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Associations of sleep duration and sleep quality with life satisfaction in

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 Archives of Gerontology and Geriatrics 65 (2016) 211–217

Contents lists available at ScienceDirect

Archives of Gerontology and Geriatrics

journal homepage: www.elsevier.com/locate/archger

Associations of sleep duration and sleep quality with life satisfaction in

elderly Chinese: The mediating role of depression
Ting-Fan Zhia,b,1, Xun-Ming Sunc,1, Shu-Juan Lid , Qun-Shan Wange, Jian Caif , Lin-Zi Lic ,
Yan-Xun Lic , Min-Jie Xua,b , Yong Wangg , Xue-Feng Chug , Zheng-Dong Wangg ,
Xiao-Yan Jianga,b,*
a
Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China
b
Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai 200092, China
c
Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and
Institutes of Biomedical Sciences, Fudan University 200433 Shanghai, China
d
Department of Neurology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China
e
Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 200092 Shanghai, China
f
Department of Neurology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830011, China
g
Rugao People’s Hospital, Rugao 226500 Jiangsu, China

A R T I C L E I N F O A B S T R A C T

Article history:
Received 18 November 2015 This study investigated whether sleep duration and quality were related to life satisfaction (LS) among
Received in revised form 25 March 2016 older Chinese adults and whether depression mediated those relationships. Cross-sectional data from the
Accepted 29 March 2016 aging arm of the Rugao Longevity and Aging Study were used. Sleep duration, sleep quality, depression, LS
Available online 30 March 2016 and covariates were analyzed using logistic regressions. To assess the potential mediation of depression
on the association between sleep duration and quality and LS, Aroian tests were used. Of 1756 older
Keywords: Chinese adults aged 70–84 years, 90.7% of the men and 83.3% of the women reported being satisfied with
Sleep duration their lives. After adjusting for covariates, older adults who slept 6 h per night were more likely to suffer
Sleep quality
from life dissatisfaction compared with those who slept 7–8 h (OR = 2.67, 95% CI 1.86–3.79), and
Depression
individuals who slept poorly were almost 2 times (OR = 2.91, 95% CI 2.16–3.91) more likely to have life
Life satisfaction
Elderly dissatisfaction. The Aroian tests confirmed that these relationships were partially mediated by
depression (p < 0.001). Between short sleep and LS, the mediating effect of depression accounted for
13.9% of the total effects. Moreover, the mediating effect of depression on the association between sleep
quality and LS was 13.3%. Short sleep duration and poor sleep quality were inversely associated with LS,
and the relationships were partially mediated by depression. Our study suggests that both sleep and
depression status are important factors for LS among the elderly.
ã 2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction longevity (Guven & Saloumidis, 2014). Therefore, it is necessary to

Throughout history, people have considered happiness to be an
ideal and the ultimate goal of human actions. Life satisfaction (LS),
an indicator of happiness, is defined as a cognitive judgment or the
subjective attitude towards one’s life (Diener, Suh, Lucas, & Smith,
1999). Moreover, LS, as a health concept, is inversely linked to all-
cause mortality (Kimm, Sull, Gombojav, Yi, & Ohrr, 2012; Li, 2013;
ST John, Mackenzie, & Menec, 2015) and positively related to
* Corresponding author at: Key Laboratory of Arrhythmias of the Ministry of
Education of China, Tongji University School of Medicine, Shanghai 200092, China.
E-mail address: xiaoyanjiang001@163.com (X.-Y. Jiang).
1
These authors contributed equally to this work.
identify the factors associated with LS.
Sleep, as a part of a healthy lifestyle, plays an important role in
sustaining health status. Sleep problems such as insufficient sleep
duration and poor sleep quality can lead to mental disorders
(Furihata et al., 2015; Park, Yoo, & Bae, 2013), chronic health
conditions (e.g., metabolic syndrome (Hung et al., 2014) and
cardiovascular disease (Chien et al., 2010)), and even death (Chien
et al., 2010; Bernert, 2015). Accordingly, it is necessary to pay close
attention to sleep status and its correlates.
Depression is a public mental health problem that is experi-
enced worldwide. Several studies have shown that short sleep
duration and poor sleep quality are linked to elevated depressive
symptoms (Furihata et al., 2015; Ozturk et al., 2015; Zhai, Zhang, &
Zhang, 2015). Meanwhile, low occurrences of depression have

