Trauma, Stress, and Sleep: Pathways Linking Adversity to Health Across Populations and Generations

Abstract

A history of adversity has been linked to poor physical, mental, and emotional health outcomes across the lifespan. However, pathways linking adversity and health remain unclear and likely involve a complex interplay of biological, physiological, psychosocial, and behavioral factors shaped by individual, social, and societal influences. While adverse childhood experiences (ACEs) are well-established risk factors for sleep disturbances, the role of intergenerational trauma (IT) on sleep health remains underexplored. Sleep is a critical determinant of health and may serve as a pathway between adversity history and long-term health outcomes. Part I of this dissertation provides a comprehensive review of the relationships between ACEs, IT, sleep health, and broader health outcomes. This section also includes empirical studies (previously published and submitted for publication), including work examining social support as a protective factor. Part II presents the primary study of this dissertation, investigating the role of ACEs/IT in relation to cardiometabolic health among Hispanic adults of Mexican descent living at the US-Mexico border. This secondary data analysis uses validated questionnaires, and a novel assessment of IT developed for this study. Cardiometabolic health was assessed using Life’s Essential 8 (LE8), the American Heart Association’s revised framework incorporating sleep as a fundamental pillar of health. ACE score was significantly associated with LE8 Global Score in unadjusted models (B = -1.639, p = 0.024), and IT was marginally associated. Current stress was significantly associated with LE8 Sleep Score in ACE and IT separate and combined models, suggesting a potential indirect pathway linking trauma, sleep, and cardiometabolic health. Age and sex were also significant predictors of LE8 by some metrics. Secondary analyses explore the role of potential resiliency factors that may partially explain the Hispanic Health Paradox.