Prediction of Death Anxiety Based on Perception of Aging and Depression Mediated by Sleep Quality in Elderly Women with Diabetes

Abstract

The present study aimed to investigate the predictive role of perception of aging and depression on death anxiety, with the mediating role of sleep quality in elderly women with diabetes. This descriptive-correlational study employed path analysis. The statistical population consisted of elderly women with diabetes residing at the Kahrizak Elderly Care Center in Tehran in 2025, from whom 250 participants were selected through purposive sampling. The research instruments included the Templer Death Anxiety Scale, Aging Perception Questionnaire (APQ), Geriatric Depression Scale (GDS), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS and AMOS software through Pearson correlation coefficient and path analysis methods. The findings demonstrated that negative perception of aging and depression both had significant direct positive effects on death anxiety (β=0.25, p<0.02; β=0.38, p<0.01). Sleep quality also had a significant direct effect on death anxiety (β=0.40, p<0.01). Furthermore, sleep quality significantly mediated the relationship between perception of aging and death anxiety (β=0.12, p<0.01), as well as between depression and death anxiety (β=0.17, p<0.01). The model fit indices also confirmed the acceptable fitness of the proposed model. The results indicated that negative perception of aging and depression directly and indirectly, through poor sleep quality, increase death anxiety among elderly women with diabetes. Therefore, psychological interventions focusing on modifying negative perceptions of aging, reducing depression, and improving sleep quality may play an important role in decreasing death anxiety and promoting mental health in the elderly population.