
14.
Popa-Velea O, Diaconescu L, Jidveian Popescu M, Truţescu C. Resilience and active coping style. Int J Psychiatry Med. 2017;52(2):124–36.PubMedCrossRef
15.
Eckle T, Dobing S, Frolova N, McAlister F, Ringrose J. Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population. Plos One. 2016;11(6):e0156735.CrossRef
16.
Liao H, Liao S. Gao Y-j, Mu J-p, Wang X, Chen D-s, Tang M: Correlation between Sleep Time, Sleep Quality, and Emotional and Cognitive Function in the Elderly. Biomed Res Int. 2022;2022:1–7.
17.
Cappuccio FP, Cooper D, D’Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484–92.PubMedCrossRef
18.
Eyigor S, Eyigor C, Uslu R. Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients. Arch Gerontol Geriatr. 2010;51(3):e57–61.PubMedCrossRef
19.
Liu W, Zhang H. Do sleep quality and psychological factors link precancerous conditions of colorectal cancer? A retrospective case-control study. Expert Rev Gastroenterol Hepatol. 2022;16(2):173–9.PubMedCrossRef
20.
Li T, Cui C, Li Y, Wang L. The impacts of resilience on the association between illness uncertainty and sleep quality among Chinese women with systemic lupus erythematosus. Clin Rheumatol. 2020;39(5):1609–16.PubMedCrossRef
21.
Xia Y, Matsuda R, Kohno T, Kohsaka S, Shiraishi Y, Katsumata Y, Hayashida K, Yuasa S, Takatsuki S, Fukuda K. Psychological disturbances and their association with sleep disturbances in patients admitted for cardiovascular diseases. Plos One. 2021;16(1):e0244484.CrossRef
22.
Helvik A-S, Engedal K, Krokstad S, Stordal E, Selbæk G. A comparison of depressive symptoms in elderly medical inpatients and the elderly in a population-based health study (the Nord-Trøndelag Health Study 3). Nord J Psychiatry. 2011;66(3):189–97.PubMedCrossRef
23.
IsHak WW, Collison K, Danovitch I, Shek L, Kharazi P, Kim T, Jaffer KY, Naghdechi L, Lopez E, Nuckols T. Screening for Depression in Hospitalized Medical Patients. J Hosp Med. 2017;12(2):118–25.PubMedCrossRef
24.
25.
Wang X, Ma X, Yang M, Wang Y, Xie Y, Hou W, Zhang Y. Proportion and related factors of depression and anxiety for inpatients with lung cancer in China: a hospital-based cross-sectional study. Support Care Cancer. 2022;30(6):5539–49.PubMedPubMedCentralCrossRef
26.
Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324–32.PubMedPubMedCentralCrossRef
27.
28.
Khan MS, Aouad R. The Effects of Insomnia and Sleep Loss on Cardiovascular Disease. Sleep Med Clin. 2017;12(2):167–77.PubMedCrossRef
29.
Lau WKW. The role of resilience in depression and anxiety symptoms: A three-wave cross-lagged study. Stress Health. 2022;38(4):804–12.PubMedCrossRef
30.
Song L, Cao Y, Li J, Lu M, Tang L. Psychological distress and resilience in patients with gastroenteropancreatic neuroendocrine tumor. Front Endocrinol. 2022;13:947998.CrossRef
31.
Toukhsati SR, Jovanovic A, Dehghani S, Tran T, Tran A, Hare DL. Low psychological resilience is associated with depression in patients with cardiovascular disease. Eur J Cardiovasc Nurs. 2016;16(1):64–9.PubMedCrossRef
32.
Tadayon M, Dabirizadeh S, Zarea K, Behroozi N, Haghighizadeh MH. Investigating the relationship between psychological hardiness and resilience with depression in women with breast cancer. Gulf J Oncolog. 2018;1(28):23–30.
33.
Liu J-C, Chang L-Y, Wu S-Y, Tsai P-S. Resilience mediates the relationship between depression and psychological health status in patients with heart failure: A cross-sectional study. Int J Nurs Stud. 2015;52(12):1846–53.PubMedCrossRef
34.
Schouten RW, Harmse VJ, Dekker FW, van Ballegooijen W, Siegert CEH, Honig A. Dimensions of Depressive Symptoms and Their Association With Mortality, Hospitalization, and Quality of Life in Dialysis Patients: A Cohort Study. Psychosom Med. 2019;81(7):649–58.PubMedPubMedCentralCrossRef
35.
