The Relationship Between Multimorbidity and Depressive symptoms among Chinese Older Adults—The Mediating Role of Activities of Daily Living and Sleep Quality

Objective: This study aimed to explore the underlying mechanisms between multimorbidity and depressive symptoms among the older adults, and further investigate the multiple mediating effects of activities of daily living (ADL) and sleep quality. Methods: A total of 7290 older adults from the China Health and Retirement Longitudinal Study database completed questionnaires on multimorbidity, depressive symptoms, activities of daily living and sleep quality. We used a series of mediation models proposed by Hayes to study the relationship between variables. Results: Multimorbidity was positively correlated with ADL (r = 0.118, P< 0.001), and depressive symptoms levels (r = 0.114, P < 0.001), respectively. Multimorbidity was negatively correlated with sleep quality (r = -0.108, P<0.001). Multimorbidity was significantly associated with depressive symptoms (P<0.001), with a direct effect of 1.563 and indirect effects through ADL (0.175) and sleep quality (0.676). A serial mediation effect was also observed (0.048). Conclusion: These findings offer crucial insights into the complexities of psychological well-being in aging populations and provide actionable strategies for enhancing mental health care tailored to this vulnerable demographic. The empirical evidence presented in this study provides support for improving the mental health status of elders population.