The impact of chronic diseases on depressive symptoms among the older adults: The role of sleep quality and empty nest status

Background: Depression is the most prevalent mental disorder among older adults. This study aimed to explore the mediating effect of sleep quality on the relationship between chronic diseases and depressive symptoms, and the moderating role of empty nest status in the mediating model. Methods: A cross-sectional survey was conducted among 3637 older adults from Taiyuan, China, using a multi-stage random cluster sampling method. The data was collected with the general questionnaire for the elderly, with the Short Form Geriatric Depression Scale (GDS-15), and the Pittsburgh Sleep Quality Index (PSQI). The Bootstrap program and simple slope method were used to test the mediating effect of sleep quality and the moderating effect of empty nest status. Results: The overall prevalence of depressive symptoms in the population was 33.4%. The mediating effect analysis showed that chronic diseases had a significant direct impact on depressive symptoms in the elderly (beta = 0.431, P < 0.001). Sleep quality as a mediation effect of 43.4% between chronic diseases and depressive symptoms was proven. The further moderating effect found that chronic diseases had a more significant impact on the sleep quality of the elderly who are in the empty nest status than those who are not (beta =-0.431, P < 0.05 ). Limitations: Given the cross-sectional study, the results cannot explain the causal relationships among the study variables. Conclusions: Chronic diseases had a major impact on the depressive symptoms of the elderly. Sleep quality mediated the relationship between chronic diseases and depressive symptoms, and the empty nest status moderated the first half of the path in the mediation model. Therefore, to reduce the incidence of the depressive symptoms of the elderly, sleep quality and empty nest status should be the primary concern.