Saraçlı Ö, Akca ASD, Atasoy N, Önder Ö, Şenormancı Ö, Kaygisız İ, Atik L. The Relationship between Quality of Life and Cognitive Functions, Anxiety and Depression among Hospitalized Elderly Patients. Clin Psychopharmacol Neurosci. 2015;13(2):194–200.PubMedPubMedCentralCrossRef
36.
Harrison JE, Weber S, Jakob R, Chute CG. ICD-11: an international classification of diseases for the twenty-first century. BMC Med Inform Decis Mak. 2021;21(S6):206.PubMedPubMedCentralCrossRef
37.
38.
Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82.PubMedCrossRef
39.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.PubMedCrossRef
40.
41.
Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.PubMedCrossRef
42.
García-Martínez P, Ballester-Arnal R, Gandhi-Morar K, Castro-Calvo J, Gea-Caballero V, Juárez-Vela R, Saus-Ortega C, Montejano-Lozoya R, Sosa-Palanca EM, Gómez-Romero MDR, et al. Perceived Stress in Relation to Quality of Life and Resilience in Patients with Advanced Chronic Kidney Disease Undergoing Hemodialysis. Int J Environ Res Public Health. 2021;18(2):536.PubMedPubMedCentralCrossRef
43.
Taylor K, Scruggs PW, Balemba OB, Wiest MM, Vella CA. Associations between physical activity, resilience, and quality of life in people with inflammatory bowel disease. Eur J Appl Physiol. 2018;118(4):829–36.PubMedCrossRef
44.
Yu S, Yao X, Sang Y, Yu L, Shen Y, Che X, Ding Y, Huang Y. The mediating role of resilience in the relationship between social support and quality of life among patients after radical cystectomy: A structural equation model analysis. Nurs Open. 2022;10(3):1574–81.PubMedPubMedCentralCrossRef
45.
Temprado Albalat MD, García Martínez P, Ballester Arnal R, Collado-Boira EJ. The relationship between resilience and quality of life in patients with a drainage enterostomy. J Health Psychol. 2020;25(10–11):1483–97.PubMedCrossRef
46.
Hinz A, Friedrich M, Kuhnt S, Zenger M, Schulte T. The influence of self-efficacy and resilient coping on cancer patients’ quality of life. Eur J Cancer Care. 2019;28(1):e12952.CrossRef
47.
Frey R, Macía P, Barranco M, Gorbeña S, Iraurgi I. Expression of resilience, coping and quality of life in people with cancer. Plos One. 2020;15(7):e0236572.CrossRef
48.
Montazeri A, Groarke A, Curtis R, Skelton J, Groarke JM. Quality of life and adjustment in men with prostate cancer: Interplay of stress, threat and resilience. Plos One. 2020;15(9):e0239469.CrossRef
49.
Majnarić LT, Bosnić Z, Guljaš S, Vučić D, Kurevija T, Volarić M, Martinović I, Wittlinger T. Low Psychological Resilience in Older Individuals: An Association with Increased Inflammation, Oxidative Stress and the Presence of Chronic Medical Conditions. Int J Mol Sci. 2021;22(16):8970.PubMedPubMedCentralCrossRef
50.
Cheng M-Y, Wang M-J, Chang M-Y, Zhang R-X, Gu C-F, Zhao Y-H. Relationship between resilience and insomnia among the middle-aged and elderly: mediating role of maladaptive emotion regulation strategies. Psychol Health Med. 2020;25(10):1266–77.PubMedCrossRef
51.
Inouye SK, Bogardus ST Jr, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc. 2000;48(12):1697–706.PubMedCrossRef
52.
Shen Q, Huang X, Luo Z, Xu X, Zhao X, He Q. Sleep quality, daytime sleepiness and health-related quality-of-life in maintenance haemodialysis patients. J Int Med Res. 2016;44(3):698–709.PubMedPubMedCentralCrossRef
53.
Mei Y, Yang X, Liu C, Li Y, Gui J, Zhang L. The impact of psychological resilience on chronic patients’ depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality. BMC Psychol. 2023;11(1):213.PubMedPubMedCentralCrossRef
54.
Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, Dauvilliers Y, Ferri R, Fung C, Gozal D, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health. 2017;3(1):6–19.PubMedCrossRef
55.
Kim GM, Lim JY, Kim EJ, Park SM. Resilience of patients with chronic diseases: A systematic review. Health Soc Care Community. 2018;27(4):797–807.PubMedCrossRef
56.
