War-related and minority-related stressors and posttraumatic stress symptoms among Palestinian Arab grandmothers in Israel: a resource-based mediation model.

In recent decades, the prevalence of multimorbidity, defined as the co-occurrence of two or more chronic medical conditions in an individual, has increased due to population aging and increased life expectancy globally (). Multi-country studies have reported that the self-reported prevalence of multimorbidity increased from 12.7% in 2001 to 16.2% in 2011 (). Moreover, driven by extended life expectancy and often limited public health resources, developing countries are experiencing a rapid rise in multimorbidity rates (, ). Indicatively, when a study about the China Health and Retirement Longitudinal Survey (CHARLS) database was conducted on 10,479 adults aged 60 years and above, multimorbidity prevalence among the Chinese elderly individuals was found to be 65.6% (). The emotional distress is common in older adults having numerous morbidities, which are mostly of a negative nature, including anxiety and depression (, ). According to a meta-analysis, the prevalence of depressive symptoms in older adults with multimorbidity was 32.4% worldwide, and the prevalence of anxiety symptoms was 27.8% (). Notably, the prevalence of depressive symptoms among older Chinese adults with multimorbidity was 35.6%, which is higher than the global average (). Such negative emotions not only reduce treatment adherence but also accelerate physical functional decline, severely harming the physical and psychological well-being of individuals with multimorbidity (, ). Illness perception is defined as the way an individual perceives a threat to health through cognitive and emotional processing based on personal beliefs and experiences (). According to Leventhal’s Common-Sense Model (CSM) of self-regulation (), when individuals develop negative perceptions of their illness—such as believing it has severe consequences, is uncontrollable, or will last a long time—they often experience strong negative emotional responses, including anxiety and depression. This interplay between cognition and emotion directly shapes coping behaviors and psychological adaptation. Conceptually, therefore, negative illness perception serves as an important antecedent of emotional distress, directly triggering or exacerbating negative emotions such as anxiety and depression. According to the CSM, different individuals may form heterogeneous patterns of illness perception based on their unique illness experiences and beliefs, leading to distinct emotional responses and coping strategies (, ). Nonetheless, most research has been conducted on individual chronic disorders, and the relationship between illness perception and emotional distress among patients with multimorbidity has not been well studied (–). Therefore, identifying heterogeneous subgroups of illness perception among older adults with multimorbidity holds important theoretical value for understanding the mechanisms underlying emotional distress in different patient populations.