Moloney Mairead E, Slade Emily, Chung Joon, Heier Kory, Moga Daniela C
University of Miami, Miller School of Medicine, Department of Informatics and Health Data Science, United States of America; University of Miami, Frost Institute for Data Science and Computing, United States of America.
University of Kentucky, College of Public Health, Department of Biostatistics, United States of America.
J Affect Disord. 2025 Jul 14;391:119929. doi: 10.1016/j.jad.2025.119929.
Rural Appalachia has some the highest rates of sleep and health disparities in the United States. This study investigates the relationship between social support and insomnia severity in rural Appalachian adults, with specific attention to the potential mediating roles of depression, anxiety, and stress.
Participants from 12 rural Eastern Kentucky counties completed validated measures of insomnia severity, social support, depression, anxiety, and perceived stress. Using R, we calculated descriptive statistics and fit mediation models for depressive symptoms, anxiety symptoms, and stress, with social support as the exposure and insomnia severity as the outcome.
Aligning with regional demographics, nearly all participants identified as Caucasian/White (97.4 %) and non-Hispanic/non-Latin (a/o)/non-Latinx (96.8 %). Of 270 participants (mean age: 46 [SD = 13.2], 79.9 % women) 30 % had clinically significant insomnia. Greater social support was associated with lower insomnia severity (r = -0.30, p < 0.001) in unadjusted analyses. Mediation analyses revealed that this relationship was significantly mediated by depressive symptoms (69 %), anxiety symptoms (64 %), and perceived stress (78 %). After accounting for these psychological mediators, the direct effect of social support on insomnia was no longer significant.
Our findings provide valuable insight into the psychological mechanisms linking social support and sleep health in rural Appalachian adults, though generalizability may be limited to similar racially homogeneous, rural populations. Social support influences insomnia symptoms in rural Appalachian adults primarily through psychological pathways, particularly by buffering against stress. Interventions addressing sleep problems in this population should target psychological factors while leveraging existing social resources within the cultural context of Appalachia.
美国阿巴拉契亚农村地区的睡眠和健康差异率位居前列。本研究调查了美国阿巴拉契亚农村地区成年人社会支持与失眠严重程度之间的关系，并特别关注抑郁、焦虑和压力的潜在中介作用。
来自肯塔基州东部12个农村县的参与者完成了失眠严重程度、社会支持、抑郁、焦虑和感知压力的有效测量。我们使用R语言计算描述性统计量，并以社会支持为暴露因素、失眠严重程度为结果，对抑郁症状、焦虑症状和压力进行中介模型拟合。
与该地区人口统计数据一致，几乎所有参与者都认定为白种人/白人（97.4%）和非西班牙裔/非拉丁裔（96.8%）。在270名参与者中（平均年龄：46岁[标准差=13.2]，79.9%为女性），30%有临床显著的失眠症状。在未调整分析中，更高的社会支持与更低的失眠严重程度相关（r=-0.30，p<0.001）。中介分析显示，这种关系由抑郁症状（69%）、焦虑症状（64%）和感知压力（78%）显著介导。在考虑这些心理中介因素后，社会支持对失眠的直接影响不再显著。
我们的研究结果为阿巴拉契亚农村地区成年人社会支持与睡眠健康之间的心理机制提供了有价值的见解，尽管其普遍性可能仅限于类似的种族同质农村人口。社会支持主要通过心理途径影响阿巴拉契亚农村地区成年人的失眠症状，特别是通过缓冲压力。针对该人群睡眠问题的干预措施应在阿巴拉契亚文化背景下利用现有社会资源的同时，针对心理因素。
