Abstract Body (Do not enter title and authors here): BACKGROUND: Social determinants of health (SDOH)—the conditions in which people are born, grow, live, work, and age—strongly influence health. Rural adults with cardiovascular disease (CVD) are especially vulnerable to the negative effects of SDOH and sleep problems, which lead to poor sleep-related functioning, such as difficulties concentrating or safe driving. Understanding how SDOH impact sleep-related functional outcomes is essential for developing effective interventions. Perceived control and depressive symptoms are key potential pathways linking SDOH to these outcomes.
OBJECTIVE: To explore if perceived control and depressive symptoms mediate the association between SDOH and sleep-related functional outcomes among rural adults with CVD.
METHOD: We enrolled 158 rural adults with CVD (female: 42%, age: 59±12) from out-patient settings. The SDOH were assessed using the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences. Sleep-related functional outcomes were measured using the Functional Outcomes of Sleep Questionnaire-10. The potential mediators, perceived control and depressive symptoms, were measured using the Control Attitudes Scale-Revised and the Patient Health Questionnaire-9, respectively. Mediation analysis using Hayes' PROCESS macro (Model 6) was conducted for data analysis.
RESULTS: Higher SDOH risks were associated with lower levels of perceived control. Higher levels of perceived control and lower levels of depressive symptoms were significantly associated with better sleep-related functional outcomes. The SDOH risks were not directly associated with sleep-related functional outcomes; but indirectly associated with sleep-related functional outcomes through the following two paths: 1) perceived control and 2) perceived control and depressive symptoms (Figure).
CONCLUSION: Rural patients with CVD who have higher SDOH risks have worse sleep-related functional outcomes due to lower levels of perceived control and higher levels of depressive symptoms. These findings suggest that interventions targeting perceived control and depressive symptoms may improve sleep-related functional outcomes for those with higher SDOH risks among rural patients with CVD.