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

doi:10.5498/wjp.122935

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Nov 19, 2026; 16(11): 122935
Published online Nov 19, 2026. doi: 10.5498/wjp.122935

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

Wen-Jun Wang, Wen-Wen Miao, Xin-Jing Li, Meng-Xia Yang, Jing-Xian Niu, Yan-Miao Han, Yu-Rong Xing

Wen-Jun Wang, Department of Gynecological Clinic, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

Wen-Wen Miao, Department of Psychiatry, The Fourth People’s Hospital of Wuhu, Wuhu 241000, Anhui Province, China

Xin-Jing Li, Meng-Xia Yang, Jing-Xian Niu, Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

Yan-Miao Han, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

Yu-Rong Xing, Department of International Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

Co-corresponding authors: Yan-Miao Han and Yu-Rong Xing.

Author contributions: Wang WJ contributed to visualization; Wang WJ and Miao WW contributed to writing - original draft; Wang WJ, Miao WW, and Niu JX contributed to formal analysis; Wang WJ, Miao WW, Han YM, and Xing YR contributed to conceptualization and methodology; Wang WJ, Li XJ, Yang MX, and Niu JX contributed to investigation; Wang WJ, Li XJ, and Yang MX contributed to data curation; Wang WJ, Miao WW, Li XJ, Yang MX, and Niu JX contributed to validation; Li XJ, Yang MX, Niu JX, Han YM, and Xing YR contributed to writing - review and editing; Han YM and Xing YR contributed to funding acquisition, project administration, resources, supervision, and they contributed equally to this manuscript and are co-corresponding authors. All authors approved the final manuscript.

AI contribution statement: ChatGPT by OpenAI was used solely as an assistive tool for language editing, proofreading, and minor assistance with manuscript organization and formatting. The AI tool was not used to generate original scientific content, collect or analyze raw data, conduct statistical analyses, create figures or tables, draw scientific conclusions, or prepare references. All AI-assisted outputs were carefully reviewed, verified, revised, and approved by the authors. The authors take full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of the manuscript and all submitted materials.

Supported by Henan Province 2026 Science and Technology Development Plan, No. 262102311030; and the First Affiliated Hospital of Zhengzhou University 2023 Nursing Research Special Program.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Approval No. 2024-KY-1996-001).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to institutional privacy policies but are available from the corresponding author on reasonable request.

Corresponding author: Yan-Miao Han, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 Longhu Zhonghuan Road, Jinshui District, Zhengzhou 450000, Henan Province, China. hanyanmiao611527@126.com

Received: May 7, 2026
Revised: June 20, 2026
Accepted: August 10, 2026
Published online: November 19, 2026
Processing time: 180 Days and 18.7 Hours

Abstract

BACKGROUND

Perimenopausal 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.

AIM

To 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.

METHODS

This 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.

RESULTS

A total of 693 participants were included. Depressive symptoms were negatively correlated with mindfulness (r = -0.444, P < 0.01) and positively correlated with PSQI 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.

CONCLUSION

Depressive symptoms were found to statistically mediate the association between mindfulness and sleep quality in perimenopausal women. However, given the cross-sectional design, these findings should be interpreted as indirect associations rather than causal relationships. Longitudinal and interventional studies are needed to further clarify these relationships.

Keywords: Perimenopause; Mindfulness; Depressive symptoms; Sleep quality; Mediation analysis

Core Tip: This cross-sectional study of 693 perimenopausal women found that depressive symptoms mediated 63.5% of the association between mindfulness and sleep quality. Higher mindfulness was associated with lower depressive symptoms, which in turn were associated with better sleep quality. These findings suggest that depressive symptoms may partially explain the mindfulness-sleep quality relationship. Due to the cross-sectional design, results indicate indirect associations only. Longitudinal studies are needed to confirm causal pathways.