http://dx.doi.org/10.1016/j.archger.2016.03.023
0167-4943/ ã 2016 Elsevier Ireland Ltd. All rights reserved.
212 T.-F. Zhi et al. / Archives of Gerontology and Geriatrics 65 (2016) 211–217
been strongly related to LS (Koivumaa-Honkanen, Kaprio, Honka-
nen, Viinamaki, & Koskenvuo, 2004; Nes et al., 2013). These results
imply that short sleep duration and poor sleep quality are
associated with life satisfaction through the mediating role of
depression.
Currently, China’s population is experiencing dramatic aging.
Unfortunately, up-to-date information regarding sleep duration,
sleep quality, depression and LS among the elderly is scarce. Given
this context, we conducted this study to examine (1) the
relationships between LS and both sleep duration and quality
among older Chinese adults aged 70–84 years and (2) the
mediating role of depression that accounts for the association.
2. Methods
2.1. Subjects
Data from the aging arm of the Rugao Longevity and Aging
Study (RuLAS, conducted between November 2014 and December
2014) were used. Details about the study have been described
elsewhere (Liu et al., 2015). Briefly, approximately 1960 individuals
were randomly selected according to 5-year age and sex strata
based on a detailed registry of all elderly individuals aged 70–
84 years (n = 11198) from the Public Health Bureau of Jiang’an
township, which is a typical medium-sized township in Rugao,
China. A detailed structured questionnaire and physical examina-
tion were administered by trained physicians from the Rugao
People’s Hospital. This study included 1756 individuals who had
complete information on sleep duration, sleep quality and LS.
2.2. Sleep duration
Information on sleep duration over the prior 30 days was
obtained by asking “How many hours of actual sleep do you obtain
at night?”. These data were measured at one time. The answered
time was rounded to the nearest whole number. The responses
were categorized into 3 categories: 6 h per night, 7–8 h per night
(as the reference group), and 9 h per night. The definition of
categories was consistent with previous studies showing that
7–8 h of sleep per night was associated with the lowest risk of
morbidity of type 2 diabetes (Yaggi, Araujo, & Mckinlay, 2006) and
mortality (Suzuki et al., 2009; Tamakoshi & Ohno, 2004).
2.3. Sleep quality
Information on sleep quality over the prior 30 days was
obtained by asking “In general, would you say your sleep quality
is . . . ,” with 4 response alternatives: “well”, “rather well”, “rather
poor” and “poor”. It was used as a categorical variable, describing
sleeping well (well or rather well, as the reference group) versus
sleeping poorly (poor or rather poor).
2.4. Katz Index of activities of daily living (ADL)
The physical health status of older adults was measured by
the Katz Index of ADL, which is based on the six daily tasks of
bathing, dressing, indoor transferring, going to the toilet and
cleaning oneself afterwards, eating, and continence. The sum
scores range from 6 to 18 (Katz, Ford, Moskowitz, Jackson, &
Jaffe, 1963). In the current study, the Cronbach’s alpha was
0.917 for ADL. This study defined people as functionally
independent when their scores equaled 18, and others were
considered functionally dependent.
2.5. Depression
Depression was measured by the Chinese version of the 15-item
Geriatric Depression Scale (GDS-15), consisting of 15 questions
(yes or no) (Yesavage, 1988). In the current study, the Cronbach’s
alpha of the GDS-15 was 0.715. The presence of depression was
defined by a GDS score 6 (yes; no, as the reference group), which
resulted in a sensitivity of 79% and a specificity of 77% (Dennis,
Kadri, & Coffey, 2012).
2.6. Life satisfaction
The respondents were asked “How satisfied are you with your
current life?” and answered from 5 options: very satisfied,
satisfied, fair, unsatisfied, very unsatisfied. This global measure
has been used as an indicator of general life satisfaction (Myers &
Diener, 1996) and has been shown to be reliable and valid (Lucas &
Donnellan, 2012; Nes et al., 2013). It was used as a categorical
variable, distinguishing between satisfied (very satisfied, satisfied
or fair, as the reference group) and unsatisfied (unsatisfied or very
unsatisfied).
2.7. Covariates
The following data were obtained as covariates: age (70–74;
75–79; 80–84), gender (men, women), occupation (farmers, others
[workers, cadre or businessmen]), marital status (married, others
[widowed, divorced or never married]), education level (illiterate;
primary school; middle school or above), smoking status (non-
smokers, others [current smokers or former smokers]), drinking
status (non-drinkers, others [current drinkers or former smokers])
and ADL (functionally independent, functionally dependent).
2.8. Statistical analyses
To examine the relationships between sleep duration and
quality and various factors, chi-squared tests were used. Logistic
regressions were used to examine the relationships between sleep
duration and quality and life satisfaction. Crude ORs were
calculated in Model 1. Model 2 added demographic variables,
e.g., age, gender, occupation, marital status, education level,
smoking status, drinking status and ADL, to Model 1. Model 3
added depression to Model 2.
The mediating role of depression in the relationships between
sleep duration and quality and life satisfaction were tested
according to the procedure recommended by Baron and Kenny
(1986). Briefly, mediating models require (1) a significant
regression path between the predictor A and the mediator B, (2)
a significant regression path between the predictor A and the
criterion C and (3) a significant regression path between the
mediator B and the criterion C. If the path between A and C is no
longer significant when B is taken into account, one can conclude
that the relationship between A and C was fully mediated by B.
Otherwise, B might only partially mediate the relationship. Then,
we used Aroian tests to explore whether the mediating effect of the
independent variable on the dependent variable through the
mediator variable was significant. A significant Aroian test
outcome suggests the existence of mediation (Iacobucci, 2012).
The size of the mediating effect was measured by the degree of
reduction of the odds ratios (ORs) for sleep duration and quality
and life satisfaction, which was computed using the formula:
((ORinequation2 OR inequation4)/OR inequation2)  100%. Statistical
analyses were performed using SPSS statistical software 19.0
 T.-F. Zhi et al. / Archives of Gerontology and Geriatrics 65 (2016) 211–217 213

