Mental Health, Substance Use, and a Composite of Sleep Health in Adults, 2018 Ohio Behavioral Risk Factor Surveillance System

Objectives Various factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear. Methods We used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4,333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey. Results Better mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p<.001), however after adjusting for covariates these associations were no longer significant. Conclusions The implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.