Sleep and happiness in urban-dwelling older adults in Ghana: A serial multiple mediation model of generalized anxiety and depressive symptoms

Razak M. GYASI*, André HAJEK, Richmond OWUSU, Peter Bai JAMES, Mary Sefa BOAMPONG, Burnett Tetteh ACCAM, Kabila ABASS, Ellis OWUSU-DABO, David R. PHILLIPS

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

3 Citations (Scopus)


Objective: Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. The authors further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling. Methods: Data came from the 2016 to 2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n = 661). The authors measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro program (Model 6) was constructed to quantify the hypothesized mediation effect. Results: The analysis included 661 adults aged greater than or equal to 50 years (mean age = 65.53 [SD] = 11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (β = −0.1277, 95%CI = −0.15950 to −0.096). Bootstrapping estimates revealed that the SP-happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect. Conclusion: Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the sub-Saharan African (SSA) context. Interventions, social and clinical, to improve happiness through sleep quality should include ways to improve mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.

Original languageEnglish
Pages (from-to)953-964
Number of pages12
JournalAmerican Journal of Geriatric Psychiatry
Issue number11
Early online date13 May 2023
Publication statusPublished - Nov 2023

Bibliographical note

Funding Information:
This work was supported by the Research Grants Council (RGC) and Lingnan University, Hong Kong [grant number RPG1129310 ]. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflict of interest.

Publisher Copyright:
© 2023 American Association for Geriatric Psychiatry


  • depressive symptoms
  • Generalized anxiety
  • Ghana
  • happiness
  • sleep
  • subjective well-being


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