JMIR Publications

ABSTRACT

Background:

There is a lack of high-quality evidence for the complex relationships between the three highly prevalent and costly global health problems (sleep disorders, pain, and depression), especially in Asian populations. While the potential benefits of social participation in alleviating depression, pain, and sleep disorders have been acknowledged, the complex interplay between 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:

It included 7,998 middle- and old-aged Chinese with complete data from T1 (2013), T2 (2015), and T3 (2018) of a nationally representative cohort - the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed by the 10-item Centre for Epidemiological Studies Depression scale (CESD-10). Sleep disorders, pain and social participation were self-reported. Structural equation modeling using Mplus was used.

Results:

Results showed significant cross-lagged effects of prior sleep disorders on subsequent pain at T2 (β=.141, P<.001) and T3 (β=.117, P <.001) and prior pain on subsequent poor sleep at T2 (β=.080, P <.001) and T3 (β=.093, P<.001). The indirect effects of prior sleep disorders on pain via depressive symptoms (β=.020, SE 0.004, P<.001, effect size 21.98%), as well as prior pain on sleep disorders via depressive symptoms (β=.012, SE 0.002, P<.001, effect size 20.69%), were significant across the three-time intervals. The predicted mediating role of depressive symptoms from pain to sleep disorders was empirically supported only in the high-level social participation population (β= .016, SE 0.007, P=.02, effect size 28.57%) but not the low-level social participation population(P=.14).

Conclusions:

There is a bidirectional relationship between sleep disorders and pain in the middle- and old-aged Asians, depression plays a longitudinal mediating role in the bidirectional relationship between them while depression only mediates the path from pain to sleep disorders in the high-level social participation population.