The mediating role of perceived stress between loneliness and medication behavior in Chinese children: a large cross-sectional study

Background Loneliness, as a critical psychosocial factor influencing medication adherence in pediatric populations, warrants particular attention in the long-term management of chronic diseases. Based on data from the “Medication Literacy Investigation of Chinese Children” conducted across children's hospitals in 18 provinces and municipalities in China from October 2023 to May 2024, this study explores the relationship between loneliness and medication management and examines the mediating role of perceived stress in this association. Methods A total of 4,404 children and adolescents aged 8–18 years (2,337 girls and 2,067 boys) were included. Data on loneliness, perceived stress, and medication adherence were collected through questionnaires. A mediation effect model was used to analyze the relationships among the variables. Results Higher levels of loneliness were significantly associated with lower medication adherence (β = −0.670, P < 0.001). Perceived stress partially mediated this relationship, with an indirect effect of β = −0.280 (95% CI: −0.331 to −0.229), accounting for approximately 41.8% of the total effect. This suggests that in pediatric chronic disease management, loneliness not only directly affects medication behavior but also further reduces adherence by exacerbating perceived stress. Conclusion As the first study to verify the partial mediating effect of perceived stress in a Chinese pediatric population, it highlights the necessity of addressing both loneliness and stress regulation in interventions aimed at improving medication adherence—particularly in the long-term management of children with chronic conditions—through integrated and multidimensional psychosocial approaches to enhance health management outcomes.