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. 2022 Jun;8(3):334-345.
doi: 10.1016/j.sleh.2022.03.004. Epub 2022 Apr 30.

Adapting the Health Stigma and Discrimination Framework to understand the association between stigma and sleep deficiency: A systematic review

Uzoji Nwanaji-Enwerem  1 , Eileen M Condon  2 , Samantha Conley  3 , Katie Wang  4 , Theddeus Iheanacho  5 , Nancy S Redeker  3
Affiliations

Adapting the Health Stigma and Discrimination Framework to understand the association between stigma and sleep deficiency: A systematic review

Uzoji Nwanaji-Enwerem et al. Sleep Health. 2022 Jun.

Abstract

Objective: Sleep deficiency and sleep disorders disproportionally affect socially disadvantaged and marginalized individuals and groups. Recent evidence suggests that stigma, a social process characterized by labeling, stereotyping, and prejudice, is associated with sleep characteristics.

Purpose: Guided by the Health Stigma and Discrimination Framework, the purpose of this systematic review is to describe associations between dimensions of stigma and sleep deficiency and to identify future directions for research.

Methods: We searched the OVIDPsycINFO, OVIDEMASE, OVIDMEDLINE, and CINAHL databases for empirical research studies that reported relationships between the 3 dimensions of stigma-internalized, perceived, and anticipated-and characteristics of sleep deficiency-duration, continuity/efficiency, timing, alertness/sleepiness, quality, and disorders.

Results: Of 1717 articles, 15 met our inclusion criteria. The most frequently assessed dimensions of stigma were internalized and perceived stigma. Characteristics of sleep deficiency were measured by self-report and included sleep quality, duration, trouble sleeping, and insomnia symptoms. We found consistent evidence that stigma, whether internalized, perceived, or anticipated, is associated with self-reported characteristics of sleep deficiency.

Conclusions: This evidence base can be further strengthened with prospective studies that incorporate both multidimensional measures of stigma and objective measures of sleep characteristics. We outline research implications that can clarify underlying mechanisms and more precisely define the relationships between stigma and sleep and inform interventions to address stigma, improve sleep, and reduce the health inequities that disproportionately affect individuals from socially disadvantaged and marginalized groups.

Keywords: Systematic review; health disparities; sleep; stigma.

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Figures

Figure 1.
Figure 1.
Adapting the Health Stigma & Discrimination Framework to Understand the Association between Stigma and Sleep Deficiency.
Figure 2.
Figure 2.
Flow chart detailing the systematic search of potential reports and selection process of included studies (n).
See this image and copyright information in PMC

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