Depressive symptoms mediate pain and quality of life in older adults during post-acute recovery from traumatic injuries.

BACKGROUND: Persistent pain and emotional distress often challenge recovery among injured older adults, reducing health-related quality of life (HRQoL). Pain is a known determinant of poor HRQoL, and depressive symptoms may further exacerbate this burden. Limited research has examined whether depressive symptoms mediate the pain-HRQoL relationship during this period. OBJECTIVE: To examine whether depressive symptoms mediate the relationship between pain intensity and HRQoL in older adults recovering from traumatic injury. METHODS: A cross-sectional study of 80 older adults (aged 60-74) hospitalised for traumatic injury at a medical centre in southern Taiwan measured pain intensity, depressive symptoms, and HRQoL 14 days after discharge. Mediation analysis used the PROCESS macro (Model 4) with 10,000 bootstrap resamples, controlling for injury severity. RESULTS: Pain intensity was significantly associated with depressive symptoms (B = 1.83, 95% CI [1.29, 2.38]) and had a significant total effect on HRQoL (B = -5.86, 95% CI [-7.23, -4.50]). Depressive symptoms were also associated with HRQoL (B = -1.29, 95% CI [-1.78, -0.79]). Pain retained a significant direct effect on HRQoL after accounting for depressive symptoms (B = -3.50, 95% CI [-4.99, -2.02]); the indirect effect through depressive symptoms was also significant (B = -2.36, 95% BCI [-3.45, -1.40]), accounting for approximately 40% of the total effect. CONCLUSION: Pain directly affects HRQoL, partly through depressive symptoms. Care strategies for injured older adults should address psychological alongside physical recovery. Given the cross-sectional design, findings reflect a statistical association rather than confirmed causal mediation; longitudinal studies are needed to verify temporal sequence.