{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:15:33Z","timestamp":1778220933251,"version":"3.51.4"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depressive symptoms are a well-established predictor of late-life cognitive impairment. Furthermore, anxiety and sleep quality\u2014both correlates of cognitive impairment\u2014could mediate the depression\u2013cognition association in older women. Nevertheless, limited research has empirically tested this hypothesis using causal mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study recruited 718 older women from rural areas of Sichuan, Chongqing, and Guizhou provinces in China using convenience sampling. Trained assessors administered the Patient Health Questionnaire-9, the Chinese Version of the Montreal Cognitive Assessment, the Generalized Anxiety Disorder-7 Scale, and the Pittsburgh Sleep Quality Index to assess depressive symptom severity, cognitive performance, anxiety levels, and sleep quality, respectively. Statistical analyses were performed using SPSS 29.0, with chi-square testing, Spearman rank correlation, and bootstrapped mediation analysis (5,000 resamples, bias-corrected) executed through the PROCESS macro (version 4.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both direct and indirect effects of depressive symptoms on cognitive impairment were found in older women in rural areas (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). As predicted, anxiety and sleep quality mediated the relationship between depressive symptoms and cognitive impairment [\n                      <jats:italic>B<\/jats:italic>\n                      <jats:sub>Anxiety<\/jats:sub>\n                      \u202f=\u202f\u22120.580, 95% confidence interval (CI): \u22120.737 to \u22120.420;\n                      <jats:italic>B<\/jats:italic>\n                      <jats:sub>sleep quality<\/jats:sub>\n                      \u202f=\u202f\u22120.168, 95% CI: \u22120.239 to \u22120.101]. In addition, serial mediation analyses indicated that the association of depressive symptoms and cognitive impairment was mediated by anxiety and sleep quality in a sequential manner (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f\u22120.059, 95% CI: \u22120.122 to \u22120.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified a modifiable pathway in older rural Chinese women: anxiety and sleep quality sequentially mediated the link between depressive symptoms and cognitive impairment, with anxiety showing an association with sleep disturbances that correlated with greater impairment. Multicomponent strategies addressing this symptom triad suggest intervention targets to mitigate the risk of decline in this underserved population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1797904","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:52:04Z","timestamp":1778219524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Depressive symptoms and cognitive impairment among rural Chinese older women: anxiety and poor sleep as sequential correlates\u2014A cross-sectional analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Hongli","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]},{"name":"Nursing School of Zunyi Medical University","place":["Zunyi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuqiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College","place":["Nanchong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuting","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Key Laboratory of Brain Function and Brain Disease Prevention and Treatment of Guizhou Province, Affiliated Hospital of Zunyi Medical University","place":["Zunyi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Chongqing Academy of Medical Sciences, Chongqing General Hospital, Chongqing University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.7507\/1672-2531.202006099","article-title":"A meta-analysis of the rate of cognitive impairment in the elderly in China","volume":"20","author":"Wang","year":"2020","journal-title":"China J Evid Based Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1354877","DOI":"10.3389\/fpubh.2024.1354877","article-title":"Association between disability and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms","volume":"12","author":"Ai","year":"2024","journal-title":"Front Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1038\/s41591-025-03564-3","article-title":"Women twice as likely to develop Alzheimer's disease as men - 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