Racial discrimination as a mediator of racial disparities in insomnia disorder

Abstract

Study Objectives Racial and ethnic minorities are more likely to suffer from insomnia that is more severe; however, few studies have examined mechanisms by which racial disparities in severity of insomnia disorder may arise. One potential mechanism for disparities in insomnia severity is perceived discrimination. This study tested discrimination as a mediator in the relationship between race and insomnia. Methods Participants were recruited from communities in the Detroit metropolitan area and were diagnosed with insomnia disorder using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). The final sample included 1,458 individuals. Insomnia symptom severity was assessed via the Insomnia Severity Index and self-reported racial discrimination was evaluated using a single item. Racial discrimination was tested as a mediator in the relationship between race and insomnia symptom severity. Individuals were categroized as either White or a racial minority (i.e., non White individuals), with sensitivity analyses examining Black individuals and non-Black racial minority groups. Results Consistent with our hypothesis, racial discrimination was a significant mediator accounting for 57.3% of the relationship between race and insomnia symptom severity. Sensitivity analyses indicated that the indirect effect of racial discrimination was stronger in the non-Black racial minority group compared to Black individuals. Conclusions These results provide support that racial discrimination is likely an important mechanism by which racial and ethnic sleep disparities exist. Implications for prevention, intervention, and treatment of insomnia in racial minorities to reduce health disparities are discussed.

Sleepless in COVID-19: racial disparities during the pandemic as a consequence of structural inequity

“…This finding is especially notable as no significant racial differences in insomnia severity were found in the same sample prior to the pandemic after receiving insomnia treatment in 2016/2017. Furthermore, the Black-White disparity in insomnia severity during the pandemic in this sample was approximately threefold the magnitude of disparities found pre-pandemic [ 17 , 68 ], suggesting that the racial disparities in insomnia grew in conjunction with the disproportionate social stressors during the pandemic. Results also indicated that Black participants reported higher levels of COVID-related stress compared to White participants, and that this stress was associated with a history of perceived racial discrimination prior to the pandemic.…”

“…social isolation from quarantine) may further exacerbate pre-existing disparities (e.g. reduced sense of belonging due to racial discrimination) that then widen the racial disparity in insomnia severity during the pandemic [ 23 , 24 , 30 ].…”

#NoJusticeNoSleep: Critical intersections of race-ethnicity, income, education, and social determinants in sleep health disparities

“…In response to this call, the articles in this virtual special issue have explored a range of social experiences that have characterized racialized identities in the U.S: essential worker status during the COVID-19 pandemic 26 ; lower socioeconomic status 27 28 ; and experiences of racial discrimination. 29 , 30 It is imperative that research continues to evolve beyond comparisons of racial-ethnic groups on sleep and other health outcomes, and instead focus on explaining the unique processes that characterize experiences among diverse groups of individuals. The finding of opposite educational gradients in sleep duration between Black and White adults 31 illustrates the need to retire a “one size fits all” approach and turn, instead, toward understanding the unique barriers and challenges that specific groups of individuals face in their quest for adequate, restorative sleep.…”

Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease

“…51 Racial discrimination has also been shown to be a significant mediator of the relationship between race and insomnia symptom severity. 52 Another study found that among women, those who identify as Black/African American, Asian/Other, or Hispanic/Latino were significantly less likely than their white counterparts to have sleep complaints, while racial differences were not apparent among men; the authors posited that it may be that non-white women may be less likely to complain about their sleep. 53…”