A longitudinal examination of psychosocial mechanisms linking discrimination with objective and subjective sleep

Abstract

Objective: Although chronic discrimination negatively impacts sleep, the cross-sectional nature of most research limits the understanding of how changes in discrimination over time are associated with sleep health. Therefore, the aims of this study were to explore the: (1) longitudinal association between daily discrimination and subjective and objective sleep; (2) mediating roles of anxiety and social well-being; and (3) moderating role of change in discrimination over time. Methods: An archival analysis was completed using data from the Midlife in the United States study across 3 timepoints. Participants were primarily female-identifying, white, and college-educated. Measures included Pittsburgh Sleep Quality Index (N = 958), sleep diaries (N = 307), and actigraphy (N = 304). Daily discrimination, the Social Well-Being Scale, and the Mood and Anxiety Symptom Questionnaire were also administered. Moderated parallel mediations were performed using the PROCESS macro controlling for depressive symptoms. Results: More discrimination at time 1 was associated with worse global sleep quality (b = 0.10 and p =.001) and daily sleep quality (b = 0.03 and p =.02) and worse objective sleep-onset latency (b = 0.93 and p =.02), wake after sleep onset (b = 1.09 and p =.002), and sleep efficiency (b = −0.52 and p <.001) at time 3. Social well-being mediated the associations between discrimination and subjective global sleep quality 95% CI [0.00, 0.03] and daily sleep quality 95% CI [0.00, 0.01] and objective TST 95% CI [0.00, 0.96] when discrimination was increasing or chronic. Anxiety mediated the discrimination—global sleep quality association regardless of changes in discrimination. Conclusions: Discrimination showed durable associations with a broad array of sleep outcomes across a 10-year period. Anxiety and social well-being linked discrimination to subjective sleep outcomes, illustrating the importance of psychosocial well-being for sleep health in those experiencing discrimination. © 2023 National Sleep Foundation