ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1658008
This article is part of the Research TopicUnveiling the Mental Health Impact of Physical Decline in Older Adults: A Holistic ApproachView all 9 articles
The relationship between chronic pain and health-related quality of life: the mediating roles of frailty and depression in chronic disease patients
Provisionally accepted
Yongli SHI1
Mengyuan Xu1Wenqiang Yin1
Ziyuan Li1Ping Dong1
宪琦 张1Haoqi Li1Xianglan Zhuge1
Xiaona Li1
Min GAO1
Dongping Ma1Kui Sun1*Haihong Cao2*
Zhongming Chen1*- 1School of Management, Shandong Second Medical University, Weifang, China
- 2Weifang People's Hospital, Weifang, China
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Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.
Keywords: Frailty, Depression, Chronic disease management, Chronic Pain, chain mediation
Received: 02 Jul 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 SHI, Xu, Yin, Li, Dong, 张, Li, Zhuge, Li, GAO, Ma, Sun, Cao and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kui Sun, School of Management, Shandong Second Medical University, Weifang, China
Haihong Cao, Weifang People's Hospital, Weifang, China
Zhongming Chen, School of Management, Shandong Second Medical University, Weifang, China
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