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This cross-cultural study investigated a moderated indirect effect model in which country membership and familismo were hypothesized to moderate the direct and indirect effects of attachment insecurity on well-being variables. A total of 360 Mexican university students from Mexico and 235 Mexican American university students from the United States completed research questionnaires. Results indicated that insecure attachment was associated with depressive symptoms and life satisfaction via an indirect effect of social self-efficacy (SSE) and that the indirect effects of attachment avoidance varied significantly by country membership. Familismo was also found to be a significant moderator for the direct effects of attachment anxiety on life satisfaction. Finally, several significant three-way interactions were found suggesting that the buffering effects of familismo on the direct and indirect paths of insecure attachment on SSE and outcome variables vary significantly by country membership. The limitations and implications are discussed.

Sleep disorders are common non-motor symptoms in patients with Parkinson’s disease (PD). The characteristics and impact of multiple comorbid sleep disorders remain to be elucidated. Our goal was to investigate the characteristics of various sleep disorder comorbidities, and their association with motor complications and the impact on the quality of life in PD patients. In this multicenter, observational, cross-sectional study, data concerning the clinical characteristics of complicated sleep disorders were collected from PD patients treated at 40 different hospitals in Shanghai. Sleep disorders were evaluated using the PD Sleep Scale-2, Epworth Sleepiness Scale, Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong, and the International Restless Legs Scale. Among the 1006 subjects evaluated, 77.53% exhibited signs of sleep disorders, and most had multiple sleep disorders (n = 502, 49.9%). A smaller percentage of patients with sleep disorders had a single disorder (n = 278, 27.6%). Furthermore, an increased number of sleep disorders, including nighttime problems, excessive daytime sleepiness, rapid eye movement sleep behavior disorder, and restless legs syndrome was a significant contributor to a poor quality of life (β = 4.33, CI: 3.33–5.33, P for trend <0.001), even when controlling for multiple factors. Moreover, motor complications partially mediated this relationship (indirect effect: β = 0.355, 95% boot CI: 0.134, 0.652).Our study showed that a large proportion of PD patients suffer from multiple comorbid sleep disorders, which greatly decreases the quality of life in PD patients and is partially mediated by motor complications.