Poor sleep quality was associated with poorer cognitive function in older adults, self-efficacy mediated this association, and depressive symptoms moderated the indirect pathway such that the association was stronger at higher levels of depressive symptoms.
Key Findings
Results
Self-efficacy showed a significant indirect effect in the association between sleep quality and cognitive function.
The indirect effect size was B = -0.034 (95% CI: -0.048 to -0.022)
This mediation effect was observed after adjusting for age, gender, marital status, education level, residence, smoking and drinking status, living alone, exercise, hypertension, diabetes, and coronary heart disease
The analysis was performed using the PROCESS macro for mediation analysis
The negative coefficient indicates that poorer sleep quality was associated with lower self-efficacy, which in turn was associated with lower cognitive function
Results
Depressive symptoms significantly moderated the association between self-efficacy and cognitive function.
The moderation effect was statistically significant (B = 0.009, p < 0.01)
The magnitude of the indirect association between sleep quality and cognitive function through self-efficacy was stronger at higher levels of depressive symptoms
This constitutes a moderated mediation model in which depressive symptoms moderate the self-efficacy-to-cognitive-function pathway
Results
Significant correlations were observed among all four key variables: sleep quality, self-efficacy, depressive symptoms, and cognitive function.
Older adults with poorer sleep quality tended to have lower cognitive function
Poorer sleep was also linked to lower self-efficacy
Lower self-efficacy was linked to poorer cognitive function
The study sample consisted of 2,030 older adults in Ningxia, China
Sleep quality, cognitive function, self-efficacy, and depressive symptoms were all assessed using validated instruments
Methods
The study employed a cross-sectional design with moderated mediation analyses in a sample of Chinese older adults.
2,030 older adults were surveyed in Ningxia, China
Multiple covariates were controlled: age, gender, marital status, education level, residence, smoking and drinking status, living alone, exercise, hypertension, diabetes, and coronary heart disease
Mediation and moderated mediation analyses were performed using the PROCESS macro
The cross-sectional design precludes conclusions about cause and effect
Results
The indirect association between sleep quality and cognitive function through self-efficacy was stronger among older adults with higher levels of depressive symptoms.
This finding indicates that depressive symptoms amplify the pathway from poor sleep to reduced self-efficacy to reduced cognitive function
Depressive symptoms functioned as a moderator of the mediated pathway rather than just a mediator or confounder
The authors suggest that sleep quality, self-efficacy, and depressive symptoms may all be relevant to cognitive health among older adults
What This Means
This research suggests that among older adults in China, poor sleep is linked to worse thinking and memory abilities, and that this relationship may be partly explained by a person's confidence in managing daily tasks (called self-efficacy). Specifically, older adults who slept poorly tended to have lower self-confidence in handling daily challenges, and those with lower self-confidence tended to perform worse on cognitive tests. The study involved 2,030 older adults in Ningxia, China, and accounted for many other health and lifestyle factors.
The research also suggests that depressive symptoms play an important amplifying role: the link between low self-efficacy and worse cognitive function was even stronger among people who had higher levels of depressive symptoms. In other words, feeling depressed may compound the negative effects that poor sleep and reduced confidence have on cognitive health. This points to a complex interplay between sleep, mood, and psychological well-being in shaping brain health as people age.
Because this was a cross-sectional study — meaning everyone was assessed at one point in time — the findings cannot prove that poor sleep causes cognitive decline. However, the results highlight that sleep quality, emotional well-being, and personal confidence in daily self-management may all be relevant targets for efforts aimed at supporting healthy cognitive aging in older adults.
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Wang L, Wang Y, Huo J, Luo Y, Ding Y, Wang Z. (2026). Associations of Sleep Quality with Cognitive Function in Chinese Older Adults: The Roles of Self-Efficacy and Depressive Symptoms.. Clinical interventions in aging. https://doi.org/10.2147/CIA.S594997