Serial Multiple Mediation Model Research Articles

The relationship between activities of daily living and psychological distress among Chinese older adults: A serial multiple mediation model

BackgroundFew studies have shed light on the mechanisms underlying the link between activities of daily living (ADL) and psychological distress. This study aimed to explore the multiple mediating roles of loneliness and sleep quality in this relationship among Chinese older adults. MethodsA total of 3250 older adults completed the Barthel Index, UCLA 20-item Loneliness Scale, Pittsburgh Sleep Quality Index, and Depression, Anxiety, and Stress Scale Questionnaire. Serial multiple mediation analysis was conducted using Hayes’ PROCESS macro. ResultsADL was found to directly impact psychological distress through three significant mediation pathways: (1) loneliness (B=-0.124, 95% CI=-0.140, -0.109), which accounted for 23.98% of the total effect, (2) sleep quality (B=-0.050, 95% CI=-0.063, -0.039), which accounted for 9.67% of the total effect, and (3) loneliness and sleep quality (B=-0.015, 95% CI=-0.020, -0.012), accounting for 2.91% of the total effect. The total mediating effect was 36.56%. LimitationsThe cross-sectional design we used limited causal interpretations. Future studies could examine longitudinal changes in outcome measures. ConclusionsThese findings highlight the role of loneliness and sleep quality as serial mediators of the relationship between ADL and psychological distress. Thus, for the early detection and prevention of psychological distress, it is necessary to conduct loneliness and sleep quality interventions for older adults with ADL limitations.

Relationships among adverse childhood experience patterns, psychological resilience, self-esteem and depressive symptoms in Chinese adolescents: A serial multiple mediation model

Adverse childhood experiences (ACEs) and adolescent depression are both prevalent social problems that can increase the risk of several negative health consequences throughout life. The original definition of ACEs misdirects the focus of intervention efforts for ACEs to only family dysfunction and parenting practices. We used a broader definition of ACEs and a latent class analysis (LCA) model to examine ACE patterns, aiming to overcome the shortcomings of cumulative and single adversity approaches based on the special social context of China. The data were derived from a middle school in Huaibei City of Anhui Province in 2019 and 2020, which was a prospective study involving 1687 junior high school students. At the initial evaluation (T1), ACEs, psychological resilience, self-esteem, and depressive symptoms were assessed by the students. At Time 2 (T2), the depressive symptoms of students were assessed. LCA and mediation analyses were conducted with Mplus version 8.2. The LCA identified the following three heterogeneous ACE classes: “low adversity” (36.4%), “moderate adversity” (44.2%), and “high adversity” (19.4%). The mediation analysis showed that the ACE patterns affected depressive symptoms through the following two mediation paths only in the moderate but not in the high adversity class: self-esteem alone and a path combining psychological resilience and self-esteem. Psychological resilience separately did not mediate the association between ACE patterns and depressive symptoms. To reduce depressive symptoms, interventions for students with ACEs need to improve self-esteem through many channels.

Mobile payment adoption process: a serial of multiple mediation and moderation analysis

Purpose Global digital payment transactions increase continuously. Due to the inconsistencies that occurred across the research findings, past researchers have called for further investigation to verify and empirically test the mobile payment acceptance model. The purpose of this paper is to develop an integrative model that is derived from the multiple technology acceptance models (TAM)’s a theoretical framework and past literature to understand how consumers decided to adopt mobile payment. By simultaneously testing mechanisms, namely, ease of use, usefulness and risk, the current study will be able to advance scholarly knowledge of the underlying consumer’s attitude and behavior that link social influence to intention to use. Design/methodology/approach A total of 370 valid responses were collected using self-administered questionnaires distributed via online platforms, a representative for Thai consumers. An ordinary least square regression and bootstrap analyzes were conducted through PROCESS Macro to analyze the moderated serial-multiple mediation model in the consecutive inducing of social influence, perceived ease of use, perceived usefulness and perceived risk toward the consumer’s intention to use mobile payment. Findings Within the context of consumers evaluating a mobile payment, statistics significant were found for the hypothesized direct and indirect effects of perceived ease of use and perceived usefulness on an intention to use. The results showed that Thai consumers’ intention to use mobile payment was significantly affected by their attitudes in terms of usefulness and the less complication in using the applications. It is confirmed that social influence indirectly affects intention to use via the increase of perceived ease of use and perceived usefulness. The study also found a significant interaction between perceived risk and perceived usefulness toward intention to use. Practical implications It is recommended to service providers to continue improving the user-friendliness, navigation, integrity and furnish the system with more value-added activities within the mobile payment application. It is also essential for the company to deliver tutorials and clear and easy-to-follow instructions to customers. At the same time, the marketer should develop marketing strategies to promote the usefulness and simplicity of using the applications to the consumers. When consumers experienced the easiness and usefulness of the applications, these could overcome the resistance feeling to use due to the concern on any potential risk. Originality/value The study contributes to the existing body of knowledge on consumer usage behavior and TAM by integrating all important variables and developed a parsimony framework to explain consumers’ usage adoption on mobile payment. Moreover, the current study was the very first that proposed and tested a serial of multiple mediations of perceived ease of use and perceived usefulness, moderated by perceived risk, in the relationship between social influence and consumers’ intention to use mobile payment and discovered a moderating role of perceived risk toward the relationship between perceived usefulness and mobile payment usage intention.

