ArticleFrontiers in public health2026
Depressive symptoms and cognitive impairment among rural Chinese older women: anxiety and poor sleep as sequential correlates-A cross-sectional analysis.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Depressive symptoms are a well-established predictor of late-life cognitive impairment. Furthermore, anxiety and sleep quality-both correlates of cognitive impairment-could mediate the depression-cognition association in older women. Nevertheless, limited research has empirically tested this hypothesis using causal mediation analysis. Methods: This cross-sectional study recruited 718 older women from rural areas of Sichuan, Chongqing, and Guizhou provinces in China using convenience sampling. Trained assessors administered the Patient Health Questionnaire-9, the Chinese Version of the Montreal Cognitive Assessment, the Generalized Anxiety Disorder-7 Scale, and the Pittsburgh Sleep Quality Index to assess depressive symptom severity, cognitive performance, anxiety levels, and sleep quality, respectively. Statistical analyses were performed using SPSS 29.0, with chi-square testing, Spearman rank correlation, and bootstrapped mediation analysis (5,000 resamples, bias-corrected) executed through the PROCESS macro (version 4.1). Results: Both direct and indirect effects of depressive symptoms on cognitive impairment were found in older women in rural areas ( Conclusion: This study identified a modifiable pathway in older rural Chinese women: anxiety and sleep quality sequentially mediated the link between depressive symptoms and cognitive impairment, with anxiety showing an association with sleep disturbances that correlated with greater impairment. Multicomponent strategies addressing this symptom triad suggest intervention targets to mitigate the risk of decline in this underserved population.
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