Mediation Role of Health Service Use and Depression on Multimorbidity and Self-rated Health in Home-based Long-term Care Residents: a Cross-sectional Study

Abstract Background: Multimorbidity is common among older people and a major cause of reduced quality of life. The study aim was to investigate the relationship between multimorbidity and self-rated health and its mediators in home-based long-term care residents.Methods: Participants were 1067 home-based long-term care residents covered by long-term care insurance in Shanghai. Stratified sampling was used to select participants from six Shanghai districts. Data were collected using face-to-face interviews. Multimorbidity was defined as co-occurrence of ≥2 chronic diseases in the same person. The 30-item Geriatric Depression Scale was used to assess depressive symptoms. Structural equation modeling was used for data analysis.Results: The findings showed that 59.4% of participants had multimorbidity and 67.7% reported depressive symptoms. The mean self-rated health score was 1.97 (standard deviation [SD] = 0.861) and mean health service use frequency was 1.61 (SD = 3.406) per month. Compared with participants with no multimorbidity, those with multimorbidity were more likely to report low self-rated health (β = −0.141, p<0.001), more severe depressive symptoms (β = 0.100, p<0.001), and more health service use (β = 0.121, p<0.001). Low self-rated health may be caused by depression and health service use (β = −0.280, p<0.001). The effect of multimorbidity on self-rated health was significantly mediated by depression (β = −0.024, p<0.001) and health service use (β = −0.034, p<0.001).Conclusion: Multimorbidity is associated with self-rated health, and depression and health service use mediate this association. Prevention and proper management of multimorbidity and depression in long-term care residents may help to maintain and improve quality of life.