The relationship between activities of daily living and suicidal ideation among Chinese rural older adults: a multiple mediation model through sleep quality and psychological distress

Abstract

Few studies clarified the mechanisms underlying the relationship between activities of daily living and suicidal ideation among older adults. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship. A total of 3,243 rural older adults were included. Multiple mediation analysis was performed using Mplus 8.3. Activities of daily living was found to directly affect suicidal ideation (β=0.092, 95% CI=0.043-0.140) and through three significantly mediation pathways: (1) the path through sleep quality (β=0.019, 95% CI=0.007-0.031), which accounted for 9.79 % of the total effect; (2) the path through psychological distress (β=0.049, 95% CI=0.036-0.063), which accounted for 25.26 % of the total effect; (3) the path through sleep quality and psychological distress (β=0.034, 95% CI=0.026-0.042), which accounted for 17.53 % of the total effect. The total mediating effect was 52.58%. Attention should be paid to sleep quality and mental health among the Chinese rural older adults with activities of daily living limitation. For early detection and prevention of suicidal ideation, it is necessary to take sleep-based and positive psychological interventions for older adults with activities of daily living limitation.

Keywords: multiple mediation; physical functioning; psychological well-being; sleep disturbances; suicidality.

Figure 1

Hypothesized model.

Figure 2

A multiple mediation model of the association between ADL and suicidal ideation through sleep quality and psychological distress. Standard error in the parentheses and path coefficients are shown. Note, Posterior Predictive P-value = 0.495, *P-value<0.001.