Cross-lagged Analyses Research Articles

Relationships Between Physical Activity, Sedentary Behavior and Anxiety in Chinese Children with Visual Impairment: A Cross-lagged Analysis

Relationships Between Physical Activity, Sedentary Behavior and Anxiety in Chinese Children with Visual Impairment: A Cross-lagged Analysis

The Relationship between Conscientiousness and Well-Being among Chinese Undergraduate Students: A Cross-Lagged Study.

Chinese culture attaches great importance to the education and cultivation of youth conscientiousness, however in the context of Chinese culture, little is known about the relationship between conscientiousness and mental and physical health. The present study aimed to investigate whether there is a reciprocal relationship between conscientiousness and well-being (subjective and physical well-being) among Chinese undergraduate students. A series of self-reported questionnaires were administered to 365 undergraduate students in 2 waves, separated by 1 year. Cross-lagged regression analyses were applied to examine the reciprocal relationships. Results indicated that conscientiousness positively predicted subsequent levels of positive affect and life satisfaction, while negatively predicted subsequent levels of negative affect and physical symptoms, controlling for the effects of gender, age, body-mass index, socioeconomic status, and the prior level of conscientiousness. Whereas, positive and negative affect, life satisfaction, and physical symptoms did not significantly predict subsequent levels of conscientiousness. This study suggests that conscientiousness is a robust and prospective predictor of subjective and physical well-being. The reciprocal relationship between conscientiousness and well-being was not confirmed in the current sample of Chinese undergraduate students.

Causal effect of anxiety and depression status on the symptoms of gastroesophageal reflux disease and functional dyspepsia during proton pump inhibitor therapy.

Although anxiety and depression status is considered related to gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) symptoms, ambiguity primarily arises from the difficulty in determining their cause-effect relationships. We aimed to examine the longitudinal reciprocal causation between anxiety/depression status and GERD/FD symptoms among symptomatic adult patients with GERD. Adult (≥ 20years) patients with GERD symptoms received PPI treatment for 4weeks after endoscopy. GERD and FD symptom subscales (GERD-SS/FD-SS) were evaluated using the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test (GERD-TEST). Anxiety and depression status were evaluated using the hospital anxiety and depression scale (HADS). A cross-lagged analysis using structural equation modeling was conducted to examine causal relationships among psychiatric bias (anxiety and depression scores) and upper gastrointestinal symptoms (GERD-SS and FD-SS scores) over time. A total of 182 patients with GERD (men: 120; age: 57.1 ± 12.8years; body mass index: 24.2 ± 4.1kg/m2; nonerosive reflux disease/erosive reflux disease: 61/121) were eligible before (T1) and after 4weeks (T2) of PPI therapy. The cross-lagged effect model indicated that anxiety at T1 contributed to the FD-SS at T2 (β = 0.18*) and depression at T1 contributed to the GERD-SS at T2 (β = 0.23*) (*p < 0.05). Psychiatric bias was a risk factor for refractory GERD and FD. Anxiety and depression status reduced the therapeutic effect of PPIs on GERD and FD symptoms. Therefore, attention is required to detect the anxiety/depression status of patients with GERD/FD symptoms to treat patients appropriately and optimize therapeutic outcomes.

Hospitality and tourism students’ perceptions of effectiveness of entrepreneurship education and its effect on entrepreneurial intentions: a cross-lagged two-wave mediation study involving entrepreneurial self-efficacy

ABSTRACT Relative to the research interest in the role of hospitality & tourism (H&T) entrepreneurship education (EE) in students’ entrepreneurial intentions (EI), less focus has been on the underlying mechanisms that explain the relationship between the two. Accordingly, based on the data collected from a sample of 113 H&T students in two waves of this research (15 months apart), this study examined the cross-lagged relations between students’ perceptions of the effectiveness of EE, their entrepreneurial self-efficacy (ESE), and their EI. In particular, we tested if ESE mediated the link between EE and EI. Cross-lagged analyses pointed to significant directional effects from students’ perceptions of the effectiveness of EE to ESE and EI, ESE to EI, but not vice versa. Also, results supported that the link between students’ perceptions of the effectiveness of EE to EI was mediated by ESE. Based on the results from this study, we draw several implications for the theory, practice, and research of entrepreneurship education.

Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning.

