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ABSTRACT
In this research, we conducted hierarchical multiple regression and complex sample general linear model (CSGLM) to expand knowledge on factors contributing to mental distress, particularly from a geographic perspective. Based on the Getis-Ord G* hot-spot analysis, geographic distribution of both FMD and insufficient sleep showed several contiguous hotspots in southeast regions. Moreover, in the hierarchical regression, even after accounting for potential covariates and multicollinearity, a significant association between FMD and insufficient sleep was found, explaining that mental distress increases with increasing insufficient sleep (R2 = 0.835). In the CSGLM, a R2 value of 0.782 indicated that the CSGLM procedure provided concrete evidence that FMD was significantly related to sleep insufficiency even after taking complex sample designs and weighting adjustments in the BRFSS into account. This geographic association between FMD and insufficient sleep based on cross-county study has not been reported before in the literature. These findings suggest a need for further investigation on geographic disparity on mental distress and insufficient sleep and have novel implications in our understanding of the etiology of mental distress.
Acknowledgements
The authors would like to thank the anonymous reviewers for their comments and suggestions to improve the paper. We are grateful for the constructive suggestions made by the reviewers. The contents of this publication are solely the responsibility of the authors and do not necessarily represent Center for Disease Control and Prevention (CDC)’s official views.
Disclosure statement
No potential conflict of interest was reported by the author.