Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目标：美国黑人受到艾滋病毒流行的不成比例的影响，并在睡眠健康方面经历了巨大的差异，心理健康,和身体健康领域。使用来自感染艾滋病毒的黑人成年人样本的纵向数据，本研究调查了污名与身心健康结果之间的关联，以及睡眠障碍如何发挥中介作用。
方法：数据来自最近的一项随机对照试验。问卷调查被用来检查内化和预期的艾滋病毒污名，基于多种社会身份的感知歧视(颁布的耻辱)(即，艾滋病毒血清状态，种族,性取向)，睡眠障碍,心理健康问题（抑郁和创伤后应激障碍[PTSD]症状），以及基线时与身心健康相关的生活质量（HRQOL），7个月随访,和13个月的随访评估。线性混合模型用于检查污名对健康结果的主要影响；因果调解分析用于估计通过睡眠障碍的间接路径。
结果：内化和预期的HIV污名化和多重歧视与更多的睡眠障碍有关，更多的抑郁和创伤后应激障碍症状，精神和身体HRQOL较差。结果还表明了重要的间接路径(即，调解）通过与HIV相关的污名和歧视以及心理健康和与健康相关的生活质量之间更大的睡眠障碍。
结论：结果支持睡眠障碍是不同形式的柱头影响健康结果的中介途径。睡眠可能是一个干预目标，以帮助改善精神和身体健康，并减少种族和少数族裔艾滋病毒感染者之间的健康差距。
方法：数据来自最近的一项随机对照试验。问卷调查被用来检查内化和预期的艾滋病毒污名，基于多种社会身份的感知歧视(颁布的耻辱)(即，艾滋病毒血清状态，种族,性取向)，睡眠障碍,心理健康问题（抑郁和创伤后应激障碍[PTSD]症状），以及基线时与身心健康相关的生活质量（HRQOL），7个月随访,和13个月的随访评估。线性混合模型用于检查污名对健康结果的主要影响；因果调解分析用于估计通过睡眠障碍的间接路径。
结果：内化和预期的HIV污名化和多重歧视与更多的睡眠障碍有关，更多的抑郁和创伤后应激障碍症状，精神和身体HRQOL较差。结果还表明了重要的间接路径(即，调解）通过与HIV相关的污名和歧视以及心理健康和与健康相关的生活质量之间更大的睡眠障碍。
结论：结果支持睡眠障碍是不同形式的柱头影响健康结果的中介途径。睡眠可能是一个干预目标，以帮助改善精神和身体健康，并减少种族和少数族裔艾滋病毒感染者之间的健康差距。
