Shi Yongli, Xu Mengyuan, Yin Wenqiang, Li Ziyuan, Dong Ping, Zhang Xianqi, Li Haoqi, Zhuge Xianglan, Li Xiaona, Gao Min, Ma Dongping, Sun Kui, Cao Haihong, Chen Zhongming
School of Management, Shandong Second Medical University, Weifang, China.
Weifang People's Hospital, Shandong Second Medical University, Weifang, China.
Front Public Health. 2025 Sep 1;13:1658008. doi: 10.3389/fpubh.2025.1658008. eCollection 2025.
Chronic pain (CP) is a prevalent comorbidity in patients with chronic diseases, yet the relationship between CP and health-related quality of life (HRQoL) remain unclear, particularly through the mediating roles of frailty and depression.
We conducted a cross-sectional survey in two provinces (eastern and central China) from October 2024 to January 2025, enrolling 3,094 patients with chronic diseases. HRQoL was assessed using the EQ-5D scale, while CP status was determined through structured logic-based questions. Frailty was evaluated using the FRAIL scale, and depressive symptoms were measured with the CES-D10. Spearman's correlation analysis was performed to assess associations among CP, frailty, depression, and HRQoL. A chain mediation model (PROCESS 4.1, Model 6) was constructed, and mediation effects were tested using a bootstrap approach with 5,000 resamples.
Frailty and depression exhibited significant mediating effects in the relationship between CP and HRQoL. The indirect effects of frailty and depression on HRQoL were -0.0747 (95% CI: -0.0881, -0.0618) and -0.0211 (95% CI: -0.0297, -0.0135). Additionally, a significant chain mediation effect was observed (-0.0192, 95% CI: -0.0242, -0.0145). The indirect effect of frailty and depression accounted for 34.09% of the association between CP and HRQoL (total effect: -0.1150, 95% CI: -0.1305, -0.0999).
The study findings demonstrated that frailty and depression serve as significant chain mediators in the relationship between CP and diminished HRQoL. Measures should be taken to reduce the incidence and severity of CP in patients with chronic diseases, improve frailty and depression, and thus improve HRQoL.
慢性疼痛（CP）是慢性病患者中普遍存在的一种共病，但CP与健康相关生活质量（HRQoL）之间的关系仍不明确，尤其是通过虚弱和抑郁的中介作用。
我们于2024年10月至2025年1月在中国东部和中部两个省份进行了一项横断面调查，纳入了3094名慢性病患者。使用EQ-5D量表评估HRQoL，通过基于结构化逻辑的问题确定CP状态。使用FRAIL量表评估虚弱程度，用CES-D10测量抑郁症状。进行Spearman相关性分析以评估CP、虚弱、抑郁和HRQoL之间的关联。构建了一个链式中介模型（PROCESS 4.1，模型6），并使用5000次重抽样的自抽样方法检验中介效应。
虚弱和抑郁在CP与HRQoL之间的关系中表现出显著的中介作用。虚弱和抑郁对HRQoL的间接效应分别为-0.0747（95%CI：-0.0881，-0.0618）和-0.0211（95%CI：-0.0297，-0.0135）。此外，观察到显著的链式中介效应（-0.0192，95%CI：-0.0242，-0.0145）。虚弱和抑郁的间接效应占CP与HRQoL之间关联的34.09%（总效应：-0.1150，95%CI：-0.1305，-0.0999）。
研究结果表明，虚弱和抑郁在CP与HRQoL降低之间的关系中是重要的链式中介因素。应采取措施降低慢性病患者CP的发生率和严重程度，改善虚弱和抑郁状况，从而提高HRQoL。
