Resilience and Quality of Life in Mild Traumatic Brain Injury: Serial Mediating Role of Sleep Quality and Depression

OBJECTIVE: To investigate the influence of resilience on quality of life (QoL) in patients with mild traumatic brain injury (mTBI), and to evaluate the mediating roles of sleep quality and depression in the relationship. Setting: Emergency and neurosurgical outpatient departments in regional medical center in northern Taiwan. PARTICIPANTS: A total of 310 adults patients diagnosed with mTBI were recruited between 3 and 12 months postinjury. DESIGN: A cross-sectional observational study using self-report measures and serial-mediation analysis. MAIN MEASURES: Participants completed the Resilience Scale for Adults, Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, and the WHO Quality of Life-BREF. Data were analyzed using PROCESS Model 6 with 5000 bootstrap resamples. RESULTS: Resilience was associated with improved QoL, both directly and indirectly through sleep quality and depression. In particular, resilience predicted higher sleep quality and fewer depressive symptoms. Poor sleep quality was associated with greater depressive symptoms, which in turn predicted lower QoL. All direct and indirect pathways in the serial mediation model were significant (P < 0.001), and the model explained 54% of the variance in QoL. CONCLUSION: Our findings suggest that resilience influences QoL through sleep quality and depression. Enhancing resilience and sleep quality may reduce depressive symptoms and improve overall well-being in patients recovering from mTBI.