Racial discrimination, sleep, fatigue, and pain outcomes in Black adolescent-caregiver dyads

Black Americans are at higher risk of exposure to racial discrimination, which is linked to poor pain outcomes. This study addresses gaps in understanding the racial discrimination-pain relationship in Black families by investigating sleep disturbance and fatigue as mediators of the relationship in Black adolescent-caregiver dyads.

Data were from 179 Black adolescent-caregiver dyads collected from August 2019 to March 2020. We used actor-partner interdependence mediation models (APIMeMs) to test the dyadic associations of racial discrimination, sleep disturbance, fatigue, and pain outcomes.

The APIMeMs predicting pain intensity via sleep disturbance and fatigue were significant, R2s = .24-.26, p < .01 for adolescents and R2s = .33-.36, p < .01 for caregivers. The APIMeMs predicting pain interference via sleep disturbance were significant, R2s = .26-.30, p < .01 for adolescents and R2s = .28-.31, p < .01 for caregivers. For actor effects, adolescents' and caregivers' own sleep disturbance and fatigue mediated the relationships between their racial discrimination experiences and their worse pain outcomes. For partner effects, greater adolescent-reported racial discrimination was associated with worse caregiver pain outcomes via higher caregiver fatigue, but not via sleep disturbance. Lastly, caregiver-reported racial discrimination was not associated with adolescent-reported pain outcomes directly or via fatigue or sleep disturbance.

Findings support sleep disturbance and fatigue as mechanisms linking racial discrimination and pain, highlighting the importance of family influences in pain outcomes. Findings suggest the need to address sleep, fatigue, and family influences in interventions to reduce the influence of racial discrimination on pain outcomes for Black families. (PsycInfo Database Record (c) 2025 APA, all rights reserved).