The mediating role of sleep quality on the relationship between perceived stress and depression among the elderly in urban communities: a cross-sectional study

Objective: This study aims to investigate the relationship between perceived stress, sleep quality, and depression among the elderly in urban communities, and further to determine whether sleep quality can serve as a mediator among the elderly in urban communities. Study design: A cross-sectional survey. Methods: Between May and July in 2015, we conducted a cross-sectional survey among 1050 community residents aged >= 60 years from Liaoning province, China. The Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Epidemiological Studies Depression Scale were used to estimate perceived stress, sleep quality, and depression, respectively. The data were analyzed with correlation, multiple linear regression, and structural equation modeling. Results: Of the 1050 participants surveyed, 1032 completed responses were ultimately acquired (98.3% effective response rate) and were included in the data analysis. Results revealed that the scores of perceived stress and sleep quality were positively correlated with Epidemiological Studies Depression Scale score. Sense of uncontrol, sense of nervous, sleep duration, and daytime dysfunction were identified as significant predictors of depression among the elderly. The effect of perceived stress on depression was partly mediated by sleep quality. Conclusions: Our study reveals that not all dimensions of sleep quality are relevant factors affecting depression in the elderly, and there maybe partial mediation effects of sleep quality, mainly through sleep duration and daytime dysfunction, within the impact of perceived stress on depression. This signifies that coping with perceived stress can be expected to ameliorate the severity of depression in the elderly by the intermediary role of sleep quality as well as the direct effect. However, longitudinal research is needed to confirm these findings and to investigate other mediators between perceived stress and depression among the elderly. (C) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.