Is the Association Between Neighborhood Characteristics and Sleep Quality Mediated by Psychological Distress?

An Analysis of Perceived and Objective Measures of 2 Pittsburgh Neighborhoods

Published in: Sleep Health, v. 2, no. 4, Dec. 2016, p. 277-282

Posted on RAND.org on November 30, 2016

by Amy Soo Jin DeSantis, Wendy M. Troxel, Robin Beckman, Madhumita Ghosh Dastidar, Gerald Hunter, Lauren Hale, Daniel J. Buysse, Tamara Dubowitz

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Research Questions

  1. How are perceptions of a neighborhood and objective characteristics associated with sleep quality?
  2. To what extent does psychological distress explain associations between sleep quality and neighborhood characteristics?

Background

Living in disadvantaged neighborhood environments is associated with poorer physical and mental health outcomes and higher overall mortality. However, the specific mechanisms underlying associations of neighborhood characteristics with health are not fully understood. Sleep quality represents an important potential mediator of these associations. Objectives: The objectives were to investigate associations of perceived and objective neighborhood characteristics with sleep and the extent to which associations are explained by psychological distress.

Design

The sample includes randomly selected households from 2 racially/ethnically and socioeconomically similar Pittsburgh communities.

Methods

Participants included 873 African American adults (77% female) with a median per capita household income of $13,300. Data were collected from in-person household surveys (sociodemographics, psychological distress, perceived neighborhood characteristics), daily sleep diaries, objective neighborhood street segment audits, and city crime data. We analyzed perceived and objective neighborhood characteristics and their association with sleep quality, and the degree to which psychological distress explained observed associations.

Results

Perceived neighborhood characteristics, including perceived safety (β = 0.13), neighborhood satisfaction (β = 0.14), social cohesion (β = 0.08), and perceived infrastructure (β = 0.07), were significantly associated with sleep quality (P values < .05), but objective neighborhood characteristics were not. Once psychological distress was considered, associations with perceived social cohesion and neighborhood infrastructure were fully attenuated. Associations of perceived safety and neighborhood satisfaction with sleep were attenuated by 20%–30% but remained significant.

Key Findings

  • Perceptions of neighborhood safety, social cohesion, and infrastructure were all associated with better sleep quality.
  • The associations found between perceptions of neighborhood characteristics and sleep, coupled with previously known links between sleep and health, suggest that neighborhood characteristics may play a role in health disparities in the lower-income neighborhoods studied.
  • Degree of psychological distress, such as feelings of hopelessness and anxiety, explained some but not all of the associations between perceptions of neighborhood characteristics and sleep.
  • In contrast to the link between sleep and neighborhood perceptions, no significant associations were found between sleep and objective neighborhood characteristics, such as broken windows, vacant lots, presence of sidewalks, and presence of services.

Recommendation

  • Efforts to build healthier communities, including enhancing neighborhood social cohesion, satisfaction, and safety, may have positive effects on sleep and downstream health consequences.

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