Shoulder pain, shoulder disability, and depression as serial mediators between stress and health-related quality of life among middle-aged women

Background: This study analyzed the mediating effects of shoulder pain, disability, and depression on the relationship between stress and health-related quality of life among middle-aged women using a serial mediation model. Methods. Data on stress, health-related quality of life, shoulder pain, shoulder disability, and depression were collected from 565 women aged 35–64 years living in Seoul, South Korea, from May 13 to 23, 2021, using a self-reported, structured survey. SPSS PROCESS macro (Model 6) and serial mediation analysis were used to analyze the relationship between stress and health-related quality of life among participants, with shoulder pain, shoulder disability, and depression as mediators. Results. The results indicate that stress had a statistically direct impact on health-related quality of life. In the serial mediation analysis, shoulder pain, disability, and depression were found to be statistically significant, thus affecting the relationship between stress and health-related quality of life, with an explanatory power of 33%. Therefore, the relationship between stress and health-related quality of life was partially mediated by these variables. Conclusions. Thus, this study suggests the need for healthcare workers to develop methods, such as exercise intervention programs based on various degrees and types of physical activity, to improve health-related quality of life and reduce stress caused by shoulder pain, shoulder disability, and depression among middle-aged women.