Somatic symptom burden and health-related quality of life in older adults with multimorbidity: A latent profile and mediation analysis

Background: Achieving the well-being of individuals with multimorbidity is a critical concern in global health. Self-efficacy and self-management ability are recognized as key factors in mitigating the impact of illness, yet how they influence the relationship betweensomatic symptomburden and health-related quality of life(HRQoL) remains to be elucidated. Moreover, previous research on self-management ability has often assumed it to be homogeneous, overlooking potential latent profiles. The present study aimed to characterize the association between somatic symptom burden and HRQoL and the mediating role of self-efficacy and self-management ability. Additionally, to explore the latent profiles of self-management ability. Methods: This multicenter cross-sectional study was conducted in seven communities and four hospitals across three cities in China, involving 1472 multimorbid older adults. Data were collected using self-reported questionnaires that assessed clinical and sociodemographic characteristics, somatic symptom burden, self-efficacy, self-management ability, and HRQoL. The mediating effects of self-efficacy and self-management were estimated using the bootstrap method in IBM SPSS 26.0. Latent Profile Analysis was employed via Mplus 8 to delineate latent subgroups among multimorbidity based on four dimensions from self-management ability. Results: The findings supported the hypothesized model based on Lazarus and Folkman’s stress and coping theory. Mediation analysis indicated that higher self-efficacy and self-management ability were associated with better HRQoL among participants with lower somatic symptom burden. Three latent profiles were identified: ‘poor self-management’, ‘intermediate self-management’, and ‘high self-management’. Conclusions: Our findings partially support the stress and coping theory. Boosting self-efficacy and self-management ability may improve HRQoL. Importantly, self-management ability exhibits clinical heterogeneity, necessitating targeted interventions tailored to the critical needs of different patient subgroups to effectively enhance HRQoL in the context of multimorbidity. Clinical trial number: Not applicable.