Social participation and insomnia in Chinese older adults with multimorbidity: mediating roles of frailty, anxiety, and depression.

Background: The harm of insomnia to the body and mind of the older adults with multimorbidity cannot be ignored. Increased social participation may improve insomnia, and that frailty, anxiety and depression may also have an impact on insomnia in older adults with multimorbidity. However, the mechanisms between social participation and insomnia in older adults remain understudied. The aim of this study is to explore the serial mediating effects of frailty, anxiety and depression on the relationship between social participation and insomnia in older adults with multimorbidity.

Methods: A total of 588 Chinese older adults with multimorbidity were selected from the Comprehensive geriatric assessment (CGA) of Department of Geriatrics, the Second Xiangya Hospital, Central South University, as the participants. All data were collected using instruments such as the FRAIL scale, Patient Health Questionnaire-9 and Athens Insomnia Scale, and were analyzed using SPSS 26.0 software. Pearson bivariate correlation analysis was used to explore the correlations. AMOS 26.0 software was used to assess the serial mediating role of frailty, anxiety and depression on the relationship between social participation and insomnia in older adults with multimorbidity via structural equation modeling.

Results: Social participation, frailty, anxiety and depression were significantly associated with insomnia in older adults with multimorbidity (p < 0.05). The direct effect of social participation on insomnia became nonsignificant after including frailty, anxiety and depression in the model, indicating a full, serial mediation effect (total effect: -0.172, 95%CI: -0.245~-0.095; direct effect: -0.024, 95%CI: -0.108 ~ 0.060; indirect effect: -0.148, 95%CI: -0.204~-0.103).

Conclusion: Based on the stress process theory, our study showed that frailty, anxiety and depression serially mediated the relationship between social participation and insomnia. These findings hold significant practical implications and suggest that improving physical and mental health and developing social participation programs may potentially help improve sleep quality among older adults with multimorbidity, so as to promote their overall well-being.