title: Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus.
abstract: BACKGROUND
  Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus.
  
  
  OBJECTIVE
  We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus.
  
  
  METHODS
  Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation.
  
  
  RESULTS
  Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R2: 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R2: 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R2: 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status.
  
  
  CONCLUSIONS
  Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096.
authors.affiliation: Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health, Farmington, CT; bermudez-millan@uchc.edu.
authors.forename: Angela
authors.identifier: http://orcid.org/0000-0002-7905-4575
authors.initials: A
authors.lastname: Bermúdez-Millán
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.affiliation: Hispanic Health Council, Hartford, CT.
authors.forename: Sofia
authors.initials: S
authors.lastname: Segura-Pérez
authors.affiliation: Hispanic Health Council, Hartford, CT.
authors.forename: Grace
authors.initials: G
authors.lastname: Damio
authors.affiliation: Research Program, Hartford Hospital, Hartford, CT; and.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Chhabra
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.affiliation: Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health, Farmington, CT.
authors.forename: Julie
authors.initials: J
authors.lastname: Wagner
mesh_terms: D000368:Aged; D001007:Anxiety; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D005260:Female; D005523:Food Supply; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012890:Sleep; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Latinos; diabetes; household food insecurity; psychological distress; sleep quality