Is sleep quality a moderated mediator between perceived stress and depression among stroke patients?

Lina Guo; Miao Wei; Genoosha Namassevayam; Mengyv Zhang; Yvying Xie; Runtang Meng; Yuanli Guo; Yanjin Liu

doi:10.3389/fpubh.2023.1284197

Is sleep quality a moderated mediator between perceived stress and depression among stroke patients?

Front Public Health. 2024 Jan 5:11:1284197. doi: 10.3389/fpubh.2023.1284197. eCollection 2023.

Authors

Lina Guo¹, Miao Wei¹, Genoosha Namassevayam², Mengyv Zhang³, Yvying Xie³, Runtang Meng⁴, Yuanli Guo¹, Yanjin Liu⁵

Affiliations

¹ Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University, Chenkalady, Sri Lanka.
³ School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
⁴ School of Public Health, Hangzhou Normal University, Hangzhou, China.
⁵ Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Background: Sleep quality can offer new insights into addressing depression among stroke patients. However, the current understanding of the mechanism by which sleep quality reduces depression is not clear in existing research.

Objectives: This study aimed to identify the relationships and mechanisms among perceived stress, sleep quality, social support, and depression in stroke patients.

Methods: A multicenter cross-sectional study was conducted from January to May 2023. Cluster random sampling was used to recruit 500 stroke patients from five hospitals in Henan Province, China. The Chinese Perceived Stress Scale (CPSS), Pittsburgh Sleep Quality Index (PSQI), Social Support Rating Scale (SSRS), and Hamilton Depression Scale (HAMD-24) were employed to assess perceived stress, sleep quality, social support, and depression, respectively. Data were analyzed using descriptive analysis, Pearson's correlation analysis, and moderated mediation analysis. The study adhered to the STROBE checklist for reporting.

Results: Out of 500 participants, 471 completed the survey (94.2%). After controlling for sex and age, mediation analysis revealed that poor sleep quality partially mediated the relationship between perceived stress and depression (β = 0.184, 95% CI: 0.110, 0.359). Additionally, social support played a moderating role in the mediation model.

Conclusion: This study explained the moderated mediation of sleep quality and social support between perceived stress and depression. It provided a theoretical basis for the development of a sleep quality intervention program for reducing depression among stroke patients.

Keywords: depression; mediating effect; moderating effect; perceived stress; sleep quality; social support; stroke.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Depression* / etiology
Humans
Psychological Tests*
Self Report*
Sleep Quality
Stress, Psychological
Stroke*

Supplementary concepts

Perceived Stress Scale

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by National Natural Science Foundation of China (72204225 and 72274179), China Postdoctoral Science Foundation (2023M733234) and Medical Science and Technology Project of Henan Province (SBGJ202102076, 222102310246, and LHGJ20220429), and Nursing Science Foundation of the first Affiliated Hospital of Zhengzhou University (HLKY2023001).