Sleep Quality and Depressive Symptoms Mediate the Relationship Between Pain and Everyday Function: A Cross-Sectional Study of Adults Living With HIV in Birmingham, Alabama.

Pain in people living with HIV (PWH) is associated with greater psychological distress, poor sleep quality, and functional limitations. Yet the interconnections among these relationships remain understudied. Our study examined whether (a) sleep quality mediates the relationship between pain and depressive symptoms, (b) depressive symptoms mediates the relationship between pain and functional limitations, and (c) pain is associated with functional limitations through a serial pathway. A cross-sectional secondary analysis of 261 PWH was conducted. Pain was assessed using the pain subscale from the Medical Outcomes Study HIV Health Survey; lower scores indicated worse pain. Participants also completed the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression scale, and the Lawton and Brody Instrumental Activity of Daily Living (IADL) scale. Mediation analysis was performed using age, race, and education as covariates. Sleep quality partially mediated the relationship between pain and depressive symptoms, accounting for approximately 42% of the total effect. Depressive symptoms partially mediated the association between pain and IADL impairments (22%), whereas the serial pathway through sleep and depressive symptoms explained 8.4% of pain's total effect on IADL impairments. Improving sleep quality and depressive symptoms may reduce the negative impacts of pain on everyday functioning.