Perceived discrimination and mental health outcomes in college students: the mediating effect of preventive health behaviors and social support

Objective: To examine the role of social support and health behaviors in the association between discrimination and mental health (e.g., anxiety/depressive symptoms, suicidal ideation) among college students experiencing various forms of discrimination. Participants: Data were collected from 709 college students (42.8% White; 72.2% female) at a large urban university in Fall 2017. Methods: Students completed an online survey assessing perceived discrimination, anxiety/depressive symptoms, suicidal behavior, health behaviors, and social support. Moderation and parallel mediation analyses were conducted in PROCESS SPSS. Results: Results indicated that preventive health behaviors and social support partially mediated associations between discrimination and mental health outcomes. Conclusions: Findings highlight the need to increase awareness regarding engaging in preventive health behaviors on college campuses. For students experiencing discrimination, prevention, and social support might be key factors in improving mental health.

Sleep and Cognition: A Narrative Review Focused on Older Adults

Little is known regarding sleep's association with the traditional developmental course of late-life cognitive functioning. As the number of older adults increases worldwide, an enhanced understanding of age-related changes in sleep and cognition is necessary to slow decline and promote optimal aging. This review synthesizes the extant literature on sleep and cognitive function in healthy older adults, older adults with insomnia, and older adults with sleep apnea, incorporating information on the potential promising effects of treating poor sleep on cognitive outcomes in older adults. Unifying theories of the sleep-cognition association, possible mechanisms of action, and important unanswered questions are identified.

0063 Biopsychosocial Predictors of Sleep Health in Black, Asian, and Hispanic/Latinx Samples

Introduction

Sleep health is an important aspect of sleep and is associated with biopsychosocial factors such as physical health, mental health, and social functioning. Disparities in sleep health are widely prevalent in individuals who identify as Black, Asian, and Hispanic/Latinx. Investigating unique associations between general sleep health and biopsychosocial factors may elucidate underlying associations and lead to innovative approaches to promote sleep health in these historically marginalized populations.

Methods

3,284 adults participated in an online study investigating sleep longitudinally across normal development (ISLAND). These analyses were conducted in the samples of individuals who self-identified as Black (n = 263, Mage = 40.6 years, 52.1% female), Asian (n = 208, Mage = 34.8 years, 39.9% female), and Hispanic/Latinx (n = 216, Mage = 35.8 years, 44.4% female). Participants were stratified across the lifespan, with equal numbers of men and women recruited. Participants completed several questionnaires including demographics, the RU-SATED, Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and the De Jong Gierveld Loneliness Scale. Multiple regression analyses were conducted within each group to determine whether biological (PHQ-15 without the sleep item), psychological (composite score of PHQ-2 and GAD-2), and social (social loneliness factor of the De Jon Gierveld Loneliness Scale) predictors of sleep health while controlling for demographic variables (i.e., age, sex, education).

Results

Within the Black sample, lower mental health functioning was associated with poorer sleep health (p=0.008). Within the Asian sample lower physical functioning and lower mental health functioning were significantly associated with poorer sleep health (p’s<.001). Within the Hispanic/Latinx sample, lower physical functioning was significantly associated with poorer sleep health (p<.001).

Conclusion

Sleep health was observed to be associated with biopsychosocial factors within Black, Asian, and Hispanic/Latinx samples. Unique patterns of associations were observed within each sample. Future research would benefit from employing longitudinal designs or using more objective measurements to further elucidate these associations.

Support (If Any)

National Institute on Aging of the National Institutes of Health under Award Number K23AG049955 (PI: Dzierzewski).

0594 Functional Limitations and Well-Being Throughout the Adult Lifespan: The Moderating Role of Sleep

Introduction

Functional limitations represent individuals’ difficulty with completing essential activities of daily living, such as sitting, stooping, and walking. Though functional limitations have been linked to lower well-being outcomes, less is known about potential protective factors for well-being in the lived experience of functional limitations. This study aimed to examine the potential moderating effect of sleep quality on the association between functional limitations and life satisfaction, a common indicator of well-being, across the adult lifespan.