Information Complexity and Behavior Intention to Prescribe Antibiotics Based on the Antimicrobial Susceptibility Testing Report: The Mediating Roles of Information Overload and Attitude.

Background: The antimicrobial susceptibility testing (AST) report has guiding significance for physicians to prescribe antibiotics. This study aims to examine the effect of the AST report information complexity on physician’s intention to prescribe antibiotics based on the AST report, as well as the mediating role of information overload and attitude. Methods: A cross-sectional study conducted on 411 physicians in a general hospital in China in July 2021. Data were collected by a self-reported questionnaire. A serial multiple mediation model was tested to explore the sequential causality between the information complexity of the AST report, information overload, attitude, and behavior intention to prescribe antibiotics based on the AST report by using the SPSS macro PROCESS program. Results: Information complexity, information overload, attitude and behavior intention were significantly correlated (p < 0.01). Information complexity can not only have a direct positive impact on the intention to prescribe antibiotics based on the AST report (effect = 0.173; SE = 0.044; Boot95%CI: LL = 0.089, UL = 0.260), but also have an indirect impact on behavior intention through the independent mediating role of information overload (effect = 0.025; SE = 0.011; Boot 95%CI: LL = 0.008, UL = 0.050) and the independent mediating role of attitude (effect = 0.130; SE = 0.025; Boot 95%CI: LL = 0.086, UL = 0.180), while the chain of information overload and attitude played a masking effect between information complexity and behavior intention (effect = −0.013; SE = 0.004; Boot 95%CI: LL = −0.023, UL = −0.005). Conclusion: The increase in information complexity can encourage physicians to prescribe antibiotics based on the AST report, information overload and attitude can promote this effect. It is necessary to provide physicians with sufficient information to prescribe antibiotics without increasing the burden on them. At the same time, publicity and standardized training should be conducted for physicians to interpret the AST report better and faster.

The mediating role of trust in physician and self-efficacy in understanding medication adherence in severe asthma

ObjectiveTo investigate the relationships between beliefs about medication, trust in physician, self-efficacy, and medication adherence in severe asthma patients. MethodsA sample of 117 patients with a diagnosis of Severe Asthma on Step 4 or 5 of GINA assessment of control treatment ladder completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), Trust in Physician Scale (TIPS), and Self-Efficacy in Taking Medication (SEAMS). ResultsOur study found that medication adherence was associated with trust in physician (p = 0.033); factor one of beliefs about medication - Necessity of taking medication (BMQ1-Necessity: p = 0.025); and two factors of self-efficacy in taking medication (SEAMS1-Difficulty: p = 0.001; SEAMS2-Uncertain: p = 0.005). Furthermore, two factors of self-efficacy and trust in physician together significantly mediated the relationship between beliefs about medication and medication adherence in a serial multiple mediator model. ConclusionsBeliefs about medication are fundamental in affecting asthma patients’ trust in physician and self-efficacy, which in turn impact medication adherence. Clinical implicationsInterventions being developed to improve medication adherence may benefit from emphasizing on asthma patients' concerns about overuse and harm of medication. In addition, education program targeting to improve provider-patient relationship could help with patients’ confidence in taking medication.

