Abstract
BACKGROUND: Lumbar disc herniation (LDH) is a prevalent degenerative spinal disorder, often accompanied by impaired sleep quality and depressive symptoms, which considerably affect patients' quality of life and hinder the recovery process. OBJECTIVE: This study aimed to explore the chain mediating effects of illness acceptance and family intimacy on the relationship between sleep quality and depressive symptoms in patients with LDH. The objective was to elucidate the psychosocial mechanisms influencing the psychological well-being of these patients. METHODS: A total of 110 patients diagnosed with LDH between January 2022 and January 2024 were enrolled in this cross-sectional study. Participants completed validated questionnaires assessing sleep quality, illness acceptance, family intimacy and depressive symptoms, including the Pittsburgh Sleep Quality Index (PSQI), Acceptance of Illness Scale (AIS), Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Self-Rating Depression Scale (SDS). Associations among the measured variables were assessed through Pearson correlation analysis. Mediation effects were analysed using the PROCESS v4.2 macro in SPSS, and the significance of the mediating effects was assessed via bootstrapping. RESULTS: A significant positive correlation was observed between the degree of sleep disturbance and depressive symptoms (r = 0.417, p < 0.01). Illness acceptance and family intimacy served as key mediators in the relationship between sleep quality and depressive symptoms. Specifically, poor sleep quality was associated with increased depressive symptoms through its negative effects on family intimacy (β = -0.211, p = 0.027) and illness acceptance (β = -0.266, p = 0.003). Mediation analysis indicated that the total indirect effect accounted for 35.10% of the total effect. The chain-mediated pathway, sleep quality → family intimacy → illness acceptance → depressive symptoms, had an effect size of 0.062 (Boot SE = 0.010, 95% CI: 0.005 to 0.043), indicating that this pathway was also valid. CONCLUSION: Sleep quality is significantly associated with depressive symptoms in patients with LDH. Illness acceptance and family intimacy function as key mediators in this relationship. These findings underscore the importance of psychosocial factors in the mental health of patients with LDH and provide a theoretical foundation for developing targeted psychological interventions.