Methods

The present study used archival data from the Midlife in the United States Refresher study. Participants included 696 individuals (50.6% female, Mage=51.58 years, SD=13.61 years) who completed measures of functional limitations (Functional Status Questionnaire), global sleep quality (Pittsburg Sleep Quality Index), and life satisfaction (single-item measure). A moderated moderation analysis was conducted to examine the moderating role of sleep quality on the association between functional limitations and life satisfaction. Age was included as a secondary moderator in the analysis to determine differences between age groups (younger, middle-aged, elders). Demographic variables of gender and racial identity were used as covariates in study analyses.

Results

Participants’ global sleep score was a significant moderator of the association between functional limitation status and life satisfaction (B = 0.16, p < .001). Overall better global sleep quality buffered the association between higher functional limitations and worse life satisfaction. A significant three-way interaction between age, global sleep, and functional limitations was detected (β = -0.003, ΔR2 = .02, F(1, 686) = 12.25, p < .001). The effect of global sleep on the association between life satisfaction and functional limitation status was significant for younger adults (B = 0.07, p < .001) and middle-aged adults (B = 0.02, p = .0224), but not for elders (B = -0.02, p = .2223). Better global sleep quality buffered the negative association between functional limitations and life satisfaction specifically for younger and middle-aged adults.

Conclusion

The current study provided evidence for the importance of sleep quality in the lived experience of functional limitations, particularly for younger and middle-aged adults. This study contributes to a rapidly growing body of literature that seeks to identify protective factors for individuals experiencing lower functioning. In the future, clinicians should integrate sleep quality screeners in medical and mental health care settings in order to identify at-risk individuals who are experiencing functional limitations, and potentially consider establishing preventative, education-based interventions concerning sleep in the experience of functional limitations.

Support (If Any)

 

197 Refining the Subjective Assessment of Sleep: An SEM Approach

Introduction

Given that sleep is multidimensional, the assessment of sleep requires an examination of a number of different domains. Accordingly, there is an abundance of self-report sleep questionnaires that are widely used for both research and clinical use. The surplus of available measures can be problematic, as it often leads to difficulties in selecting the best measure for a given purpose/context. In addition, the use of multiple measures to assess sleep may be an inefficient use of time and resources if they are not measuring unique constructs. The purpose of the current study is to evaluate the factor structure of five sleep measures. A confirmatory factor analysis (CFA) was initially used to evaluate whether each of these scales are measuring different factors of sleep, with follow-up exploratory factor analysis (EFA) as needed.

Methods

An archival analysis was performed using data from an online study, Investigating Sleep Across Normal Development (ISLAND Study). The sample consisted of 3,284 adults aged 18+. The following measures were utilized: RU SATED, PROMIS Sleep-Related Impairment, Sleep Self-Efficacy, Insomnia Severity Index, and the Sleep Regularity Questionnaire.

Results

As expected, the CFA model fit was determined to be poor and an EFA was then conducted to assess the factor structure of these scales. The EFA revealed a four-factor structure comprised of 25 items: Sleep-Related Daytime Impairment, Sleep Regularity, Sleep Disturbance, and Sleep-Related Daytime Enhancement.

Conclusion

The findings from the current study add to the literature supporting the multidimensionality of sleep, as well as the continued need to assess the various facets that comprise this construct. Although the literature supports the utility of these five measures, the present study found that within a community sample, these measures are not entirely unique. Further, the present study extends our knowledge and the literature by revealing a novel factor of sleep – Sleep-Related Daytime Enhancement. It may be worthwhile for researchers and clinicians to consider latent sleep factors that contribute to sleep disturbance and sleep health. Future work is needed to further confirm the observed factor structure and assess the psychometrics of this new scale.

Support (if any)

National Institute on Aging (K23AG049955, PI: Dzierzewski).