The effects of frontline bank employees' social capital on adaptive selling behavior: serial multiple mediation model

PurposeThis study investigated the effects of social capital on frontline bank employee's adaptive selling behavior via the psychological process. Frontline bank employees' positive social relationships enhance their perception of the work environment and encourage work engagement. With the multiple mediation model, both internal and external social capital have direct and indirect influence on the frontline bank employee's adaptive selling behavior.Design/methodology/approachData for this study were collected from a cross-sectional sample of retail banking industry in Korea. Specifically, using two-step procedures, employees of financial service or insurance sales department in banks were selected and online survey questionnaires were distributed to them. Data from 330 employees were collected and analyzed.FindingsThe results of this study showed how social capital affects frontline bank employees' person–job fit as a cognitive psychological process, leading to work engagement as an emotional psychological process and, in turn, more adaptive selling behavior. Using multiple mediation analysis, the results showed that work engagement on its own exerts a mediating effect on social capital, whereas a person–job fit does not.Research limitations/implicationsThis study applied both aspects of the social capital concept by dividing it into internal and external social capital, and exploring each separately. This study examined the influence on psychological processes and behavioral response by distinguishing between the two forms of social capital. Second, this study expands the previous studies by introducing social capital as an antecedent factor of frontline bank employees' adaptive selling behavior. Finally, this study explains how frontline bank employees' relational resources (i.e. social capital) influence their emotional aspect (i.e. work engagement) and cognitive aspect (i.e. person–job fit), which ultimately influence performance-driven behavior (i.e. adaptive selling behavior).Practical implicationsThis research showed the importance of hiring frontline bank employees with excellent social capital capabilities. Furthermore, this study underscored the fact that organizations require preparing and providing practical management methods that can improve the social capital of their current frontline employees. Last, organization need to design the job in a way that innately improves frontline employees' social capital. Therefore, these jobs provide many opportunities for frontline bank employees to use their ability to build relationships in their interactions with customers and make practical decisions to achieve job performance.Originality/valueThis study improved our understanding regarding the importance of employees' social capital by revealing the psychological process of how frontline bank employees' social capital affects adaptive selling behavior. Second, this study expands on the literature by introducing internal and external social capital as an antecedent factor affecting the adaptive selling behavior of frontline bank employees. Furthermore, this study advances understanding on the manner in which relational resources of frontline bank employees (i.e. social capital) influence the emotional (i.e. work engagement) as well as the cognitive aspects (i.e. person–job fit), which ultimately influence performance-driven behavior (i.e. adaptive selling behavior).

Understanding others as a mediator between verbal memory and negative symptoms in schizophrenia-spectrum disorder

From the onset of schizophrenia, verbal memory (VM) deficits and negative symptoms are strongly associated, and both additively predict functional outcomes. Emotion recognition (ER) and theory of mind (ToM; the ability to infer others' mental states), two components of social cognition, are also particularly affected in schizophrenia. Explanatory models of negative symptoms have integrated these cognitive impairments as potential precursors and previous studies revealed relationships between ER and/or ToM and VM, as well as with negative symptoms, but the organization of these associations remains unclear. We aimed to determine whether impairments in VM and social cognition sequentially pave the way for negative symptoms in schizophrenia. To this end, we used mediation analyses. One hundred and forty participants with a diagnosis of schizophrenia or schizoaffective disorder were recruited. First, correlational analyses were conducted between our variables of interest. The mediating effect of social cognition between VM and negative symptoms was then examined using the PROCESS macro. Variables of interest were significantly correlated (r = |0.166| to |0.391|), except for ER and negative symptoms. Only the serial multiple mediation model with 2 mediators (ER followed by ToM) revealed a significant indirect effect of VM on negative symptoms (β = - 0.160, 95% CI = -.370 to -.004). This relationship was selective for expressive negative symptoms (e.g., blunted affect and alogia). This study illustrates the richness of the relationship between cognitive deficits and negative symptoms and provides additional information for the involvement of social cognition in negative symptoms’ etiology.

A serial multiple mediator model of sense of coherence, coping strategies, depression, and quality of life among gynecologic cancer patients undergoing chemotherapy.