Vulnerability models posit that executive functioning (EF) problems centrally impact future common (vs. rare) psychopathology symptoms. Conversely, scar theory postulates that depression/anxiety (vs. other psychopathology) symptoms centrally influence reduced EF. However, most studies so far have been cross-sectional. We used cross-lagged panel network analysis to determine temporal and component-to-component relations on this topic. Community older adults participated across four time-points. Cognitive tests and the caregiver-rated Neuropsychiatric Inventory assessed nine psychopathology and eight cognitive functioning nodes. Nodes with the highest bridge expected influence cross-sectionally were agitation and episodic memory. Episodic memory had the strongest inverse relation with age. Agitation had the strongest negative association with global cognition. EF nodes tended to be centrally impacted by prior depressed and anxious moods rather than influential on any future nodes. Heightened anxious and depressed mood (vs. other nodes) centrally predicted future decreased EF-related (vs. non-EF-related) nodes in older adults, supporting scar (vs. vulnerability) theory.

The relationship between social participation and depressive symptoms among Chinese middle-aged and older adults: A cross-lagged panel analysis.

ObjectivesThis study examined the mutual effects of social participation and depressive symptoms in middle-aged and older Chinese adults from offline and online perspectives. Reciprocal relationships between depressive symptoms and the four subtypes of offline participation were also examined.MethodsBased on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for three waves of data from 2013, 2015, and 2018. One thousand nine hundred ninety-nine samples for individuals over 50 were obtained. A series of cross-lagged analyses were conducted to examine the mutual influence of social participation and depressive symptoms. Depressive symptoms were assessed using the short version of the Center for Epidemiologic Studies Depression Scale (CESD-10). The social participation questionnaire included nine items referring to offline participation (eight items) and online participation (one item). Several demographic variables were adjusted when conducting the cross-lagged analyses.ResultsSocial and offline participation had significant two-way associations with depressive symptoms. Depressive symptoms had greater impacts on social and offline participation than in the opposite direction. Online participation has a significant one-way impact on depressive symptoms. The relationship between specific types of offline participation and depressive symptoms varied in existence and direction.DiscussionOverall, there was significant bidirectional causality between social participation and depressive symptoms. Social participation, both offline and online, played a positive role in alleviating depressive symptoms. Depressive symptoms also affected the level of social participation to some extent among middle-aged and older Chinese adults over time.

Threats of COVID-19 arouse public awareness of climate change risks

Public climate change awareness is indispensable to dealing with climate change threats. Understanding whether and how the COVID-19 pandemic impacts on individuals’ climate change risk perception would thus be critical to green economic recovery. We conducted a longitudinal survey study in China when the pandemic was at its height and when it was mitigated. The cross-lagged analysis confirmed our assumed “arousal” effect of perceived COVID-19 risks on climate change risk awareness. We further tested and verified the proposed “dual-pathway” mechanisms of affective generalization (i.e., negative affective states aroused by COVID-19 “spillover” to the assessment of climate change risk) and cognitive association (i.e., the outbreak of COVID-19 awakens people’s recognition of the human-nature-climate issues) via multiple mediation analyses. Our results implied that climate policies could be integrated into pandemic control, and that the public should be more awakened to confront multiple crises with proper guidance.

Life satisfaction and mental health from age 17 to 21 years in a general population sample

Adolescence is a period when both mental health (MH) and wellbeing start deteriorating, which raises the question of how the two phenomena are linked and whether deterioration in one might be used to flag problematic developments in the other. While research shows that wellbeing and MH are associated, the direction of the association is not clear and longitudinal analyses, that might help disentangle the cause and effect, are scarce. Moreover, few studies have investigated the directional relation between MH and wellbeing early in the life course. In emerging adulthood, evidence indicates reciprocal associations and no gender differences, whereas, in early and middle adolescence, results are mixed and differ across gender. Thus, we investigated the relationship between MH and wellbeing and the moderating effect of gender in the crucial developmental transition from middle adolescence to emerging adulthood. We undertake a cross-lagged longitudinal data analysis from a pooled sample of six pseudo-cohorts, including information from 661 young people who participated in the UK Household Longitudinal Study at ages 17, 19, and 21. Using a 7-points overall life satisfaction (LS) scale as an index of wellbeing and the 12-item General Health Questionnaire as a measure of MH, we found no associations between LS and MH in the 17–19 transition and bidirectional associations in the 19–21 transition. There were no substantial gender differences in either transition. We conclude that LS and MH predict each other in the transition from late adolescence (age 19) to emerging adulthood (age 21) for both males and females.

