Multidimensional Sleep Problems as Mediators between Recession Hardships and Changes in Physical Health

TL;DR

This study finds that sleep problems during the 2008 Recession partially explain how economic hardships led to worse physical health in adults.

Contribution

The study introduces a novel composite measure of multidimensional sleep problems as a mediator linking recession hardships to health declines.

Findings

Recession hardships were linked to increased sleep problems and worse physical health outcomes.

Sleep problems partially mediated the relationship between economic hardships and chronic conditions.

Targeting sleep health could be an effective intervention to mitigate recession-related health declines.

Abstract

The 2008 economic Recession was associated with physical health declines and poor sleep outcomes. This study tests a novel composite measure of poor sleep as a mediator of Recession-related changes in physical health in a longitudinal sample of adults from the Midlife in the United States study (n = 2,674). Participants reported sleep problems across five dimensions (Regularity, Satisfaction, Alertness, Efficiency, and Duration) and functional health and total chronic conditions at pre-recession (2004-2006) and post-recession (2013-2014). Hardships included financial, housing, and job events attributed to the 2008 Recession. Adjusting for relevant covariates and pre-Recession sleep problems, regression models showed that recession hardships were positively associated with total post-Recession sleep problems (a = 0.05, 95% CI [0.03, 0.07], p <.001) and were positively associated with functional limitations (c = 0.03, 95% CI [0.02, 0.04], p <.001) and chronic conditions (c = 0.10, 95% CI [0.05, 0.15], p <.001). Further, post-recession sleep problems were associated with increases in functional limitations (b = 0.11, 95% CI [0.08, 0.14], p <.001) and chronic conditions (b = 0.48, 95% CI [0.38, 0.58], p <.001). The bootstrap estimate of the indirect effects of Recession hardships on health outcomes via post-Recession sleep problems were statistically significant (Functional limitations a*b = .004, 95%CI [.002, .006]; Chronic conditions a*b= 0.01, 95% CI [.006, .02]). More sleep health problems may be a key pathway through which Recession hardships lead to poorer health in middle and older adulthood and may be important targets for intervention.