Dong Lu, Bogart Laura M, Mutchler Matt G, Klein David J, Ghosh-Dastidar Madhumita Bonnie, Lawrence Sean J, Goggin Kathy, Wagner Glenn J
RAND Corporation, 1776 Main Street, Santa Monica, CA, USA.
Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
J Racial Ethn Health Disparities. 2024 Jul 11. doi: 10.1007/s40615-024-02083-0.
Black Americans have been disproportionally affected by the HIV epidemic, and experience significant disparities in sleep health, mental health, and physical health domains. Using longitudinal data from a sample of Black adults with HIV, the current study examined the associations between stigma and mental and physical health outcomes and how sleep disturbance may play a mediating role.
Data were drawn from a recent randomized controlled trial. Questionnaires were used to examine internalized and anticipated HIV stigma, perceived discrimination (enacted stigma) based on multiple social identities (i.e., HIV-serostatus, race, sexual orientation), sleep disturbance, mental health problems (depressive and posttraumatic stress disorder [PTSD] symptoms), and mental and physical health-related quality of life (HRQOL) at baseline, 7-month follow-up, and 13-month follow-up assessments. Linear mixed modeling was used to examine main effects of stigma on health outcomes; causal mediation analysis was used to estimate indirect paths through sleep disturbance.
Internalized and anticipated HIV stigma and multiple discrimination were associated with more sleep disturbance, more depressive and PTSD symptoms, and poorer mental and physical HRQOL. Results also indicated significant indirect paths (i.e., mediation) through greater sleep disturbance between HIV-related stigma and discrimination and mental health and health-related quality of life.
Results support that sleep disturbance is a mediating pathway through which different forms of stigmas impact health outcomes. Sleep may be an intervention target to help improve mental and physical well-being and reduce health disparities among racial and ethnic minority people with HIV.
美国黑人受艾滋病毒流行的影响尤为严重，在睡眠健康、心理健康和身体健康方面存在显著差异。本研究利用一组感染艾滋病毒的黑人成年人的纵向数据，检验了耻辱感与心理健康和身体健康结果之间的关联，以及睡眠障碍可能如何发挥中介作用。
数据来自最近一项随机对照试验。通过问卷调查在基线、7个月随访和13个月随访评估时，考察内化的和预期的艾滋病毒耻辱感、基于多种社会身份（即艾滋病毒血清状态、种族、性取向）的感知歧视（实际耻辱感）、睡眠障碍、心理健康问题（抑郁和创伤后应激障碍[PTSD]症状）以及与身心健康相关的生活质量（HRQOL）。采用线性混合模型检验耻辱感对健康结果的主要影响；采用因果中介分析估计通过睡眠障碍的间接路径。
内化的和预期的艾滋病毒耻辱感以及多重歧视与更多的睡眠障碍、更多的抑郁和创伤后应激障碍症状以及更差的身心健康相关生活质量有关。结果还表明，在与艾滋病毒相关的耻辱感和歧视与心理健康及与健康相关的生活质量之间，通过更大的睡眠障碍存在显著的间接路径（即中介作用）。
结果支持睡眠障碍是不同形式的耻辱感影响健康结果的一条中介途径。睡眠可能是一个干预靶点，有助于改善身心健康，减少感染艾滋病毒的种族和少数民族人群之间的健康差距。