This study evaluated whether coping strategies (positive reframing, planning, and active coping) and depression mediate the relationship between sense of coherence (SOC) and quality of life (QoL) using a serial multiple mediator model in patients with gynecologic cancer who are undergoing chemotherapy. A sample of 148 participants, with a mean age of 52.17 years (range 20-75) and diagnosed with gynecological cancer (e.g., cervix, ovary and endometrium) was surveyed in a cross-sectional study. Data were collected using a structured self-reporting questionnaire. A serial multiple mediator model was analyzed to explain sequential causality among two mediators (coping strategy and depression) and to investigate the direct and indirect effects of the mediator model in SPSSWIN 26.0 and PROCESS macro program. The conceptual serial mediation model of SOC, positive reframing, depression, and QoL revealed a significant positive total effect (coefficient c=13.099, SE=1.647, p<0.001). The path through single mediation of positive reframing (Effect=0.925) and depression (Effect=5.942) and that through both mediators (Effect=1.161) were statistically significant. The total indirect effect was also statistically significant (Effect=8.028). Moreover, the conceptual serial mediation model on SOC, planning, depression, and QoL revealed a significant positive total effect (coefficient c=13.099, SE=1.647, p<0.001). The path through both mediation of planning and depression (Effect=1.162) and the total indirect effect were statistically significant (Effect=8.172). Helping patients with gynecologic cancer undergoing chemotherapy to strengthen SOC may improve QoL by equipping them with efficient positive reframing or planning strategies to reduce depression.

Explaining Effects of Transformational Leadership on Teachers’ Cooperative Professional Development through Structural Equation Model and Phantom Model Approach

This study aims to explore strategies for promoting Korean teachers’ cooperative professional development in the context of Education for Sustainable Development (ESD). To this end, this study aimed to provide empirical evidence that may help in explaining the mechanism through which transformative leadership affects cooperative professional development. Based on research purposes, the author constructed a serial multiple mediation model that incorporates self-efficacy and attitudes as an underlying mechanism that explains transformational leaders’ positive impact on cooperative professional development related to ESD. A total of 203 valid cases were used to test the hypothesized model. Furthermore, the author constructed structural equation modeling (SEM) and phantom models specifying the specific indirect effects of transformative leadership on cooperative professional development. In addition, bias-corrected bootstrapped point estimates for the specific indirect effects were calculated. The data were analyzed using SPSS Ver. 25.0 and AMOS Ver. 26.0. The findings strongly supported predictive links among transformational leadership, self-efficacy in ESD teachers’ attitudes toward ESD, and cooperative professional development. Therefore, findings provided greater insight into transformational leadership and ESD research and revealed mechanisms through which transformational leadership works in the ESD contexts. Finally, the major findings were discussed to encourage teachers to participate in cooperative professional development.

Physical Exercise and Psychological Distress: The Mediating Roles of Problematic Mobile Phone Use and Learning Burnout among Adolescents.

Psychological distress among adolescents adversely affects their development and negatively impacts them later in life. The aim of the present study was to determine whether an association exists between physical exercise and psychological distress and to explore the roles of problematic mobile phone use and learning burnout with respect to this association. A total of 2077 Chinese adolescents were evaluated by using the Physical Exercise Questionnaire, the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use, the Learning Burnout Questionnaire, and the Depression Anxiety Stress Scale-21. A serial multiple mediation model was constructed using the SPSS PROCESS macro. The results showed that physical exercise was negatively associated with psychological distress in this Chinese adolescent population. Serial multiple mediation analysis revealed that problematic mobile phone use and learning burnout both independently and serially mediated the association between physical exercise and psychological distress. These findings provide evidence suggesting that increased attention should be given to problematic mobile phone use and learning burnout when establishing and implementing specific strategies that leverage greater participation in physical exercise to decrease psychological distress in adolescents.

Explaining Job Satisfaction Among Residents in Standardized Residency Training Programs: A Serial Multiple Mediation Model.

BackgroundDespite a flood of research on job satisfaction, few studies have examined how and why social support influences job satisfaction. This study aimed to explore how social support has an indirect effect on job satisfaction by examining its impact on emotional exhaustion and anxiety symptoms among residents of the physicians standardized residency training program in China.MethodsThis cross-sectional study adopted questionnaires to collect data from residents in the standardized residency training program in China. The PROCESS macro for SPSS based on ordinary least-squares regression and the bootstrap method was used. The indirect effect of social support was examined using bootstrapping procedures. A serial multiple mediation model was examined in which social support was associated with job satisfaction via emotional exhaustion and anxiety symptoms.ResultsThere were 269 residents who provided usable data for the analysis. The mean age of residents was 25.98 years old. Close to half (52%) of the participants were female. The total indirect effect of social support on job satisfaction was significant (ab=0.21, SE=0.05, CI=0.12 to 0.32). The specific indirect effect 1 (social support→emotional exhaustion→job satisfaction) was significant (a1b1=0.12, SE=0.04, CI=0.05 to 0.19). The specific indirect effect 2 (social support→anxiety symptoms→job satisfaction) was significant (a2b2=0.07, SE=0.03, CI=0.02 to 0.13).The specific indirect effect 3 (social support→emotional exhaustion→anxiety symptoms→job satisfaction) was also found to be significant through both optimism and work engagement (a1a3b2=0.03, SE=0.01, CI=0.01 to 0.05).ConclusionIt seems critical for hospital management to develop a supportive work environment to improve the effects of emotional exhaustion and anxiety symptoms and to provide sufficient support to improve job satisfaction among residents in standardized residency training programs.

Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation.

The purpose of the study is to analyses the relationship between interoceptive sensibility and somatoform disorders among persons with Autism Spectrum Disorder (ASD). It has been assumed that the interoceptive sensibility is accompanied by a high level of alexithymia and emotion dysregulation in somatoform disorders. Persons under the care of the foundation helping people with ASD were asked to participate in the study. In total, 205 people took part in the research. The participants aged from 18 to 63 (M = 34.91; SD = 8.44). The ASD group comprised 79 persons (38.5% of subjects). The control group comprised 126 individuals (61.5% of subjects). Participants completed self-report questionnaires measuring autism (AQ), interoceptive sensibility (BPQ), alexithymia (TAS20), emotional dysregulation (DERS), and somatoform disorder (SDQ). The analyses showed a moderation effect of the group, which indicates the existence of a relationship between interoceptive sensibility and somatoform disorders to the greater extent in the clinical group than in the control group. In addition, the serial multiple mediation model analysis allowed to verify the mediating effect of emotion dysregulation and alexithymia on the abovementioned relationship. The indirect effect, which assumed the mediating role of alexithymia turned out to be significant, contrary to the indirect effect where emotion dysregulation was a mediator in a situation where both variables were applied simultaneously. Interoceptive sensibility correlated with level of alexithymia, in particular, difficulties in identifying and verbalizing emotions and emotion dysregulation in the lack of emotional awareness and lack of emotional clarity and is associated with somatoform disorders in the investigated group regardless of participants' belonging to the ASD or control group.

The Impact of Social Network Site Addiction on Depression in Chinese Medical Students: A Serial Multiple Mediator Model Involving Loneliness and Unmet Interpersonal Needs.

The use of social network sites (SNSs) is inevitable in daily life. Everyone is likely to be addicted to SNSs, especially medical students. This study is aimed to assess the degree of SNS addiction and its relation to psychosocial factors such as depression, loneliness and unmet interpersonal needs among Chinese medical students. The cross-section survey was conducted from March to May in 2018 in Shanghai Jiao Tong University School of Medicine. Of the total 1067 participants, 33.18% had an SNS addiction, 87.7% of the participants used SNSs every day during last month and 53.42% of the participants used SNSs for at least an hour per day during the last week. SNS addiction is positively related with depression both directly and indirectly. The mediating roles of loneliness and unmet interpersonal needs on the relationship between SNS addiction and depression are significant. For the well-being of medical students, efforts should be taken to prevent them from becoming addicted to SNSs.

Stress and quality of life of intensive care nurses during the COVID-19 pandemic: Self-efficacy and resilience as resources.

BackgroundHealth care workers employed in the COVID‐19 emergency are at a high risk of stress.Aims and objectivesTo explore the mediating roles of self‐efficacy and resilience between stress and both physical and mental quality‐of‐life components in intensive care nurses during the COVID‐19 pandemic.DesignCross‐sectional survey design.MethodsThe stress subscale (depression, anxiety, and stress scale in Spanish Scale, DASS‐21), the summary components (physical and mental) of health‐related quality of life (SF‐36), the general self‐efficacy scale (GSES), and the resilience scale (RS‐14) were administered in 308 intensive care nurses. Serial multiple mediator models were used.ResultsThere was a significant indirect effect of levels of perceived stress on both physical and mental health components through self‐efficacy and resilience. Specifically, greater perception of self‐efficacy was associated with a lower perception of stress and greater resilience, while higher resilience was associated with greater physical and mental health (B = −0.03; SE = 0.02; 95% confidence interval [CI] = [−0.07, −0.01]; B = −0.03, SE = 0.01, 95% CI = [−0.07, −0.01], respectively). It was observed that self‐efficacy alone also mediates the relationship of the perception of stress on the components of physical and mental health (B = −0.07; SE = 0.05; 95% CI = [−0.18, −0.03]; B = −0.09; SE = 0.04; 95% CI = [−0.17, −0.24], respectively). However, resilience alone was not a significant mediator of these associations.ConclusionsIt can be concluded that stress is linked to the physical and mental health components related to quality of life through self‐efficacy and resilience.Relevance to clinical practiceThese psychological resources would allow the nursing staff to maintain a good quality of life despite high levels of stress. These findings have implications for future research in terms of both model testing and clinical application.

