Abstract
BACKGROUND: Previous research has found a link between sleep quality and psychological distress. However, the underlying mechanisms of this connection have still not been well explored. The aim of this study was to examine the roles of activities of daily living (ADL), physical activity, and perceived social support in the link between sleep quality and psychological distress among older adults. METHODS: Three thousand two hundred fifty valid individuals (aged 60 years or above) participated in face-to-face questionnaire-based surveys. Older individuals were assessed using the Pittsburgh Sleep Quality Index, Barthel Index, International Physical Activity Questionnaire, Perceived Social Support Scale, and Depression Anxiety Stress Scale-21. The PROCESS macro developed by Hayes was used to conduct moderated mediation analysis. RESULTS: In older adults, sleep quality had a substantial direct influence on psychological distress. ADL mediated the association between sleep quality and psychological distress. Physical activity significantly reduced ADL's mediating influence on the relationship between sleep quality and psychological distress. Furthermore, perceived social support moderated the direct relationship between sleep quality and psychological distress, as well as the second half of the mediating effect of the ADL. Moreover, physical activity and perceived social support were preventive factors that might successfully mitigate the detrimental effects of poor sleep quality on ADL and psychological distress. CONCLUSIONS: The findings contribute to existing understanding by clarifying the fundamental mechanisms that link sleep quality and psychological distress. These results may provide a valuable reference to the Chinese government for improving mental health in older individuals.