| BackgroundWith the population aging and urbanization,there were more and more mental health problems existed among rural older adults.The burden of medical system has also become heavier.Senile syndrome referred to the simultaneous appearance of multiple physical and psychological symptoms.The underlying mechanism has not been clarified.Based on the theory of psychological distress,it could be concluded that stressors stimulate the body through mediating mechanisms(e.g.,stress perceiving and cognitive evaluation),and result in the occurrence or aggravation of psychological distress.Although previous studies have demonstrated that chronic conditions were the risk factor of psychological distress,there were little research investigated the potential mechanism of chronic conditions and psychological distress.Meanwhile,the role of persistent pain and sleep quality in the relationship between chronic conditions and psychological were still unclear.Obj ectiveBased on the psychological distress theory,this study aims to explore the rate of psychological distress among rural older people,find the influencing factors of the occurrence and deterioration of psychological distress.Moreover,we also aim to investigate the effects of chronic conditions,persistent pain,and other physical symptoms on psychological distress,as well as the effects of sleep quality on psychological distress.We also want to clarify whether persistent pain and sleep quality play the mediating roles in the relationship between chronic conditions and psychological distress.This study will provide empirical evidence for the intervention for the rural older people.MethodsThis study adopted a multi-stage stratified sampling method to survey 2748 older adults in rural Shandong Province.Data were collected using face-to-face interviews.Epidata3.1,Stata14.0(Stata Corp,College Station,TX,USA)、SPSS 22.0(IBM Corp,Armonk,NY,USA)and Mplus 8.3(Muthén&Muthén,Los Angeles,CA,USA)were employed for data entry and analysis.Descriptive analysis was used to describe the basic characteristics and psychological distress status of rural older people.Univariate analysis and Spearman correlation analysis were employed to explore the relationship between chronic diseases and psychological distress.Path analysis were used to explore the mediating effect of persistent pain and sleep quality.The fit index of path analysis model was evaluated.ResultsThis study found that 47.49%of rural older people had mild level or above psychological distress.With one or more chronic conditions,with persistent pain,and had poor sleep quality were all risk factors for psychological distress.After adjusting the basic characteristics,the standardized effect of each path in the pathway analysis model was as follows:the total effect of chronic condition on psychological distress was 0.155(P<0.001).The direct effect was 0.068(P<0.001),the total indirect effect was 0.087(P<0.001),and the total indirect effect accounted for 56.13%(0.087/0.155).The mediating effect of chronic diseases on psychological distress through persistent pain was significant,the pathway effect was 0.023(P=0.010),and the effect of this pathway accounts for 14.84%of the total effect(0.023/0.155).Chronic conditions associated with psychological distress through sleep quality.The mediating mechanism of sleep quality was significant,and the pathway effect was 0.048(P<0.001),accounting for 30.97%of the total effect(0.048/0.155).The multiple mediating effects between the relationship of chronic conditions and psychological distress through persistent pain and sleep quality were also significant.The effect of this pathway is 0.016(P=0.001),which accounts for 10.32%(0.016/0.155)of the total effect.Conclusions and suggestionsConclusionsThis study found that the psychological distress rate among the rural older people in Shandong was relatively high.The types of chronic conditions,the appearance of persistent pain,and the decrease in sleep quality are all risk factors for the occurrence or deterioration of psychological distress.More attention should be paid to the older people with poorer physical status,more mental health problems,and poorer sleep quality.Physical and mental health intervention should be provided timely.Suggestions1.Strengthen the screening and evaluation of the psychological distress among the rural older people.2.Pay more attention to improving the self-management of chronic conditions and pain among the rural older people.3.Improve the sleep quality of the rural older people and reduce the occurrence of sleep problems.4.Increase investment in rural education and carry out diversified health education for rural older people. |
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