The mediation role of depression on the relationship between elder abuse and sleep quality: findings from Ardakan Cohort Study on Aging (ACSA)

Elder abuse is linked to depression and poor sleep quality, yet depression's mediating role remains underexplored, particularly in Iran. This cross-sectional study analyzed baseline data from the Ardakan Cohort Study on Aging (n = 3,128 adults aged ≥ 60 years). Sleep quality, depression, and elder abuse were measured using the Pittsburgh Sleep Quality Index (PSQI), CESD-10, and Elder Abuse Suspicion Index (EASI). Logistic regression and mediation analysis were performed in Stata 18, adjusting for confounders. Elder abuse prevalence was 16.37%; abused individuals were older (69.61±6.75 vs. 68.20±5.98, p=.001) and more often female (p=.03). Depression (27.61% vs. 14.53%) and poor sleep quality (83.40% vs. 72.57%) were more prevalent among abused elders (p<.001). Elder abuse increased odds of poor sleep quality by 46% (OR=1.46; 95%CI:1.12-1.92; p<.001), rising to 75% (OR=1.75; 95%CI:1.25-2.58; p<.001) with depression as mediator. Elder abuse impairs sleep quality, mediated substantially by depression, underscoring the need for mental health-focused elder abuse interventions.