2.9. Ethical considerations
Written informed consent was obtained. The Human Ethics
Committee of Fudan University School of Life Sciences approved
the research study.
3. Results
The mean (standard deviation) age of the study subjects was
75.3 (3.9) years. There were 820 (46.7%) men and 936 (53.3%)
women. Of the population, 90.7% of the men and 83.3% of the
women reported being satisfied with their lives. The mean sleep
duration of the respondents was 6.45 h (range, 3–10 h). The
descriptive characteristics of the sample are shown in Tables 1 and
2.
Short sleep duration (6 h per night) and poor sleep quality
were significantly associated with life dissatisfaction in Model 1
(Table 3). After adjusting for confounders (Model 2), the elderly
who slept 6 h per night were more likely to suffer from life
dissatisfaction compared with the individuals sleeping 7–8 h
(OR = 2.67; P < 0.001), and longer sleep (9 h per night) had no
association with LS (OR = 0.87; P = 0.695). Moreover, individuals
who slept poorly were almost 2 times (OR = 2.91, P < 0.001) more
likely to have life dissatisfaction. The associations between short
sleep and sleep quality and life satisfaction remained significant
after additional adjustment for depression (Model 3).
We tested depression as a potential mediator of the relationship
between short sleep and LS (Table 4 and Fig. 1). In the first
regression equation, short sleep was positively associated with
depression (p < 0.001). In the second equation, short sleep was
positively associated with LS (p < 0.001). In the third equation,
depression was also positively associated with LS (p < 0.001).
Finally, in the fourth equation with short sleep and depression
included in the model, both factors were positively associated with
LS (p < 0.001). The Aroian test confirmed the mediating effect
(Zmediation = 4.231; p < 0.001). The mediating effect accounted for

Table 1
Participant characteristics stratified by sleep duration (n = 1756).