Stress and career adaptability during COVID-19: A serial multiple mediation model

To understand how the COVID-19 pandemic has affected students about to enter the job market, we surveyed 754 university seniors to investigate the perceived stress–career adaptability relationship. We also assessed if positive psychological capital (PsyCap) and work volition mediated this relationship. The results show that the seniors' perceived stress during the COVID-19 pandemic negatively predicted career adaptability. Moreover, the sequential mediation effect (perceived stress reduces positive PsyCap and work volition, which predicts career adaptability) was supported. Thus, lower positive PsyCap can reduce work volition and adaptability. We are among the first researchers to explore how the COVID-19 pandemic has disadvantaged recent university graduates in the labor market, and we have provided new perspectives on how to improve their career adaptability.

Expatriates' dual commitment: a serial multiple mediation model of workplace friendships and adjustment

PurposeThe purpose of this article is to advance the understanding of expatriates' psychological attachment toward both their parent company and its foreign subsidiary by highlighting how workplace friendships enhance the process of adjustment for expatriates and how these effects on adjustment subsequently translate into expatriates' dual commitment.Design/methodology/approachHypotheses were tested using a sample of 187 expatriates, working in managerial positions, in subsidiaries of multinational corporations, all of whom were assigned expatriates. Serial multiple indirect effects were tested.FindingsThe results indicated that the relationship between workplace friendships and interaction adjustment was supported, but the relationship between workplace friendships and work adjustment was not supported. The serial indirect effects of international adjustment and work adjustment on the relationship between interaction adjustment and expatriates' dual commitment were supported.Originality/valueThis study seeks to fill a gap in the research literature on expatriates by focusing on the issue of workplace friendships and expatriates' dual commitment. The findings help bolster the literature on relational schemas in that expatriates' workplace friendships establish scripts for expatriates' expected outlines of adjustment in work domains. This study also provides insights relevant to the literature on social interaction and adjustment, as the findings support our theory that expatriate commitment is not directly contingent on workplace friendships but rather on the mediating roles of both interaction adjustment and work adjustment.

Association Between Physical Performance and Cognitive Function in Chinese Community-Dwelling Older Adults: Serial Mediation of Malnutrition and Depression.

PurposeWe aimed to propose a serial mediational model to further analyze the relationship between poor physical performance, malnutrition, depression and cognitive impairment in Chinese community-dwelling older adults.Patients and MethodsThis study consisted of 1386 community-dwelling Chinese older adults aged 65 years and older in Shanghai, China. Mild cognitive impairment (MCI) was assessed by the Mini-Mental State Examination (MMSE) and Instrumental Activities Of Daily Living (IADL). Physical performance was assessed by short physical performance battery (SPPB). Malnutrition was defined with the Mini Nutritional Assessment (MNA). Depressive symptoms were evaluated by the 30-item Geriatric Depression Scale (GDS). Serial multiple mediator models were used.ResultsThe mean age of the final analysis sample was 73.62±6.14, and 57.6% (n=809) were females. The prevalence of MCI was 14.35% (n=199). Physical performance (p<0.001), nutritional status (p=0.025), and depressive symptoms (p=0.002) were correlated with MCI. The serial mediational model revealed that MNA and GDS scores significantly mediated association of SPPB and MMSE scores (c’=0.4728, p<0.001). Furthermore, depressive symptoms significantly mediated the association of physical performance and cognition (p=0.0311), while malnutrition had no independent mediating effect between these two factors (p=0.794).ConclusionOur study examined the serial multiple mediation roles of nutritional status and depressive symptoms on the relationship between physical performance and cognitive function in community-dwelling Chinese older adults. Older adults who were in poor physical condition tend to have worse nutritional status, more severe depression, and poorer cognitive function.

