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Chessa A, Schrempft S, Richard V, Baysson H, Pullen N, Zaballa ME, Lorthe E, Nehme M, Guessous I, Stringhini S. Perceived financial hardship and sleep in an adult population-based cohort: The mediating role of psychosocial and lifestyle-related factors. Sleep Health 2025; 11:222-229. [PMID: 39848817 DOI: 10.1016/j.sleh.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/14/2024] [Accepted: 12/14/2024] [Indexed: 01/25/2025]
Abstract
BACKGROUND Social inequalities in sleep have been reported, but there is less research on the mechanisms underlying this association. This study investigates the relationship between financial hardship and sleep within the general adult population, focusing on the mediating effects of psychosocial and lifestyle-related factors. METHODS We used data from the Specchio cohort, a population-based study in Geneva, Switzerland, initiated in December 2020. Perceived financial hardship and sleep outcomes (insomnia, sleep quality, and sleep duration) were assessed by questionnaire in 2020 to 2021. Counterfactual mediation analysis was conducted to examine the extent to which perceived financial hardship impacts sleep through psychosocial (psychological distress and loneliness) and lifestyle-related (weight, smoking, and physical inactivity) pathways. Models were adjusted for age, sex, education, living alone, and chronic disease. RESULTS Among 4388 participants, those experiencing financial hardship had a greater risk of insomnia (odds ratio: 2.11; 95% confidence interval: 1.70-2.61), poor sleep quality (odds ratio: 1.69; 95%confidence interval: 1.41-2.02), and not meeting sleep duration guidelines (odds ratio: 1.40; 95% confidence interval: 1.18-1.66) compared to those without financial difficulties. Psychosocial factors explained 40% of the relationship of financial hardship with insomnia, 35% of the relationship with poor sleep quality, and 10% of the association with suboptimal sleep duration. The contribution of lifestyle-related factors was 8%, 12%, and 17%, respectively. CONCLUSION Perceived financial hardship is a significant predictor of poor sleep, and this association is mediated by psychosocial and, to a lesser extent, lifestyle-related factors. These findings highlight the need for integrative approaches addressing social inequalities in sleep.
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Affiliation(s)
- Ambra Chessa
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
| | - Viviane Richard
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Nick Pullen
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - María-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Mayssam Nehme
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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