Association between mindfulness and sleep quality in perimenopausal women: A cross-sectional mediation analysis of depressive symptoms

Abstract

BACKGROUNDPerimenopausal women are vulnerable to both sleep disturbances and depressive symptoms.Mindfulness has been associated with better psychological well-being and sleep outcomes, but the specific psychological pathway linking mindfulness to sleep quality in this population remains insufficiently defined.In particular, it remains unclear whether depressive symptoms represent an intermediate pathway between mindfulness and sleep quality among perimenopausal women. AIMTo examine the associations among mindfulness, depressive symptoms, and sleep quality in perimenopausal women, and to test an a priori mediation model in which depressive symptoms mediate the association between mindfulness and sleep quality. METHODSThis observational study included perimenopausal women recruited using a convenience sampling approach from a tertiary hospital in Zhengzhou, Henan Province, China, between October 2023 and December 2024.Participants completed the Mindful Attention Awareness Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the Pittsburgh Sleep Quality Index (PSQI).Spearman correlation analysis, multiple linear regression, and mediation analysis using Mplus were performed.Multiple linear regression and mediation analyses were adjusted for age, body mass index, marital status, income level, number of pregnancies, and presence of complications to control for potential confounding effects.Because of the cross-sectional design, mediation results were interpreted as indirect associations rather than evidence of causal direction. RESULTSA total of 693 participants were included.Depressive symptoms were negatively correlated with mindfulness (r = -0.444,P < 0.01) and positively correlated with PSQI 4 / 22 scores (r = 0.422, P < 0.01), indicating poorer sleep quality.Mindfulness was negatively correlated with PSQI scores in unadjusted correlation analysis (r = -0.268,P < 0.01).In multivariable analysis, both mindfulness and depressive symptoms were independently associated with sleep quality (P < 0.001).Mediation analysis showed that depressive symptoms significantly mediated the association between mindfulness and sleep quality (indirect effect = -0.176,95% confidence interval: -0.222 to -0.131), accounting for 63.5% of the total effect. CONCLUSIONDepressive symptoms were found to statistically mediate the association between mindfulness and sleep quality in perimenopausal women.However, given the crosssectional design, these findings should be interpreted as indirect associations rather than causal relationships.Longitudinal and interventional studies are needed to further clarify these relationships.