This study proved the relationship among self-assessment living standard, mental health and sleep quality among the elderly in rural areas of Anhui Province. The results showed that self-assessment living standard was closely related to mental health, and the elderly with low self-assessment living standard had a higher risk of psychological problems. However, this correlation occurs through both direct and indirect effects. Sleep quality played a significant partially mediating role between self-assessment living standard and mental health.
Rural elderly Self-assessment living standard, Sleep quality and Mental health status
Among the 1,188 respondents, 705 (59.34%) thought their living standard was average, 201 (16.92%) thought their living standard was poor or even very poor, and 282 (23.74%) thought their living standard was good, among which the proportion of self-assessment was average or poor was significantly higher than the research results of Jiang Haochen . The reason may be that the regional distribution of the survey objects and the total number of samples are different. Meanwhile, the economic status and medical level of rural areas are lower than the national level. Some studies have classified the lifestyle of the elderly in China into four types: survival type, healthy type, risk type and mixed type, with 45%, 25%, 13% and 17% respectively. The life style of the elderly in rural Areas of China is mainly subsistence lifestyle . They control the living cost and have few social participation behaviors, mostly watching TV and listening to radio, and less intake of fresh fruits and fish in daily life, which may be an important reason for their low self-assessment of living standard.
The results of this study show that 24.7% of the rural elderly have a tendency to have mental health problems, which is similar to 18.5%~24.47% of the general elderly population [30-32]. Compared with the urban elderly, the rural elderly in China have less financial resources, social support, family companionship, etc., and relatively overlapping living environment, which may have a negative impact on their mental health . Gender, education level and working state have statistical significance to mental health difference, which is consistent with the research conclusions of Liang Xiaoli ; Zhang Pei et al. [34,35]. In addition, 21.5% of participants with PSQI scores above 11, and 2.5% of participants reported serious sleep problems, which was higher than the results of Ding Kunxiang's study .
The effect of Self-assessment living standard on Mental health
Previous studies have observed a correlation between self-assessment living standards and mental health . Previous studies have revealed the impact of poverty on the mental health of the elderly. For example, Bayapa et al. (2012) found that poverty was significantly correlated with cognitive impairment and depression in the elderly in India . Wen Xingxiang (2017) et al.’s study on the elderly in rural China shows that the mental health status of the elderly in poor families is worse . Jiang Haochen et al. (2021) conducted a study on the elderly aged 65 and above in China, which verified that the elderly with lower self-rated living standards had more severe negative psychological emotions . The negative impact of lower living standards on mental health may come from the negative impact of less economic foundation and resources on individuals' physical health and social behavior, or the poverty-related living environment may lead to more stress and negative emotions, thus affecting mental health . In addition, social comparison theory believes that social comparison is intra-group and inter-group comparison, and the latter has a more obvious impact on individual psychological development . However, these studies use different participant groups (e.g., young adults) or analytical methods (e.g., traditional regression and correlation). Although those studies differed from ours in terms of specific details, the results regarding the negative relationship between self-assessment living standard and mental health were consistent, which confirms the results of our study.
Self-assessment of the impact of Living standards on Sleep quality
This study found that self-assessment living standard was associated with an increased likelihood of high sleep quality among the elderly in rural areas in Anhui province. A study conducted in Yunnan Province, China, showed that older people in rural areas with lower family property have a higher likelihood of sleep disorders . It may be related to their sensitive emotions. The elderly with lower living standards are more likely to have negative thoughts and to have random thoughts before going to sleep, which affects their sleep. Low level of self-reported life means not only a single economic sources, less material resources, and poor living environment, also means that more stressful life events and negative mood , which will result in its sleep problems obviously increased, low level of self-reported life will bring such as difficulty falling asleep, wake up, wake up at night and having nightmares and other sleep problems.
The mediating role of Sleep quality in Self-assessment living standard and Mental health
The results of this study show the correlation between low sleep quality and high tendency of mental health problems, which is consistent with the results of previous investigations on employees of public institutions . The analysis also found that sleep quality was the mediating variable between the self-rated living standard and mental health of the rural elderly, playing a partial mediating role, accounting for 14.46% of the total effect. As a mediating factor, sleep quality is correlated with self-rated living standard and mental health. Self-rated living standard can indirectly affect mental health by acting on sleep quality, that is, the lower the self-rated living standard is, the worse the sleep quality is, and the lower the mental health level is. Earlier studies have also confirmed this conclusion. Jeffrey J. Kim et al found in a study of German communities and students that when individuals' sleep quality and mental health are not healthy, measures to improve sleep can better promote the improvement of mental health . Lu Jiehua confirmed that there is a positive correlation between sleep quality and mental health of Chinese elderly in his evitable investigation of longitudinal data of Chinese elderly. Su Y's study found that poor sleep quality is associated with increased incidence of violations, aggression, depression and anxiety . Possible explanations for this result is that although China has comprehensive poverty alleviation, rural residents general living standards improve gradually, but the income of the rural elderly people in China still is generally low, cultural life still relatively monotonous and boring , coupled with the decline in physiological function, relative lack of medical resources, children migrant workers and other factors, It will have a negative impact on their economic status and living standards for a long time. Over time, they are easy to fall into sleep difficulties, easy to wake up, nightmares and other sleep disorders, leading to their inability to relieve mental stress through sleep, resulting in psychological problems. The study of Jiang Guanghui et al. shows that when the proportion of children going out is high, the negative time loss effect is dominant, which is not conducive to the improvement of parents' health. This survey found that 70.1% of the elderly live alone or only with their partners, and the proportion of children going out is high. Previous studies have found that cognitive behavioral therapy is particularly effective in improving individual sleep quality and mental health outcomes [50,51]. Therefore, China can help prevent sleep and psychological problems in the elderly by strengthening the training of primary medical workers in this therapy.
Advantages and Limitations
Advantages: First, the effective response rate of this study is 99.00% (1188/1223), as we all know, studies with higher effective response rates were more reliable. Secondly, we used internationally recognized measurement questionnaires to make objective measurements of the study subjects. In addition, this is the first study to examine the relationship between the three variables and the mediating role of sleep quality in the elderly population in Anhui Province.
However, this study also has the following limitations: First, self-rated living standards, sleep quality, and mental health were measured through questionnaires, which means that self-reported biases may affect the results. Second, since this study is a cross-sectional study, although there is a correlation between self-rated living standards, sleep quality and mental health, it is difficult to determine the causal association. Finally, the investigation objects of this study only cover rural areas of Anhui Province, and the extensibility of the results of this study is limited by factors such as economic development and cultural background.