AUTHOR=Makhoul Melissa , Bartley E. J. 

TITLE=Exploring the relationship between gratitude and depression among older adults with chronic low back pain: a sequential mediation analysis

JOURNAL=Frontiers in Pain Research

VOLUME=Volume 4 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1140778

DOI=10.3389/fpain.2023.1140778

ISSN=2673-561X

ABSTRACT=Introduction: Gratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-α) on the relationship between gratitude and depressive symptoms.
Methods: A total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-α and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed. 
Results: Gratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-α. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms.
Conclusion: Perceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.