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

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 (beta = 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 (beta = 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: beta = -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 (beta = 0.114, SE = 0.029, P< .01); psychological distress fully mediated this relation (direct effect: beta = -0.025, SE = 0.031, ns). Among individuals with obesity, psychological distress fully mediated the relation between weight discrimination and sleep quality (direct effect: beta = 0.036,SE = 0.025, ns), and partially mediated the relation between weight discrimination and non-restfulness (direct effect: beta = 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. (C) 2016 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.