538 Sleep and Self-Efficacy: The Role of Domain Specificity in Predicting Sleep

Introduction

Poor sleep occurs across the lifespan and has a number of consequences across biopsychosocial life domains. As such, it is important to identify modifiable psychobehavioral mechanisms contributing to sleep disturbance as potential targets for research and intervention. Self-efficacy may play a significant role in sleep behavior outcomes. The present study aimed to determine the differential associations between general and sleep self-efficacy and sleep among a lifespan sample of adults.

Methods

Data from the Investigating Sleep Longitudinally Across Normal Development (ISLAND) study were utilized for the present investigation. Participants were 3,284 adults (48.5% female, 6.4% other-identifying, Mage= 43 yrs., SD=16.72 yrs.) who completed self-report sleep, general-, and sleep self-efficacy measures as part of their study involvement. A Structural Equation Model (SEM) was estimated to investigate whether general or sleep self-efficacy were significant predictors of a latent sleep disturbance variable, which was comprised of the presence of insomnia symptoms (Insomnia Severity Index) and the absence of sleep health (RU-SATED). Invariance tests were utilized to determine whether the model held across age and sex.

Results

The structural model evidenced good fit to the data and indicated that general self-efficacy did not have a significant, direct impact on the latent sleep construct (b=-.01, p=.33); however, sleep self-efficacy did display a significant, negative association with sleep disturbance (b=-.82, p<.001), whereby increased sleep self-efficacy was associated lower levels of disturbed sleep. The model was largely invariant across age and sex.

Conclusion

Sleep self-efficacy surfaced as an important predictor of sleep disturbance above and beyond general self-efficacy. Findings highlight the importance of domain specificity in the predicting sleep outcomes. Additionally, findings suggest the need for increased research into and application of interventions targeted toward increasing sleep self-efficacy in individuals with sleep disturbance as a potential avenue to improve sleep health.

Support (if any):

548 Predicting Perceived Functional Limitation in Midlife and Older Adulthood: The Role of Sleep and Perceived Control

Introduction

Functional limitations become increasingly common and debilitating as individuals age, potentially impacting several facets of well-being. As such, it is important to understand malleable factors that may potentially impact functional limitation outcomes. Both sleep and perceived control have been linked to the development of functional limitation. The current study sought to clarify the unique contributions of both sleep quality and perceived control to functional limitation status in middle-aged and older adults.

Methods

Data from the second wave of the Midlife in the United States study were used for the current study. Participants included 527 participants (59.9% female, Mage=59.83 years, SD=9.75 years) who completed measures of functional limitation levels (Functional Status Questionnaire), subjective sleep quality (Pittsburg Sleep Quality Index), and perceived control (MIDI Sense of Control Scales). A hierarchical regression analysis was conducted to examine sleep quality and perceived control as predictors in a unique model for predicting functional limitation. Demographic variables of age, gender, and race were used as covariates in study analyses.

Results

The overall model predicted 19.0% of the variance in functional limitation levels. Sleep quality was significantly associated with self-reported functional limitation (β=-.27, p<.001) over and above perceived control (β=.20, p<.001). Specifically, findings indicate that worse sleep quality is associated with increased functional limitation, while higher levels of perceived control are associated with lower levels of functional limitation.

Conclusion

Though perceived control is known to be associated with functional limitation status, the present study suggests a unique effect of sleep quality on functional limitation even after accounting for perceived control. Due to the potential for negative effects of functional limitation in middle-aged to older adults, it is important to identify and target constructs for research and intervention related to the development of these limitations. Care models for individuals who report experiencing functional limitations may benefit from targeting sleep health and control beliefs in intervention and assessment.

Support (if any):

131 Sleep Quality as a Pathway from Stress to Cold Symptom Severity

Introduction

Stress is a known contributor to immune system suppression associated with higher illness susceptibility, including acute infectious respiratory illness, or the common cold. Sleep quality, shown to impact immunity, is an additional mechanism that may underlie the association between stress and cold symptomatology. Although the associations between stress and sleep and cold symptomatology have been examined separately, little is known about the mechanistic role of sleep in these associations. The present study examined sleep quality as a potential pathway between stress and cold symptomatology difference scores.