Longitudinal relations between abusive supervision, subordinates' emotional exhaustion, and job neglect among Pakistani Nurses: The moderating role of self-compassion.

The main purpose of this study was to investigate reciprocal relationships between abusive supervision, subordinates’ emotional exhaustion, and job neglect, and to examine the mediating role of emotional exhaustion in the cross-lagged relationship between abusive supervision and job neglect. Besides, we tested the moderating role of self-compassion in the cross-lagged relationship between abusive supervision and emotional exhaustion. We applied a two-wave cross-lagged panel design with a time lag of six months. Participants were 331 staff nurses of public sector hospitals in Islamabad, Pakistan. Data were collected using a self-report questionnaire at two points in time. Longitudinal structural equation modeling (SEM) was used to compare nested models. Results of cross-lagged SEM analyses supported the posited reciprocal model, indicating that abusive supervision, emotional exhaustion, and job neglect are mutually related. Results of mediation analysis showed that emotional exhaustion partially mediates the cross-lagged relationship between abusive supervision and job neglect. Further, we found that self-compassion attenuates the positive cross-lagged effect of abusive supervision on emotional exhaustion, and the indirect effect of abusive supervision on job neglect was weaker at higher levels of self-compassion. Our findings suggest that subordinates may find themselves in abusive relationships, in part, because their own behavioral responses to abuse can reinforce abusive supervision. Moreover, we identified the stress-buffering effect of self-compassion on emotional exhaustion.

Pursuing Pleasure or Meaning: A Cross-Lagged Analysis of Happiness Motives and Well-being in Adolescents

Pursuing Pleasure or Meaning: A Cross-Lagged Analysis of Happiness Motives and Well-being in Adolescents

The role of language in the association between theory of mind and executive functioning in early childhood: New longitudinal evidence

This study examined the temporal associations between theory of mind (ToM) and executive function (EF) and the effect of language skills on these associations in the development of young children. Data were collected on three occasions in a longitudinal study of children aged 3-6 years (N = 142). A longitudinal cross-lagged analysis was used to examine the bidirectional effects of ToM and EF and associations with language skills. Results extend previous findings by showing that EF measured at the first observation (average age 56 months) was likely to influence ToM at the second observation (average age 64 months). This effect was not reciprocal. However, the effect between ToM and EF became bidirectional over a six month period from the second to third observation (average age 70 months). In addition, language was found to influence both ToM and EF beyond the directional effect of these constructs on each other.

Does arterial stiffness progression temporally precede higher low-grade inflammation in adolescents? Causal longitudinal evidence using auto-regressive cross-lagged structural equation models

Abstract Background Arterial stiffness, a precursor of arteriosclerosis, measured using carotid-femoral pulse wave velocity (cfPWV) is a strong predictor of cardiovascular morbidity and mortality in adults. Emerging evidence among adolescents, young adults, and middle-aged adults suggest that arterial stiffness may predict the risk of hypertension, obesity, insulin resistance, and the onset of type 2 diabetes and could be a causal risk factor for these diseases. However, it is unknown whether higher arterial stiffness temporally precedes elevated inflammation in the young population or if there is a bi-directional relationship. This evidence is crucial to developing interventions for attenuating arterial stiffness in early life. Purpose To examine the temporal causal longitudinal associations between repeated measures of cfPWV and high sensitivity C-reactive protein (hsCRP). Methods We studied 3862 adolescents, aged 17.7 years, followed-up for 7 years, from Avon Longitudinal Study of Parents and Children, birth cohort, UK. Fasting plasma hsCRP was assessed at 17.7 and 24.5-year clinic visits. In the same clinic visits, cfPWV was computed from pressure waveforms obtained using the Vicorder device (Skidmore Medical, Bristol, UK), 5 minutes after participants rested in a semi-prone position, with 2 blood pressure measurement channels and 2 Velcro pressure sensor cuffs applied over each of the carotid and femoral arteries. The assessment was repeated until three readings that were within 0.5 m/s of each other were recorded. We conducted autoregressive cross-lagged structural equation model path analyses to untangle temporal associations. We adjusted for sex, time in years between ages 17.7 and 24.5 years, age, low-density lipoprotein cholesterol, insulin, triglyceride, high-density lipoprotein cholesterol, fasting blood glucose, systolic blood pressure, heart rate, dual-energy Xray absorptiometry measured total fat mass and lean mass, ActiGraph measured moderate to vigorous physical activity at 15.5 years, smoking status, and family history of cardiovascular and metabolic diseases. Results Among 3862 adolescents (55.5% female), median (IQR) hsCRP at 17.7 and 24.5 years were 0.56 (0.98) mg/L and 0.84 (1.62) mg/L, respectively. The median (IQR) cfPWV at 17.7 and 24.5 years were 5.79 (0.66) m/s and 6.12 (1.12) m/s, respectively. Higher hsCRP at age 17.7 years was associated with higher cfPWV [Standardized β = 0.058, standard error = 0.004, p=0.037] at age 24.5 years. However, higher cfPWV at age 17.7 years was not associated with higher hsCRP [β = 0.023, standard error = 0.243, p=0.341] at 24.5 years. Conclusion We observed that elevated low-grade inflammation in adolescence may temporally cause higher arterial stiffness 7 years later, but not vice versa. Clinical and public health interventions targeted at reducing low-grade inflammation to regress the development of arteriosclerotic cardiovascular disease before mid-adulthood are needed. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Cultural Foundation

