Objective. The aim of this study was to uncover possible psychosocial underpinnings of pain and sleep disturbance in a safety-net primary care sample. Methods. Patients (n = 210) awaiting care in a safety-net primary care clinic waiting room completed measures of cynical hostility, social support, mental health, sleep disturbance, and pain. This study was cross-sectional and observational. Results. A structural equation model suggested that higher cynical hostility was associated with lower social support, which in turn was associated with poorer mental health, which then corresponded with higher pain and sleep disturbance. All possible indirect (mediational) effects within this model were statistically significant, suggesting a possible route through which cynical hostility may shape pain and sleep, two common presenting problems in primary care. Conclusions. These findings illustrate the interplay of psychosocial factors with chronic pain and sleep disturbance in a sample of low-income, predominantly African-American patients seeking care at a safety-net primary care clinic. The findings support integrated primary care as a way to target not only behavioral health issues but also the psychosocial factors entangled with physical health.

中文翻译：

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安全网初级保健患者的疼痛和睡眠障碍的心理社会基础

目标。这项研究的目的是在安全网初级保健样本中发现疼痛和睡眠障碍的可能的社会心理基础。方法。 在安全网初级保健诊所候诊室中等待护理的患者（n = 210）完成了对愤世嫉俗的敌意，社会支持，心理健康，睡眠障碍和疼痛的测量。这项研究是横断面和观察性的。结果。结构方程模型表明，较高的愤世嫉俗的敌意与较低的社会支持有关，而社交支持又与较差的心理健康有关，然后与较高的痛苦和睡眠障碍相对应。在该模型中，所有可能的间接（中介）作用在统计学上都非常显着，这表明愤世嫉俗的敌意可能会影响疼痛和睡眠，这是初级保健中两个常见的问题。结论。这些发现说明了在低收入，主要是在安全网初级保健诊所就诊的非裔美国人样本中，社会心理因素与慢性疼痛和睡眠障碍的相互作用。这些发现支持综合的初级保健，不仅是针对行为健康问题的方法，而且还针对与身体健康相关的社会心理因素。