Sleep duration P P
(6 h/7–8 h) (9 h/7–8 h)
6 h 7–8 h 8 h
N = 931(53.0%) N = 654(37.2%) N = 171(9.7%)
N(%) N(%) N(%)
Age
70–74 438(47.0%) 333(50.9%) 74(43.3%) 0.306 0.190
75–79 326(35.0%) 215(32.9%) 63(36.8%)
80–74 167(17.9%) 106(16.2%) 34(19.9%)

Gender
Men 370(39.7%) 353(54.0%) 97(56.7%) <0.001 0.520
Women 561(60.3%) 301(46.0%) 74(43.3%)

Occupation
Farmers 845(91.6%) 555(86.7%) 157(92.4%) 0.002 0.045
Othersa 77(8.4%) 85(13.3%) 13(7.6%)

Marital status
Married 596(64.4%) 442(67.9%) 110(64.7%) 0.145 0.430
Othersb 330(35.6%) 209(32.1%) 60(35.3%)

Education level
Illiterate 555(60.3%) 296(45.9%) 70(42.2%) <0.001 0.202
Primary school 217(23.6%) 180(27.9%) 58(34.9%)
Middle school or above 148(16.1%) 169(26.2%) 38(22.9%)

Smoking status
Non-smoker 726(78.3%) 459(70.4%) 115(68.0%) <0.001 0.553
Othersc 201(21.7%) 193(29.6%) 54(32.0%)

Drinking status
Non-drinker 682(73.5%) 448(68.6%) 105(62.1%) 0.034 0.110
Othersd 246(26.5%) 205(31.4%) 64(37.9%)

ADL
Functionally independent 842(90.4%) 630(96.3%)) 161(94.2%) <0.001 0.202
Functionally dependent 89(9.6%) 24(3.7%) 10(5.8%)

Depression
Yes 121(13.1%) 39(6.0%) 9(5.3%) <0.001 0.746
No 803(86.9%) 613(94.0%) 160(94.7%)

Life satisfaction
Satisfied 756(81.2%) 608(93.0%) 160(93.6%) <0.001 0.783
Unsatisfied 175(18.8%) 46(7.0%) 11(6.4%)

ADL: activities of daily living scale.

Subjects with missing data were excluded.
Except for sleep duration, all percentages were column percentages.
a
Others include workers, cadre or businessmen.
b
Others include widowed, divorced or never married.
c
Others include current smokers or former smokers.
d
Others include current drinkers or former drinkers.
214 T.-F. Zhi et al. / Archives of Gerontology and Geriatrics 65 (2016) 211–217

Table 2 13.9% of the total effect. These results suggested that the effect of
Participant characteristics stratified by sleep quality (n = 1756).
short sleep on LS was partially mediated by depression.
Sleep quality P The analysis of depression as a potential mediator of the
Sleep well Sleep poorly
relationship between sleep quality and LS produced similar results.
N = 1220(69.5%) N = 536(30.5%) Therefore, depression may be considered a partial mediator of the
N(%) N(%) effect of sleep quality on LS (Table 5 and Fig. 2). The Aroian test
Age confirmed the mediating effect (Zmediation = 5.039; p < 0.001). The
70–74 588(48.2%) 257(47.9%) 0.984 mediating effect of depression on the association between sleep
75–79 420(34.4%) 184(34.3%) quality and LS was 13.3%.
80–74 212(17.4%) 95(17.7%)