Methods

Archival data from the Common Cold Project (Pittsburgh Cold Study 3) were utilized for the present study. Participants were 213 adults (Mean Age=30.1 yrs., SD=10.9 yrs., 42.3% female) who completed a 5-day viral challenge and self-report measures of cold severity (Jackson Symptom Score; measured from beginning to end of viral challenge), baseline sleep quality (PSQI), and perceived stress as part of study participation. SPSS v 27 and Hayes’ PROCESS mediation macro were used to assess study aims. Age and sex were included as covariates.

Results

Greater perceived stress was significantly associated with worse sleep quality [B=.15, 95% CI .10, .21]. Sleep quality fully mediated the association between stress and changes in symptomatology; better sleep was associated with larger changes in cold severity [B=-.23, 95% CI -.43, -.04], defined as differences in symptomatology from beginning to end of the viral challenge, beyond stress alone. Zero-order correlation analyses revealed a trend level (r=.04, p=.06) association between sleep quality and aggregate cold severity, suggesting that as sleep improves, symptoms decrease.

Conclusion

Within the present sample, sleep quality surfaced as an indirect pathway linking stress to changes in cold severity. Better sleep was associated with greater changes in cold severity above perceived stress. These findings, together with the trend level, positive association between sleep quality and cold symptomatology, suggest that better sleep may be associated with less severe symptomatology. Future research should attend to mechanisms underlying the associations between stress, sleep, and cold symptomatology.

Support (if any):

179 Insomnia Symptoms in Latinx emerging adults: The role of perceived discrimination

Introduction

An individual’s culture presents unique risk and protective factors related to sleep outcomes. Similarly, emerging adulthood also represents a unique developmental period as it relates to sleep. The study of cultural factors during emerging adulthood is critical for better understanding the development of sleep dysfunction in vulnerable segments of the population. The present study investigated the association between perceived discrimination and insomnia symptoms in Latinx emerging adults. We hypothesized that perceived discrimination would result in higher insomnia symptom presentation above and beyond anxiety and depressive symptoms.

Methods

Participants included 198 (73.7% female; mean age=18.96) college-aged individuals self-identifying as Hispanic/Latinx who completed an online survey that assessed perceived racial/ethnic discrimination (Everyday Discrimination Scale; EDS), anxiety symptoms (General Anxiety Disorder Scale; GAD-7), depression symptoms (Patient Health Questionnaire; PHQ-9), and insomnia symptoms (Insomnia Severity Index; ISI). A three-block hierarchical regression was used to assess the impact of perceived discrimination on the presentation of insomnia symptomology above and beyond demographic characteristics and anxiety and depressive symptoms.

Results

The final model significantly predicted insomnia symptom presentation, F(5, 191)=26.379, p<.001, R2=.408. When age and gender identity were entered into the model they did not significantly predict insomnia symptoms F(2, 194)=.199, p=.82, R2=.002. Blocks 2, anxiety and depression symptoms (∆R2=.388), and 3, perceived discrimination (∆R2=.018), accounted for significant change in variance. In the final model, perceived discrimination significantly predicted insomnia symptoms (β=.151) above and beyond age (β=.016), gender identity (β= -.085), anxiety (β= -.075), and depression (β=.621).

Conclusion

Results suggest that discrimination among Hispanic/Latinx emerging adults is a unique contributor that may explain some of the higher prevalence rates of insomnia symptomology in this segment of the population. As such, it would be beneficial to tailor existing approaches aimed at improving sleep outcomes by accounting for stressors that could result from or influence discrimination against the individual and incorporate other cultural factors into treatment protocols.

Support (if any)

National Institute on Aging (K23AG049955, PI: Dzierzewski).

