Caregiver Sleep Quality and Depression: The Roles of Dementia Caregiving, Support Availability, and Rural-Urban Contexts

Abstract Background and Objectives Dementia caregivers experience elevated psychological distress, with sleep health emerging as a critical determinant of mental health. This study examines how dementia caregiving affects depressive symptoms via sleep disturbances and evaluates the moderating role of social support. Additionally, it explores whether these dynamics differ between rural and urban caregivers, given existing differences in resources and access to care. Research Design and Methods Using data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC, N= 1,422), a mediation model assessed whether dementia status predicted depression through interrupted sleep. Moderated mediation examined whether social support buffered the associations between interrupted sleep and depressive symptoms. Multigroup modeling explored differences between rural and urban caregivers. Results Probable dementia caregiving predicted worse sleep quality, which mediated the relationship with higher depressive symptoms. The relationship between interrupted sleep and depression was most pronounced under low levels of support. For urban caregivers, interrupted sleep predicted depression, moderated by social support, while no significant effects were observed among rural caregivers. Discussion and Implications These findings highlight the critical role of support in mitigating the mental health impacts of sleep disturbance and underscore the importance of both informal and formal support systems in reducing the impact of sleep disturbances on caregiver depressive symptoms. Future research should explore context-specific stressors for rural-residing caregivers, which can inform culturally appropriate support strategies to enhance caregiver well-being in both rural and urban contexts.