Gender 4. Discussion
Men 665(54.5%) 155(28.9%) <0.001
Women 555(45.5%) 381(71.1%) This study explored the associations between LS and both sleep
duration and sleep quality and whether depression mediated these
Occupation
Farmers 1053(87.9%) 504(94.4%) <0.001
associations. We found that both short sleep duration and poor
Othersa 145(12.1%) 30(5.6%) sleep quality increased the odds of life dissatisfaction among the
elderly in China; the relationships remained significant after
Marital status controlling for potential covariates. Furthermore, the relationships
Married 805(66.4%) 343(64.2%) 0.387
were found to be partially mediated by depression. To our
Othersb 408(33.6%) 191(35.8%)
knowledge, this is the first study to investigate the relationship
Education level between sleep duration and quality and LS and the mediating role
Illiterate 575(47.8%) 346(65.5%) <0.001 of depression on those relationship in older Chinese adults.
Primary school 339(28.2%) 116(22.0%)
Of our population, 90.7% of the men and 83.3% of the women
Middle school or above 289(24.0%) 66(12.5%)
reported being satisfied with their lives. The rate of LS in our study
Smoking status was higher than those found in other studies conducted in China.
Non-smokers 866(71.3%) 434(81.4%) <0.001 Using data from the Sample Survey on the Aged Population in
Othersc 349(28.7%) 99(18.6%) Urban/Rural China (SSAPUR) that was conducted by the China
Research Center on Aging (CRCA) in December 2000, Hong Li et al.
Drinking status
Non-drinkers 813(66.9%) 422(79.0%) <0.001 found that 60.2% of rural adults aged 60 years and older were
Othersd 403(33.1%) 112(21.0%) satisfied with their lives (Li, Chi, & Xu, 2013). Jinqun Guan et al.
analyzed data from the 2005Chinese Longitudinal Healthy
ADL Longevity Survey (CLHLS) and showed that 61.3% of the total
Functionally independent 1144(93.8%) 489(91.2%) 0.055
Functionally dependent 76(6.2%) 47(8.8%)
population (with an average age of 85.37 years) reported
satisfaction with their lives (Guan, Li, Sun, Wang, & Wu, 2015).
Depression We considered two reasons that could account for the difference
Yes 85(7.0%) 84(15.7%) <0.001 between our findings and theirs. First, our study was only aimed at
No 1125(93.0%) 451(84.3%)
older adults aged 70–84 years, which was a different age group
Life satisfaction from the other studies. Second, as we know, social support is an
Satisfied 1115(91.4%) 409(76.3%) <0.001 important factor that affects life satisfaction among older adults
Unsatisfied 105(8.6%) 127(23.7%) (Diener, 2012). The high LS in Rugao (termed as a “longevity town”)
ADL: activities of daily living scale. in China might be attributed to the local government’s preferential
Subjects with missing data were excluded. care schemes for the elderly such as delivering milk every day,
Except for sleep quality, all percentages were column percentages. providing an allowance and performing door-to-door physical
a
Others include workers, cadre or businessmen.
b examinations free of charge (Liu et al., 2014).
Others include widowed, divorced or never married.
c
Others include current smokers or former smokers. With regard to sleep duration, short sleep (6 h per night) was
d
Others include current drinkers or former drinkers. inversely associated with LS, while long sleep (9 h per night)
showed no associations compared with individuals sleeping 7–8 h.
Compared with previous studies using similar constructs to LS
such as subjective well-being (SWB) and quality of life, the inverse

Table 3
Crude and adjusted odds ratios (ORs) for sleep duration and quality and life satisfaction.

