Abstract
BACKGROUND: Late-life depression (LLD) is a significant global public health concern, with particularly high prevalence rates among individuals in nursing homes. The severity of LLD is a critical factor influencing the occurrence of neuropsychiatric symptoms (NPS) in patients. To our knowledge, no studies have investigated the mediating effects of sleep quality and resilience on the relationship between depression severity and NPS in nursing home residents with LLD. Accordingly, this study aims to assess the prevalence of NPS among this population and examine the relationship between depression severity and NPS, focusing on the mediating roles of sleep quality and resilience. METHODS: Using cross-sectional data from the baseline phase of a multicenter longitudinal study, we enrolled 414 patients with LLD from 42 nursing homes in Fujian Province, China. Standardized assessments included the 15-item Geriatric Depression Scale (GDS-15), the Mild Behavioral Impairment Checklist (MBI-C), the Pittsburgh Sleep Quality Index (PSQI), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Mediation and moderated mediation analysis were conducted with the PROCESS macro to examine the interactive relationships among depression severity, sleep quality, resilience, and NPS. RESULTS: The prevalence of NPS among patients with LLD was 33.33%. Depression severity showed a significant positive correlation with NPS (β = 0.362, p < 0.001). Mediation analysis indicated that sleep quality partially mediated this relationship (β = 0.265, p < 0.001). Importantly, resilience significantly moderated both the direct pathway between depression severity and NPS (β = -0.102, p = 0.005) and the indirect pathway through sleep quality (β = -0.096, p = 0.016). Specifically, the effects of greater depression severity and poorer sleep quality on NPS were weaker among patients with higher resilience levels. CONCLUSION: Our findings indicate that both sleep quality and resilience significantly influence the relationship between depression severity and NPS. These results underscore the importance of improving sleep quality and strengthening resilience as potential strategies to reduce the incidence of NPS in patients with LLD. Future intervention studies should specifically focus on enhancing sleep quality and resilience in this vulnerable population.