Serial Multiple Mediation Model of Depression, Anxiety and Sleep Quality Between Perceived Stress and Life Satisfaction

Life satisfaction can both affect and be affected by occupational factors in military personnel. Perceived stress is considered an important predictor of life satisfaction. The objective of this study is to evaluate the direct and indirect effects of perceived stress on life satisfaction and the mediating role of depression, anxiety, and sleep quality among Iranian military personnel. In this cross-sectional study, a total of 301 military personnel were investigated by using standard self-report questionnaires, consisting of the Revised Symptom Checklist-90 (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), and Satisfaction with Life Scale (SWLS) in our study. Data analysis was conducted using descriptive statistics, the Pearson correlation coefficient, ordinary least square regression, and the bootstrap method. The direct effect of perceived stress on life satisfaction was significant. Perceived stress also affects life satisfaction indirectly through single mediation of sleep quality; serial multiple mediations of anxiety as the first and sleep quality as the second mediator; and the serial multiple mediations of depression, anxiety, and sleep quality, as the first to the third mediator, respectively. Lower levels of perceived stress, depression, and anxiety, along with better sleep quality, are correlated to higher levels of life satisfaction in military personnel. There are several points of prevention and intervention in order to increase the life satisfaction of military personnel, which can improve their quality of life and occupational efficiency.

The role of anxiety and depression in the relationship between physical activity and sleep quality: A serial multiple mediation model

BackgroundPhysical inactivity exacerbates poorer sleep quality, but potential underlying mechanisms of this association remain unknown. The present study aims to disentangle the pathways linking psychical activity to sleep quality through the serial mediation effect of anxiety and depression in a Chinese population. MethodsData analyzed were from Guangdong Sleep and Psychosomatic Health Survey, a cross-sectional population-based study with a representative sample of adult inhabitants aged 18-85 years living in Guangdong province, China. A total of 13,768 participants were included with the response rate of 80.4%. Singe and serial mediation analyses were conducted to examine whether anxiety and depression mediated the relationship between physical activity and sleep quality, independently and jointly. ResultsBoth direct and indirect effects of physical activity on sleep quality were found. As predicted, anxiety and depression mediated the relationship between physical activity and sleep quality (B Anxiety = -0.17, 95% bootstrap CI: -0.20 to -0.15; B Depression= -0.25, 95% bootstrap CI: -0.28 to -0.21), respectively. In addition, serial mediation analyses indicated that the association of physical activity and sleep quality is mediated by anxiety and depression in a sequential manner (B = -0.13, 95% bootstrap CI: -0.15 to -0.11). LimitationsThe primary limitation of the study is the cross-sectional design, which limits the causal inference ability. ConclusionsThese findings highlight the role of anxiety and depression as serial mediators of the relationship between physical activity and sleep quality. Thus, exercise-based programs focusing on improving sleep could benefit from a multi-faceted approach therapeutically targeting psychiatric disorders.

Impact of Body Mass Index on Eating Disorders in Adolescents with Type 1 Diabetes: Focusing on Mediating Effect of Body Dissatisfaction, Self-esteem, and Depression

Purpose: The purpose of this study was to verify the mediating effects of body dissatisfaction, selfesteem, and depression on the association between the body mass index (BMI) and eating disorders in adolescents with type 1 diabetes.Methods: Secondary data were analyzed in this study. The original analysis was conducted using data from 136 adolescents aged 13–18 years with type 1 diabetes. The results of testing for mediating effects were analyzed using a serial-multiple mediation model (model 6) using the PROCESS macro in SPSS ver. 3.3.Results: The direct effect of the BMI on eating disorders was not statistically significant (effect=0.22; 95 % confidence interval [CI], -0.20 to 0.64), but the indirect effects were statistically significant (effect=0.28; 95% CI, 0.05–0.63). In detail, the indirect effect of BMI on eating disorders mediated by body dissatisfaction was statistically significant (effect=0.28; 95% CI, 0.10–0.61); by body dissatisfaction and depression was statistically significant (effect=0.06; 95% CI, 0.01–0.15); and by body dissatisfaction, self-esteem, and depression was statistically significant (effect=0.05; 95% CI, 0.01–0.11).Conclusion: Individual interventions according to BMI are required to prevent the development of eating disorders in adolescents with type 1 diabetes. Adolescents with type 1 diabetes require intervention programs that may positively change their attitudes toward themselves, increasing self-esteem and lowering depression.