Perceived family functioning mediates the relationship between sleep quality and depressive symptoms among institutionalized older adults: a cross-sectional study in China

Objectives Poor sleep quality and depressive symptoms are common among institutionalized older adults. While their association is well-established, the psychosocial mechanisms underlying this link remain underexplored. This study explores the mediating effect of perceived family functioning on the association between sleep quality and depressive symptoms among older adults in Chinese nursing homes.Method A cross-sectional survey was conducted with 269 older adults from six nursing homes in Xi’an and Chongqing, China. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Geriatric Depression Scale (GDS), and the Family APGAR Index. Mediation was tested using PROCESS macro (Model 4) with 5000 bootstrap samples, controlling for demographic variables.Results Poor sleep quality was positively associated with depressive symptoms (β = 0.7079, p < 0.01) and negatively with perceived family functioning (β = −0.2294, p < 0.01). Perceived family functioning was inversely related to depressive symptoms (β = −0.5208, p < 0.01). The indirect effect was significant (β = 0.1195), indicating 14.4% partial mediation.Conclusion Perceived family functioning partially mediates the link between sleep quality and depression. Interventions aimed at improving both sleep hygiene and perceived familial support may be effective strategies for reducing depressive symptoms in this vulnerable population.