Discrimination and sleep quality among older US adults: the mediating role of psychological distress

Abstract

Objective: To examine the association between everyday discrimination and sleep quality and identify mediating pathways between discrimination and sleep quality.

Design: Longitudinal.

Setting: Health and Retirement Study (HRS).

Participants: Participants (N = 9223, mean age 66.7 years, 12.8 years of education; 85% White, 12% African American, and 3% another race or ethnicity) who participated in 2006, 2008, 2010, and 2012.

Measurements: At each assessment, participants completed measures of everyday discrimination, lifetime discrimination, attributions of discrimination, depressive symptoms, anxiety symptoms, sleep quality, and non-restfulness.

Results: More experiences with everyday discrimination were associated with worse sleep quality (β = 0.048, SE = 0.009, P < .01). When psychological distress was added to this model, the direct effect was lower in both magnitude and significance (β = 0.029, SE = 0.011, P < .05), which indicated partial mediation. Psychological distress also fully mediated the relation between everyday discrimination and non-restfulness (direct effect: β = -0.003, SE = 0.010, ns). Individuals who experienced physical disability-based discrimination had worse sleep quality than those who did not experience this form of discrimination (β = 0.114, SE = 0.029, P < .01); psychological distress fully mediated this relation (direct effect: β = -0.025, SE = 0.031, ns). Among individuals with obesity, psychological distress fully mediated the relation between weight discrimination and sleep quality (direct effect: β = 0.036, SE = 0.025, ns), and partially mediated the relation between weight discrimination and non-restfulness (direct effect: β = 0.049, SE = 0.025, P < .05).

Conclusions: Everyday discrimination and discrimination based specifically on weight or a physical disability were associated with worse sleep quality. The findings suggest that psychological distress may be one pathway through which these experiences are associated with worse sleep.

Keywords: Discrimination; Older adults; Psychological distress; Sleep.