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

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.