Kuang D, Gu D-F, Cao H, Yuan Q-F, Dong Z-X, Yu D, Shen X-M. Impacts of psychological resilience on self-efficacy and quality of life in patients with diabetic foot ulcers: a prospective cross-sectional study. Ann Palliat Med. 2021;10(5):5610–8.PubMedCrossRef
57.
Acciari AS, Leal RF, Coy CSR, Dias CC. Ayrizono MdLS: Relationship among Psychological Well-Being, Resilience and Coping with Social and Clinical Features in Crohn’s Disease Patients. Arq Gastroenterol. 2019;56(2):131–40.PubMedCrossRef
58.
Creed F, Morgan R, Fiddler M, Marshall S, Guthrie E, House A. Depression and Anxiety Impair Health-Related Quality of Life and Are Associated With Increased Costs in General Medical Inpatient. Psychosomatics. 2002;43(4):302–9.PubMedCrossRef
59.
Dehn LB, Beblo T. Verstimmt, verzerrt, vergesslich: Das Zusammenwirken emotionaler und kognitiver Dysfunktionen bei Depression. Neuropsychiatrie. 2019;33(3):123–30.PubMedCrossRef
60.
Warraich HJ, Kitzman DW, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, Nelson MB, Upadhya B, Reeves GR. Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction. Circ Heart Fail. 2018;11(11):e005254.PubMedPubMedCentralCrossRef
61.
Nanni MG, Caruso R, Travado L, Ventura C, Palma A, Berardi AM, Meggiolaro E, Ruffilli F, Martins C, Kissane D, et al. Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients. Psychooncology. 2018;27(11):2616–22.PubMedCrossRef
62.
Taylor SE, Stanton AL. Coping Resources, Coping Processes, and Mental Health. Annu Rev Clin Psychol. 2007;3(1):377–401.PubMedCrossRef
63.
Johansson YA, Bergh I, Ericsson I, Sarenmalm EK. Delirium in older hospitalized patients—signs and actions: a retrospective patient record review. BMC Geriatrics. 2018;18(1):43.PubMedPubMedCentralCrossRef
64.
Vareta DA, Ventura F, Família C, Oliveira C. Person-Centered Practice in Hospitalized Older Adults with Chronic Illness: Clinical Study Protocol. Int J Environ Res Public Health. 2022;19(17):11145.PubMedPubMedCentralCrossRef
65.
George T, Shah F, Tiwari A, Gutierrez E, Ji J, Kuchel GA, Cohen HJ, Sedrak MS. Resilience in older adults with cancer: A scoping literature review. J Geriatr Oncol. 2023;14(1):101349.PubMedCrossRef
66.
Sihvola S, Kuosmanen L, Kvist T. Resilience and related factors in colorectal cancer patients: A systematic review. Eur J Oncol Nurs. 2022;56:102079.PubMedCrossRef
67.
Szady P, Bączyk G, Kozłowska K. Fatigue and sleep quality in rheumatoid arthritis patients during hospital admission. Rheumatology. 2017;55(2):65–72.PubMedPubMedCentralCrossRef
68.
Aarts N, Zuurbier LA, Noordam R, Hofman A, Tiemeier H, Stricker BH, Visser LE. Use of Selective Serotonin Reuptake Inhibitors and Sleep Quality: A Population-Based Study. J Clin Sleep Med. 2016;12(07):989–95.PubMedPubMedCentralCrossRef
69.
Bužgová R, Jarošová D, Hajnová E. Assessing anxiety and depression with respect to the quality of life in cancer inpatients receiving palliative care. Eur J Oncol Nurs. 2015;19(6):667–72.PubMedCrossRef
70.
Joyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB. Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open. 2018;8(6):e017858.PubMedPubMedCentralCrossRef
71.
Mao H, Wu J, Xu Y, Liu Y, Tang X. Effectiveness of sleep self-management group intervention in Chinese patients with insomnia disorder. Perspect Psychiatr Care. 2018;54(2):156–61.PubMedCrossRef
72.
73.
Schuch FB, Stubbs B. The Role of Exercise in Preventing and Treating Depression. Curr Sport Med Rep. 2019;18(8):299–304.CrossRef
Metadata
Title
Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression
Authors
Jiashuang Xu
Lin Zhang
Hong Sun
Ziyun Gao
Meiding Wang
Mengya Hu
Qiqi Ji
Leilei Guo
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-023-04473-1

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