Associations of social isolation with sleep duration and sleep quality in the elderly: Mediating influence of depression

doi:10.5498/wjp.v15.i4.102447

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Apr 19, 2025 (publication date) through Mar 25, 2025

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Psychiatry. Apr 19, 2025; 15(4): 102447
Published online Apr 19, 2025. doi: 10.5498/wjp.v15.i4.102447

Table 1 Baseline characteristic, n (%)

	Men (n = 3486)	Women (n = 4276)	All (n = 7762)	χ²/t	P value
Age	71.4 ± 6.9	70.9 ± 6.7	71.1 ± 6.8	3.80	< 0.001
Urban and rural
Rural	2295 (65.8)	2708 (63.3)	5003 (64.5)	5.26	0.022
Urban	1191 (34.2)	1568 (36.7)	2759 (35.5)
Education
< 6 years	2414 (69.2)	3495 (81.7)	5909 (76.1)	154.76	< 0.001
≥ 6 years	1072 (30.8)	781 (18.3)	1853 (23.9)
Marital status
Married	3166 (90.8)	3425 (80.1)	6591 (84.9)	172.35	< 0.001
Widowed/divorced/never married	320 (9.2)	851 (19.9)	1171 (15.1)
Pension income				162.61	< 0.001
< 2000 CNY/month	2221 (63.7)	2926 (68.4)	5147 (66.3)
2000-5000 CNY/month	947 (27.2)	1243 (29.1)	2190 (28.2)
> 5000 CNY/month	318 (9.1)	107 (2.5)	425 (5.5)
Sedentary				0.58	0.747
< 3 hours/day	1406 (40.3)	1758 (41.1)	3164 (40.8)
3-5 hours/day	1367 (39.2)	1666 (39.0)	3033 (39.1)
> 5 hours/day	713 (20.5)	852 (19.9)	1565 (20.2)
Physical activity				23.04	< 0.001
< 3 times/week	2083 (59.8)	2323 (54.3)	4406 (56.8)
≥ 3 times/week	1403 (40.2)	1953 (45.7)	3356 (43.2)
Smoking history	1736 (49.8)	174 (4.1)	1910 (24.6)	2164.73	< 0.001
Drinking history	1858 (53.3)	382 (8.9)	2240 (28.9)	1841.12	< 0.001
Chronic disease history	2328 (66.8)	3000 (70.2)	5328 (68.6)	10.18	0.001
Regular diet	3439 (98.7)	4201 (98.2)	7640 (98.4)	2.04	0.153
Self-rated health				9.90	0.007
Good	1535 (44.0)	1745 (40.8)	3280 (42.3)
Intermediate	1731 (49.7)	2213 (51.8)	3944 (50.8)
Poor	220 (6.3)	318 (7.4)	538 (6.9)
Depression (yes)	600 (17.2)	778 (18.2)	1378 (17.8)	1.27	0.260
Anxiety (yes)	393 (11.3)	513 (12.0)	906 (11.7)	0.98	0.323
Social isolation (yes)	309 (8.9)	608 (14.2)	917 (11.8)	52.86	< 0.001
Sleep duration (abnormal)	1099 (31.5)	1557 (36.4)	2656 (34.2)	20.37	< 0.001
Sleep quality (poor)	404 (11.6)	711 (16.6)	1115 (14.4)	39.63	< 0.001

CNY: China yuan.

Table 2 The association of social isolation with sleep duration and sleep quality

	Sleep duration		Sleep quality
	OR (95%CI)	P value	OR (95%CI)	P value
Model 1¹	1.56 (1.35-1.80)	< 0.001	1.45 (1.21-1.74)	< 0.001
Model 2²	1.54 (1.33-1.78)	< 0.001	1.40 (1.16-1.69)	< 0.001
Model 3³	1.49 (1.29-1.73)	< 0.001	1.32 (1.09-1.59)	< 0.001

¹Model 1 including age and sex.

²Model 2 adjusted based on model 1 for residence, education, pension income, sedentary time, physical exercise, regular diet, and self-rated health.

³Model 3 adjusted based on model 2 for depression and anxiety.

OR: Odds ratio.

Table 3 The association of social isolation with sleep duration and sleep quality in different age and sex

	Sleep duration		Sleep quality
	OR¹ (95%CI)	P value	OR¹ (95%CI)	P value
Sex
Male	1.36 (1.06-1.74)	0.014	1.25 (0.88-1.76)	0.217
Female	1.54 (1.28-1.85)	< 0.001	1.33 (1.06-1.68)	0.015
Age (years)
< 80	1.56 (1.32-1.84)	< 0.001	1.42 (1.15-1.76)	0.001
≥ 80	1.31 (0.95 -1.81)	0.104	1.23 (0.81-1.87)	0.330

¹Multivariate adjusting variables as model 3 in Table 2.

OR: Odds ratio.

Table 4 The mediating effects of depression and anxiety on social isolation, sleep behaviors

	Total effect, OR¹ (95%CI)	Direct effect, OR (95%CI)	Indirect effect, OR (95%CI)	Mediated (%)
Sleep duration
Depression	1.53 (1.32-1.77)	1.49 (1.29-1.73)	1.02 (1.01-1.04)	5.68
Anxiety	1.49 (1.29-1.73)	1.49 (1.29-1.73)	1.00 (0.99-1.00)	-
Sleep quality
Depression	1.36 (1.12-1.64)	1.32 (1.09-1.59)	1.03 (1.01-1.05)	9.87
Anxiety	1.32 (1.09-1.59)	1.32 (1.09-1.59)	1.00 (1.00-1.00)	-

¹Multivariate adjusting variables as model 3 in Table 2.

-: Anxiety was not taken into KHB analysis as the mediation effects were not significant.

Table 5 The mediating effects of depression on social isolation, sleep behaviors in different age and sex

		Total effect, OR¹ (95%CI)	Direct effect, OR (95%CI)	Indirect effect, OR (95%CI)	Mediated (%)
Sleep duration
Sex	Male	1.37 (1.07-1.76)	1.36 (1.06-1.74)	1.01 (1.00-1.03)	3.39
Sex	Female	1.59 (1.32-1.91)	1.53 (1.27-1.85)	1.03 (1.01-1.06)	7.30
Age (years)	< 80	1.59 (1.35-1.88)	1.56 (1.32-1.84)	1.02 (1.01-1.04)	4.58
Age (years)	≥ 80	1.37 (0.99-1.90)	1.30 (0.95-1.81)	1.05 (0.99-1.12)	-
Sleep quality
Sex	Male	1.27 (0.89-1.79)	1.24 (0.87-1.76)	1.02 (0.99-1.04)	-
Sex	Female	1.38 (1.10-1.74)	1.33 (1.06-1.68)	1.04 (1.01-1.06)	11.39
Age (years)	< 80	1.46 (1.18-1.81)	1.41 (1.15-1.76)	1.03 (1.01-1.05)	7.93
Age (years)	≥ 80	1.27 (0.94-1.93)	1.23 (0.81-1.87)	1.03 (0.99-1.08)	-

¹Multivariate adjusting variables as model 3 in Table 2.

Citation: Yang HY, Li L, Yu LJ, Bian GL. Associations of social isolation with sleep duration and sleep quality in the elderly: Mediating influence of depression. World J Psychiatry 2025; 15(4): 102447
URL: https://www.wjgnet.com/2220-3206/full/v15/i4/102447.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i4.102447