Model 1 Model 2 Model 3

OR(95%CI) P OR(95%CI) P OR(95%CI) P

Sleep duration
Less than 7 h 3.06(2.17–4.31) <0.001 2.67(1.88–3.79) <0.001 2.44(1.68–3.54) <0.001
7–8 h REF REF REF REF REF REF
More than 8 h 0.91(0.46–1.80) 0.783 0.87(0.42–1.77) 0.695 0.89(0.42–1.87) 0.762

Sleep quality
Sleep well REF REF REF REF REF REF
Sleep poorly 3.30(2.49–4.37) <0.001 2.91(2.16–3.91) <0.001 2.66(1.93–3.67) <0.001

Model 1: crude effects.

Model 2: adjusted for age, gender, occupation, marital status, education level, smoking status, drinking status and ADL.
Model 3: adjusted for age, gender, occupation, marital status, education level, smoking status, drinking status, ADL and depression.
 T.-F. Zhi et al. / Archives of Gerontology and Geriatrics 65 (2016) 211–217 215

Table 4
Regression analyses using short sleep, depression and life satisfaction.

Regression equation Independent Dependent B SE P OR(95%CI) ZMediation pmediation Reduction of ORs

1 Short sleep Depression 0.862 0.192 <0.001 2.37(1.63–3.45) 4.231 <0.001 13.9%
2 Short sleep Life satisfaction 1.118 0.174 <0.001 3.06(2.17–4.31)
3 Depression Life satisfaction 2.451 0.178 <0.001 11.59(8.19–16.42)
4 Short sleep Life satisfaction 0.969 0.184 <0.001 2.64(1.84–3.78)
Depression 2.344 0.181 <0.001 10.42(7.30–14.87)

Reductions in the odds ratios (ORs) for short sleep duration and life satisfaction were computed using the formula: ((ORinequation2 OR inequation4)/OR inequation2)  100%.

1.118(0.174) ***
Short sleep Life satisfaction

Depression
0.862(0.192) *** 2.344(0.181) ***

Short sleep Life satisfaction

0.969(0.148) ***

Aroian Test

Zmediation = 4.231, p<0.001

Note: ***p<0.001

Fig. 1. Beta coefficients for the mediating role of depression between short sleep and life satisfaction.
Note: ***p<0.001

Table 5
Hierarchical regression analyses using sleep quality, depression and life satisfaction.

Regression equation Independent Dependent B SE P OR Zmediation pmediation Reduction of ORs

1 Sleep quality Depression 0.902 0.164 <0.001 2.47 (1.79–3.40) 5.039 <0.001 13.3%
2 Sleep quality Life satisfaction 1.193 0.144 <0.001 3.30 (2.49–4.37)
3 Depression Life satisfaction 2.451 0.178 <0.001 11.60 (8.19–16.42)
4 Sleep quality Life satisfaction 1.050 0.156 <0.001 2.86 (2.11–3.88)
Depression 2.338 0.183 <0.001 10.36 (7.24–14.82)

Reductions in the odds ratios (ORs) for sleep quality and life satisfaction were computed using the formula: ((ORinequation2 OR inequation4)/OR inequation2)  100%.

association between LS and short sleep duration was notable. Eise
Yokoyama et al. observed an inverted U-shaped association
between sleep duration and SWB (Yokoyama et al., 2008).
Christopher A. Magee et al. using cross-sectional data from the
45 and Up Study found that <6 h of sleep (OR = 1.80, 95% CI
1.57–2.07) and 6 h of sleep (OR = 1.36, 95% CI 1.24–1.49) were both
associated with poorer quality of life compared with 7–8 h sleep
(Magee, Caputi, & Iverson, 2011). However, our study did not find
that longer durations of sleep were negatively associated with LS in
our Chinese elderly population as other studies did (Yokoyama
et al., 2008; Magee et al., 2011). In our population, only 171 (9.7%)
older adults reported sleeping 9 h per night. Therefore, we
assumed that the statistical power was insufficient because the
number of people sleeping 9 h was too small. With regard to sleep
quality, our study reported that older adults who slept poorly were
more likely to have life dissatisfaction, which was consistent with
previous results. The results from the Kuopio Depression Study
reported that the long-term life dissatisfaction burden was
significantly associated with poor sleep (B = 0.052; p = 0.001)
(Rissanen et al., 2013). In a nationwide cohort of 18,631 same-
sex Finnish twins, poor sleep predicted a consistent pattern of life
dissatisfaction (OR = 2.1, 95% CI 1.7–2.7) (Paunio et al., 2009). These
findings emphasize that a poor sleeping status could impair LS in
older adults.
Furthermore, we found that depression mediated the relation-
ships between sleep duration and LS and sleep quality and LS.
Previous studies have confirmed that depression mediates the
relationships between LS and several factors such as military
service (Britton, Ouimette, & Bossarte, 2012). However, no studies
to date have examined the mediating role of depression on the
216 T.-F. Zhi et al. / Archives of Gerontology and Geriatrics 65 (2016) 211–217

