Department of Preventive Medicine and Health Education, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China; Health Communication Institute, Fudan University, Shanghai 200032, China.
Songjiang Center of Disease Prevention and Control, Shanghai 201620, China.
J Affect Disord. 2024 Dec 1;366:36-43. doi: 10.1016/j.jad.2024.08.116. Epub 2024 Aug 24.
The relationship between age-friendliness of community (AFC), mental health and sleep quality is still unclear.
Using a sample of Chinese older adults aged ≥60 years (N = 3099), this cross-sectional study aimed to investigate the serial mediating roles of resilience and depressive symptoms between AFC and sleep quality through structural equation modeling. Additionally, this study examined the association between each AFC dimension and sleep quality stratified by mental health, using the multivariable linear regression models. Mental health was categorized based on levels of resilience and depressive symptoms. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The AFC dimensions included housing, transportation, built environment, social participation, as well as social inclusion and health services.
Resilience and depressive symptoms completely mediated the relationship between AFC and sleep quality through three paths: (1) the independent mediating role of resilience or (2) depressive symptoms, and (3) the serial mediating roles of resilience and depressive symptoms. Furthermore, higher AFC and higher age-friendliness in transportation dimension as well as social inclusion and health services dimension were associated with better sleep quality among older adults with high levels of mental health.
Resilience and depressive symptoms played serial mediating roles in the relationship between AFC and sleep quality. For older adults with low or medium levels of mental health, a community-based approach may not be recommended.
This cross-sectional study used self-reported sleep measures and could not make cause inferences.
社区的年龄友好程度（AFC）、心理健康和睡眠质量之间的关系尚不清楚。
本横断面研究使用了年龄≥60 岁的中国老年人样本（N=3099），通过结构方程模型探讨了韧性和抑郁症状在 AFC 与睡眠质量之间的序列中介作用。此外，本研究还使用多变量线性回归模型，根据韧性和抑郁症状水平，检验了每个 AFC 维度与睡眠质量之间的关联。心理健康根据韧性和抑郁症状水平进行分类。睡眠质量采用匹兹堡睡眠质量指数（PSQI）进行评估。AFC 维度包括住房、交通、建筑环境、社会参与以及社会包容和卫生服务。
韧性和抑郁症状通过三条路径完全中介了 AFC 与睡眠质量之间的关系：（1）韧性或（2）抑郁症状的独立中介作用，以及（3）韧性和抑郁症状的序列中介作用。此外，在心理健康水平较高的老年人中，较高的 AFC 和交通维度以及社会包容和卫生服务维度的年龄友好程度与较好的睡眠质量相关。
韧性和抑郁症状在 AFC 与睡眠质量之间的关系中发挥了序列中介作用。对于心理健康水平较低或中等的老年人，不建议采用基于社区的方法。
本横断面研究使用了自我报告的睡眠测量方法，不能进行因果推断。