Sleep Health as Measured by RU SATED: A Psychometric Evaluation

Objective/Background: Sleep health is a multidimensional construct of sleep and wakefulness that operationalizes optimal sleep as more than the absence disease. Despite its importance to public health promotion efforts, empirical research examining sleep health is currently limited, possibly due to the lack of empirically validated measures. Therefore, the purpose of the current study was to evaluate the psychometric properties of a previously proposed six-item sleep health scale (RU- SATED). Participants: A sample of 3,401 adults (Mean Age = 42.77, 47.8% female) completed an online survey of sleep and health. Methods: Participants completed the RU-SATED scale, as well as other sleep-related measures including the Insomnia Severity Index (ISI) and the Sleep Self-Efficacy Scale (SSE). Results: An exploratory factor analysis (EFA) revealed a two-factor structure. A confirmatory factor analysis (CFA) using this two-factor structure demonstrated adequate to good model fit indices (X 2 = 45.96, df = 8, p < .01; RMSEA = .04; CFI = .98; NFI = .98; TLI = .97). Cronbach's α was .64 and the average interitem correlation was .22. RU-SATED was negatively associated with insomnia severity and positively associated with both self-reported sleep and sleep self-efficacy. Conclusions: RU-SATED appears to be a valid instrument for the assessment of sleep health among adults that is related to, but distinct from, other established sleep constructs. Future research may benefit from examining the test-retest reliability of the measure and assessing the predictive validity of sleep health as it relates to health-related outcomes.

0378 Social Well-Being as a Longitudinal Mediator of the Association Between Discrimination and Sleep Quality

Introduction

Discrimination is a risk factor for poor sleep outcomes. Physiological activation is one mechanism tying the experience of discrimination to disturbed sleep. Discrimination, however, can also impact psychosocial well-being, which is a necessary precursor for healthy sleep. Feelings of safety derived from social connections can be threatened when individuals face discrimination. The objective of the current study was to examine the role of social well-being as a factor underlying the longitudinal association between discrimination and sleep quality.

Methods

An archival analysis was conducted with 937 adults participating in the longitudinal Midlife in the United States (MIDUS) study. Data was collected at three time points across 10 years. Perceived daily discrimination and overall social well-being were assessed via self-report. Sleep quality was assessed via the Pittsburgh Sleep Quality Index, Global Sleep Quality score.

Results

The overall model accounted for 15.6% of variance in global sleep quality. Controlling for multiple covariates, more frequent experiences of discrimination predicted worse global sleep quality 10 years later (β=.06, p=.03). Worse overall social well-being was a significant mediator of the discrimination-global sleep quality association (95% CI [.0001, .0118]), such that more frequent discrimination predicted lower overall social well-being, which, in turn, was associated with worse global sleep quality.

Conclusion

Given the persistence of sleep disparities among stigmatized and marginalized groups and the importance of sleep as a means of health disparity reduction, there is a need to identify mechanisms linking discrimination to poor sleep outcomes. Daily experiences of discrimination, such as being given less respect or treated as though less intelligent, have long-lasting associations with social well-being. Furthermore, social well-being is a predictor of future sleep quality. In addition to addressing discriminatory practices, targeting the effects of social well-being on sleep is a direction for future research.

Support

N/A

Sleep and Cognition in Older Adults

Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.

Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders

PURPOSE

The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US.

METHODS

Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted.

RESULTS

Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast.

CONCLUSIONS

Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities.

Daily variations in objective nighttime sleep and subjective morning pain in older adults with insomnia: evidence of covariation over time

OBJECTIVES

To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia; to examine not only the difference between persons in the association between sleep and pain (mean level over 14 days), but also the within-person, day-to-day association.

DESIGN

Cross-sectional.

SETTING

North-central Florida.

PARTICIPANTS

Fifty community-dwelling older adults (mean age+/-standard deviation 69.1+/-7.0, range 60-90) with insomnia.

MEASUREMENTS

Daily home-based assessment using nightly actigraphic measurement of sleep and daily self-report of pain over 14 consecutive days.

RESULTS

Between persons, average sleep over 14 days was not associated with average levels of rated pain, but after a night in which an older adult with insomnia experienced above-average total sleep time he or she subsequently reported below-average pain ratings. The model explained approximately 24% of the within-person and 8% of the between-person variance in pain ratings.

CONCLUSIONS

Sleep and pain show day-to-day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep.