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.

Keywords: Discrimination; Health disparities; Insomnia.

Fig. 1

Study enrollment flowchart.

Fig. 2

Schematic of the mediation approach.

Fig. 3

Panel A) Comparison of insomnia severity by White versus non-White individuals. Insomnia values for specific racial groups in the non-White category indicated with the following labels: Blk = Black ; Multi = More than one race; AsAm = Asian American; AI/AN = American Indian/Alaska Native. Panel B) Insomnia severity by discrimination. Error bars indicate one standard error.