The Effect of Sleep Quality on Perceived Stress in Patients With Chronic Pain: The Mediating Role of Rumination

Sina Amraeipour; Maryam Rostamnezhad

Authors

Sina Amraeipour Department of Health Psychology, To.C., Islamic Azad University, Tonekabon, Iran Author https://orcid.org/0009-0008-7369-7052
Maryam Rostamnezhad Department of Psychology, To.C., Islamic Azad University, Tonekabon, Iran https://orcid.org/0000-0002-7681-9579

Keywords:

sleep quality, perceived stress, rumination, chronic pain

Abstract

This study aimed to investigate the effect of sleep quality on perceived stress in patients with chronic pain and to determine the mediating role of rumination in this relationship. This applied study employed a descriptive-correlational design using structural equation modeling. The statistical population consisted of individuals diagnosed with chronic pain who attended pain treatment clinics and physiotherapy centers in western Tehran between June and August 2026. A total of 150 eligible patients were selected through purposive sampling. Data were collected using the Pittsburgh Sleep Quality Index, the Cohen Perceived Stress Scale, and the Nolen-Hoeksema Ruminative Responses Scale. Data analysis was conducted using SPSS version 27 and SmartPLS version 3. Pearson correlation analysis was used to examine bivariate relationships among the study variables, and partial least squares structural equation modeling was applied to test the direct and indirect effects within the proposed conceptual model. Sleep quality had a significant positive direct effect on perceived stress (β = .379, t = 4.580, p < .01) and rumination (β = .647, t = 12.673, p < .01). Rumination also had a significant positive effect on perceived stress (β = .428, t = 6.568, p < .01). The indirect effect of sleep quality on perceived stress through rumination was statistically significant (β = .277, t = 5.382, p < .01), with a variance accounted for value of 42.2%, indicating partial mediation. The model explained 53.7% of the variance in perceived stress (R² = .537), and the predictive relevance index was satisfactory (Q² = .329). The overall goodness-of-fit index was .533, indicating an acceptable structural model. Poorer sleep quality is associated with higher perceived stress among patients with chronic pain, both directly and indirectly through increased rumination. Rumination therefore appears to be an important cognitive mechanism linking sleep disturbance to psychological stress in this population and may represent a relevant target for psychological interventions designed to reduce stress and improve adjustment to chronic pain.

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