Multiple psychosocial stressors and coping strategies in relation to sleep health

To determine associations between multiple domains of psychosocial stressors and coping strategies in relation to sleep health among Black/African American (BAA) women.

Among 1678 BAA participants with complete data enrolled in the Study of Environment, Lifestyle and Fibroids, we conducted principal components analysis on 43 self-reported stressors, yielding six components of psychosocial stressors and three components of coping strategies. Self-reported sleep measures included sleep duration (very short, short, vs. recommended sleep), frequent insomnia symptoms (trouble falling or staying asleep at least 15 days/month vs. <15 days/month), and waking up feeling unrested (≥4 days/week vs. <4 days/week). Using Poisson regression with robust variance while adjusting for sociodemographic characteristics, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep measure comparing the presence vs. absence of stressors.

Median age (interquartile range) was 29.3 (26.3-32.0) years and 45% had an annual household income of less than $20 000. The following psychosocial stressors were highly prevalent: perceived racism (84.5%), financial strain (84.1%), and emotional distress (73.7%). Emotional distress (PR = 2.26 [95% CI = 1.63 to 3.12]) and financial strain (PR = 1.41 [1.05-1.91]) were associated with more frequent insomnia symptoms. Social/emotional support (PR = 0.80 [0.68-0.95]) and resilience/personal strength (PR = 0.82 [0.70-0.97]) were associated with lower prevalence of very short sleep duration. BAA women reporting experiences with racism vs. not had a higher prevalence of short sleep (PR = 1.14 [1.05-1.23]). Among women who did shift work, financial strain was associated with a 22% (PR = 1.22 [1.03-1.45]) higher prevalence of short sleep.

These findings may inform interventions aimed at addressing stressors associated with poor sleep. Statement of Significance Based on a novel array of 43 potential psychosocial stressors, we found that stressors such as financial strain, emotional distress, and medical/crime/family problems were associated with poor sleep health (e.g. insomnia symptoms) while coping strategies (e.g. social/emotional support and resilience/personal strength) were associated with more favorable sleep health (e.g. recommended hours of sleep) among an understudied sample of 1678 young Black/African American women. Our study measuring specific, understudied stressors is novel and important to identify which stressors/coping strategies to prioritize for intervention. For instance, our observed associations between racism and medical/crime/family problems in relation to poorer sleep health indicates a need to address medical problems, such as improving healthcare quality, addressing race-based perceived unfair treatment, and increasing access to healthcare.