Sleep Health and Serious Psychological Distress: A Nationally Representative Study of the United States among White, Black, and Hispanic/Latinx Adults

Abstract

Purpose

Prior studies investigating the relationship between sleep and serious psychological distress (SPD) have lacked racial/ethnic diversity and generalizability. We investigated associations between sleep and SPD among a large, nationally representative, and racially/ethnically diverse sample of US adults.

Methods

We pooled cross-sectional data from the 2004 to 2017 National Health Interview Survey. Participants self-reported sleep duration and sleep disturbances (eg, trouble falling and staying asleep). SPD was defined as a Kessler Psychological Distress Scale (K6) score ≥13. Adjusting for sociodemographic, health behavior, and clinical characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of SPD for each sleep characteristic, overall and by race/ethnicity.

Results

Among 316,840 participants, the mean age ± standard error was 46.9 ± 0.1 years, 52% were women, 75% were non-Hispanic (NH)-White, 16% NH-Black, and 9% Hispanic/Latinx. The prevalence of SPD was 3.4% for NH-Whites, 4.1% for NH-Blacks, and 4.5% for Hispanics/Latinxs. Participants with <7 hours versus 7–9 hours of sleep duration were more likely to have SPD, and the magnitude of the association was strongest among NH-Black participants (PR_NH-Blacks=3.50 [95% CI: 2.97–4.13], PR _{Hispanics/Latinx}=2.95 [2.42–3.61], and PR_NH-Whites=2.66 [2.44–2.89]). Positive associations between sleep disturbances and SPD were generally stronger among NH-Black and Hispanic/Latinx compared to NH-White adults.

Conclusion

Poor sleep health was positively associated with SPD, and the magnitude of the association was generally stronger among racial/ethnic minorities. Future investigations should prospectively focus on the determinants and health consequences of SPD attributable to objectively measured sleep across racial/ethnic groups.

Keywords:

• sleep initiation and maintenance disorders
• sleep
• psychological stress
• health status disparities
• continental population groups
• race factors

Acknowledgments

This research was presented, in part, at Society for Advancement of Chicanos and Native Americans in Science – The National Diversity in STEM Conference in Honolulu, Hawaii on October 31 – November 2, 2019 and at the State of North Carolina Undergraduate Research and Creativity Symposium in Durham, North Carolina on November 23, 2019. We are grateful to Stacy Mantooth and Erin Knight for assistance with the literature search.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. Authors: Samuel J. Goldstein, Symielle A. Gaston, John A. McGrath, Chandra L. Jackson Study concept and design: CL Jackson Acquisition of data: CL Jackson Statistical Analysis: JA McGrath, SJ Goldstein Interpretation of data: SJ Goldstein, SA Gaston, JA McGrath, CL Jackson Drafting of the manuscript: SJ Goldstein Critical revision of the manuscript for important intellectual content: SJ Goldstein, SA Gaston, J McGrath, CL Jackson Administrative, technical, and material support: CL Jackson Obtaining funding and study supervision: CL Jackson Final Approval: Goldstein SJ; Gaston SA; McGrath JA; Jackson CL.

Disclosure

The authors have no conflicts of interest to disclose.

Additional information

Funding

This work was funded by the Intramural Program at the NIH, NIEHS (Z1AES103325-01) and the NIEHS Scholars Connect Program.