Complexity of Participation Post-Stroke: Longitudinal Assessment of Community Participation, Positive Affect, Social Support and Functional Independence

ObjectiveTo investigate longitudinal, predictive associations between community participation, positive affect, social support, and functional independence for individuals post-stroke at 3 and 12 months post-discharge.DesignLongitudinal design.SubjectsData from 544 participants were obtained from the Stroke Recovery in Underserved Populations (2005–06) database.MethodsA cross-lagged panel network analysis to identify the complex set of predictive relationships between community participation, positive affect, social support, and functional independence 3 months post-discharge to 12 months post-discharge.ResultsCommunity participation, particularly religious/spiritual activities, was an early predictor of later motor (functional) independence and social support. In addition, positive affect was an early predictor of social support.ConclusionWhile participation in social situations is a desired outcome post-stroke, the results of this study indicate the importance of identifying early factors that influence community participation throughout the recovery process.LAY ABSTRACTThe ability to participate in desired activities is a common outcome goal of rehabilitation for stroke survivors. However, there are many factors that influence success in achieving this goal, including support from family and friends, mental health, and functional independence. This study sought to understand how these factors influence each other and participation over time. The results indicate that early participation post-stroke is an important predictor of later motor independence and social support needs. The results indicate that, while participation is often viewed as a rehabilitation outcome, understanding participation as a predictor of other rehabilitation outcomes is also important.

Temporal causal longitudinal associations of high-sensitivity C-reactive protein with carotid intima-media thickness progression in adolescents: the ALSPAC birth cohort study

Abstract Background The causal role of high-sensitivity C-reactive protein (hsCRP) in the evolution of preclinical cardiovascular disease remains unclear. A previous longitudinal study concluded that hsCRP measured in childhood was not associated with a single measure of carotid intima-media thickness (cIMT) assessed at mid-adulthood. The use of hsCRP samples stored for 25 years prior to analysis might have confounded this previous findings. In the young population of adolescents and young adults no study has investigated whether elevated hsCRP temporally precedes higher cIMT or if bi-directional associations exist, due to the lack of repeated measures of cIMT. Purpose To examine the temporal causal longitudinal associations between repeated measures of cIMT and hsCRP in a young population. Methods We studied 3862 adolescents, aged 17.7 years, followed-up for 7 years, from Avon Longitudinal Study of Parents and Children, birth cohort, UK. Fasting plasma hsCRP was assessed at age 17.7 and 24.5-year clinic visits. cIMT from the right and left common carotid arteries at 17 years was assessed by ultrasound using a linear 12-MHz transducer (Vivid7, GE Medical, Chicago, Illinois) and cIMT from the right and left common carotid arteries at 24 years was measured using an ultrasound machine (CardioHealth Panasonic and a 13.5 MHz linear array broadband transducer (probe; centre frequency 9.0 MHz). We conducted autoregressive cross-lagged structural equation model path analyses to untangle temporal and bi-directional associations. We adjusted for sex, time in years between ages 17.7 and 24.5 years, age, low-density lipoprotein cholesterol, insulin, triglyceride, high-density lipoprotein cholesterol, fasting plasma glucose, systolic blood pressure, heart rate, dual-energy Xray absorptiometry measured total fat mass and lean mass, ActiGraph measured moderate to vigorous physical activity at 15.5 years, smoking status, and family history of cardiovascular and metabolic diseases. Results Among 3862 adolescents (55.5% female), median (IQR) hsCRP values at 17.7 and 24.5 years were 0.56 (0.98) mg/L and 0.84 (1.62) mg/L, respectively. The median (IQR) cIMT values at 17.7 and 24.5 years were 0.48 (0.05) mm and 0.54 (0.09) mm, respectively. Higher hsCRP at age 17.7 years was associated with cIMT [Standardized β = 0.062, standard error = 0.004, p=0.035] at age 24.5 years. However, higher cIMT at age 17.7 years was not associated with higher hsCRP [β = −0.014, standard error = 0.284, p=0.523] at 24.5 years. Conclusion These findings in the largest adolescent population to date suggest that higher inflammation in adolescence temporally precede higher carotid thickness 7 years later and there was no bi-directional relationship. Clinical and public health interventions targeted at reducing low-grade inflammation to potentially attenuate the development of atherosclerotic cardiovascular disease in the young population are warranted. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Cultural Foundation

The associations among athlete gratitude, athlete engagement, athlete burnout: A cross-lagged study in China.

The purpose of this study is to explore the causal relationship among athlete gratitude, athlete engagement, athlete burnout by cross-lag analysis of longitudinal associations. Two questionnaire surveys were conducted on 352 Chinese athletes with an interval of 1 year using gratitude questionnaire, athlete engagement questionnaire and athlete burnout questionnaire. The analysis yielded four main findings. (1) The overall level of athlete gratitude and athlete engagement was high in China. Chinese athletes at master level had higher levels of gratitude and athlete engagement than athletes at I and II grades. (2) Athlete gratitude is a significant negative predictor of athlete burnout, and also a significant positive predictor of athlete engagement. (3) Athlete engagement and athlete burnout are mutually causal and can be mutually predicted. (4) Athlete gratitude indirectly affects athlete burnout through athlete engagement, and also indirectly affects athlete engagement through athlete burnout. The results of the current study demonstrated the important value of gratitude in the growth process of athletes, and clarified the mechanism of gratitude affecting athlete engagement and athlete burnout. These findings have important implications for athlete development by raising athlete gratitude, motivating athlete engagement levels and relieve athlete burnout.

Enhancing working alliance through positive emotional experience: A cross-lag analysis

Although psychotherapy research has traditionally focused on decrease in distress, emotion research suggests the important role of positive emotional experience in healing and growing. Objective: The present study investigates the relationship between positive emotional experiences and working alliance. Method: We chose to investigate this relationship in accelerated experiential dynamic psychotherapy (AEDP), taking advantage of the modality’s focus on both negative and positive emotional experiences. Fifty-eight clients receiving 16-sessions individual AEDP reported on their post-session levels of working alliance and positive emotions (enlivenment affect, positive relational affect, and peacefulness). The alliance-emotion relationship for each emotional categories was tested with separate disaggregated cross-lagged panel models. Results: Across the three categories, higher positive emotions at the end of the previous session were associated with higher working alliance at the end of the next session. On the other hand, working alliance did not contribute to any of the positive emotions in the next time point. Furthermore, the three emotion categories showed different patterns of development. Conclusion: The findings suggest that fostering positive emotions may be a promising venue to enhance working alliance. Furthermore, differentiating specific positive emotions is likely important both for research and practice.

Clarifying longitudinal relations between individuals' support for human rights and climate change beliefs

The devastating effects of climate change on human rights has led the United Nations to recommend a human rights-based approach to climate action. However, no research has examined the relations between support for human rights and climate change beliefs, which is critical if such a rights-based approach is to receive widespread public backing. Here we combine variable- and person-centred analyses to investigate the cross-sectional and longitudinal relations between support for human rights and climate change beliefs/concern with data from the New Zealand Attitudes and Values Study (N ≈ 17,656). Cross-lagged analyses indicate that support for the broader human rights item about the right to food, clothing, housing and medicine had a bidirectional relationship with climate change beliefs/concern. A latent profile analysis then revealed four distinct subgroups of New Zealanders whose climate change beliefs/concern differed between subgroups, while all subgroups consistently supported human rights. Lastly, latent transition analysis revealed that, although two of these distinct profiles were relatively unstable across the one-year period, New Zealanders generally moved from profiles of lower to higher levels of climate beliefs/concern. Findings reveal novel implications for a rights-based climate change response.

Cross-Lagged Analyses Across Middle-Adulthood of the Bidirectional Associations Between Substance Use Disorders and Psychosocial Dysfunction.

We sought to clarify the causal nature of the bidirectional associations in adulthood between substance use disorder (SUD) and psychosocial dysfunction (PSD). As assessed from National Swedish registers, SUD is measured by alcohol use disorder (AUD) and drug use disorder (DUD) and PSD by unemployment (UN), low income (LI), and high community deprivation (HCD). A cross-lagged structural equation model from ages 31 to 48 is applied to the native Swedish population born 1960-1980 and residing in Sweden at age 29 followed through 2017 (n = 2,283,330), excluding individuals with prior SUD and PSD. All models fitted well. Focusing on the cross-lagged paths, across sexes, substances, and forms of PSD, parameter estimates for the SUD to PSD paths consistently exceeded those for the parallel PSD to SUD paths. SUD to PSD paths were nearly all statistically significant. Although the UN to SUD and LI to SUD paths were usually significant, most HCD to SUD paths were not. The differences between the UN to SUD and SUD to UN paths grew larger with increasing age, whereas the opposite pattern was seen for the HCD to SUD and SUD to HCD paths. Across sexes, forms of SUD, and dimensions of PSD, in a fully parametrized and good-fitting cross-lagged model of middle adult life, a diagnosis of SUD consistently predicted future PSD whereas PSD often but not always predicted future SUD. The SUD to PSD paths were consistently larger than the parallel PSD to SUD paths. Our results suggest a bidirectional causal relationship between SUD and PSD across adulthood, driven largely, but not entirely, by the negative effects of SUD on future psychosocial functioning.

Psychological empowerment as a route for positive adjustment during adolescence

Empowerment theory (Zimmerman, 2000) provides a framework for understanding and promoting positive youth development during adolescence. The current study considers reciprocal associations between psychological empowerment and adolescents' prosocial behavior, responsible decision making, social support giving, and delinquent behavior across the school year (n = 837 8th grade youth; 50.5% female). Results from cross-lagged analyses support Zimmerman's (2000) model of empowerment. Psychological empowerment was related to increases in prosocial behavior, responsible decision making and social support giving, and decreases in delinquent behavior over time, controlling for prior levels. Also in support of empowerment theory, we found less evidence for behavior predicting changes in empowerment. Results suggest that supporting adolescents' empowerment provides a route for positive youth development above and beyond prior behavioral tendencies.

Longitudinal associations between sleep quality and menopausal symptoms among community-dwelling climacteric women: A multi-centered study

Study objectivesMenopausal symptoms exist in most climacteric women, which can harm the quality and satisfaction of life for them. Moreover, a series of ineluctable negative life changes experienced in middle-age usually make the situation more complicated and stressful. We aimed to determine the trajectories and influential factors of sleep quality and menopausal symptoms and their longitudinal interrelationships among climacteric women. MethodsA total of 1875 community-dwelling climacteric women were included in this study. The Pittsburgh Sleep Quality Index (PSQI) and the Menopause Rating Scale (MRS) were adopted to assess sleep quality and menopausal symptoms, respectively. Data were collected 4 times from March 2019 to December 2019, at a 3-month interval. ResultsThe Cross-lagged analysis showed that worse sleep quality and more severe menopausal symptoms over time after controlling for specified covariates, and more severe menopausal symptoms were predicted by declined sleep quality. The Generalized estimation equation model showed that education level, marital status, chronic diseases, life events, income, and age were the influential factors of sleep quality, while menopausal symptoms were impacted by marital status and income. ConclusionsIncreasing negative sleep quality and more severe menopausal symptoms over time contribute to the health burden of climacteric women. Menopausal symptoms could be alleviated by sleep quality improvement, which is influenced by education level, marital status, chronic diseases, life events, age, and economic factors.