1.193(0.144) ***
Sleep quality Life satisfaction

Depression
0.902(0.164) *** 2.338(0.183) ***

Sleep quality Life satisfaction

1.050(0.156) ***

Aroian Test

Zmediation= 5.039, p<0.001

Note: ***p<0.001

Fig. 2. Beta coefficients for the mediating role of depression between sleep quality and life satisfaction.
Note: ***p<0.001.

association between LS and sleep. The relationships between sleep
status and depression have undoubtedly attracted people’s
attention. A meta-analysis indicated that a short sleep duration
was significantly associated with an increased risk of depression in
adults (Zhai et al., 2015). Among male patients with severe
obstructive sleep apnea (OSA), Wonhee Lee et al. reported that
sleep quality was the strongest predictor of depression evaluated
using the Beck Depression Inventory (b = 0.425, p < 0.001) (Lee,
Lee, Chung, & Kim, 2015). Meanwhile, previous studies have
suggested depression to be positively associated with life
dissatisfaction. Nes et al. (2013) showed that individuals fulfilling
the DSM-IV criteria for Major Depressive Disorder (MDD) reported
significantly lower levels of LS (a correlation estimate of 0.60).
Moreover, the treatment of depression could lead to improved
satisfaction with life (Koivumaa-Honkanen et al., 2008). These
results suggest that short sleep duration and poor sleep quality are
associated with life satisfaction through the mediating role of
depression.
In light of previous research, the mechanisms of our findings
may be described as having two pathways. First, short sleep
duration and poor sleep quality at night may lead to daytime
tiredness, which increases negative events and emotions and
eventually predisposes individuals to a risk of depression (Nes
et al., 2013). In general, mental health is an important criterion that
people use to evaluate whether they are satisfied with life. Hence,
the presence of depression decreases LS. Second, short sleep and
poor sleep quality may also be a consequence of poor LS. An
unsatisfactory living environment may result in mental illness
(e.g., depression) (Koivumaa-Honkanen et al., 2004). In particular,
individuals with mental illness could be more likely to experience
short and disturbed sleep (Magee et al., 2011).
5. Limitations
First, given the cross-sectional design of this study, causal
inferences are not possible. Second, our data on sleep duration and
quality were based on self-reporting, which may be easily affected
by subjective factors. Hence, longitudinal studies and research
using objective information about sleep status should explore the
causal relationships.
6. Conclusions
Our study demonstrated that short sleep duration and poor
sleep quality were inversely associated with LS and that the
associations were partially mediated by the effects of depression.
We suggest that appropriate sleep duration and good sleep quality
are beneficial to LS. Meanwhile, reducing the occurrence of
depression, an additional goal of maintaining good sleep status,
could also improve LS among older adults.
Conflict of interest
There were no conflicts of interest.
Acknowledgements
We acknowledge all of the people involved in this study. This
work was supported by grants from the National Natural Science
Foundation (81571372,31171216, 81100551, 81270259, 81260180),
and a grant from Shanghai Municipal Natural Science Foundation
(16ZR1439600).
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