Abstract
Objectives
Sexual minority men experience worse sleep than heterosexuals. Little is known about
how minority stress may account for these differences. Therefore, the aims of this
study are to (1) understand the relationship between minority stress and sleep disturbance
in a sample of sexual minority men, and (2) test whether these relationships are mediated
by generalized anxiety symptoms and perception of stress.
Methods
In 2020, 239 sexual minority men were recruited to complete an online survey. Participants
responded to scales assessing minority stress (ie, internalized homophobia, experiences
of harassment, microaggressions), perception of stress, generalized anxiety symptoms,
and sleep disturbance. Linear regressions were used to test the relationship between
minority stress and sleep disturbance and to test generalized anxiety symptoms and
perception of stress as mediators.
Results
The final model was significant (F = 16.916, p < .001) and accounted for 43.5% of the variance in sleep disturbance. Generalized
anxiety symptoms and perception of stress fully mediated the relationships between
minority stress and sleep disturbance.
Conclusions
Findings from this study suggest the need for psychological intervention to improve
sleep for sexual minority men. Future research should test this model longitudinally,
and include objective measures of stress. Future interventions could target stress
perception using mindfulness or cognitive-based interventions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Sleep Health: Journal of the National Sleep FoundationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Sleep duration, sleep quality, and sexual orientation: findings from the 2013-2015 National Health Interview Survey.Sleep Health. 2018; 4: 56-62https://doi.org/10.1016/j.sleh.2017.10.004
- Poor sleep health and its association with mental health, substance use, and condomless anal intercourse among gay, bisexual, and other men who have sex with men.Sleep Health. 2016; 2: 316-321https://doi.org/10.1016/j.sleh.2016.07.003
- The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.National Academies Press (US), Washington, DC2011https://doi.org/10.17226/13128
- Minority stress and physical health among sexual minorities.Perspect Psychol Sci. 2013; 8: 521-548https://doi.org/10.1177/1745691613497965
- Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Psychol Bull. 2003; 129: 674-697https://doi.org/10.1037/0033-2909.129.5.674
- Minority stress and mental health among LGBT populations: an update on the evidence.Minerva Psichiatr. 2019; 60https://doi.org/10.23736/S0391-1772.18.01995-7
- Discrimination and sleep: a systematic review.Sleep Med. 2016; 18: 88-95https://doi.org/10.1016/j.sleep.2015.01.012
- Minority stress and the health of sexual minorities.In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of Psychology and Sexual Orientation. New York, NY: Oxford University Press, 2013: 252-266
- A systematic review of allostatic load, health, and health disparities.Biol Res Nurs. 2012; 14: 311-346https://doi.org/10.1177/1099800412455688
- Associations of allostatic load with sleep apnea, insomnia, short sleep duration, and other sleep disturbances: findings from the National Health and Nutrition Examination Survey 2005 to 2008.Ann Epidemiol. 2014; 24: 612-619https://doi.org/10.1016/j.annepidem.2014.05.014
- Differential impact of experienced and anticipated discrimination on sleep and health among sexual minorities.Arch Sex Behav. 2021; 50: 3053-3063https://doi.org/10.1007/s10508-021-01981-2
- What reduces sexual minority stress? A review of the intervention “toolkit.”.J Soc Issues. 2017; 73: 586-617https://doi.org/10.1111/josi.12233
- Sleep disturbance in anxiety disorders.Int Rev Psychiatry. 2005; 17: 229-236https://doi.org/10.1080/09540260500104524
- Sleep and anxiety disorders.Dialog Clin Neurosci. 2003; 5: 249-258https://doi.org/10.31887/DCNS.2003.5.3/lstaner
- Sleep disturbance in generalized anxiety disorder and its treatment.Sleep Med Rev. 2000; 4: 263-276https://doi.org/10.1053/smrv.1999.0096
- Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder.J Affect Disord. 2013; 147: 379-384https://doi.org/10.1016/j.jad.2012.08.015
- Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).Arch Gen Psychiatry. 2001; 58: 85-91https://doi.org/10.1001/archpsyc.58.1.85
- Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.J Abnorm Psychol. 2009; 118: 647-658https://doi.org/10.1037/a0016501
- The mental health of sexual minority adults in and out of the closet: a population-based study.J Consult Clin Psychol. 2015; 83: 890-901https://doi.org/10.1037/ccp0000047
- Markers of chronic stress: prolonged physiological activation and (un)conscious perseverative cognition.Neurosci Biobehav Rev. 2010; 35: 46-50https://doi.org/10.1016/j.neubiorev.2010.01.004
- Physiological concomitants of perseverative cognition: a systematic review and meta-analysis.Psychol Bull. 2016; 142: 231-259https://doi.org/10.1037/bul0000036
- The effects of daily stress on positive and negative mental health: mediation through self-efficacy.Int J Clin Health Psychol. 2016; 16: 1-10https://doi.org/10.1016/j.ijchp.2015.08.005
- Reducing perceived stress improves sleep quality: a longitudinal outcomes study.CHEST. 2010; 138: 913Ahttps://doi.org/10.1378/chest.10417
- Venue-based versus geosocial networking application-based recruitment of young men who have sex with men: An examination of feasibility.Field Methods. 2022; 34(2): 142-162; https://doi.org/10.1177/1525822X211012260
National Center for Health Statistics. Urban rural classification scheme for counties. 2022. Available at: https://www.cdc.gov/nchs/data_access/urban_rural.htm Accessed October 22, 2022.
- Minority stress and mental health in gay men.J Health Soc Behav. 1995; 36: 38-56https://doi.org/10.2307/2137286
- Social discrimination, concurrent sexual partnerships, and HIV risk among men who have sex with men in Shanghai, China.AIDS Behav. 2008; 12: 71https://doi.org/10.1007/s10461-008-9394-0
- Validation of the sexual orientation microaggression inventory in two diverse samples of LGBTQ youth.Arch Sex Behav. 2016; 45: 1289-1298https://doi.org/10.1007/s10508-016-0718-2
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097https://doi.org/10.1001/archinte.166.10.1092
- Development of short forms from the PROMISTM sleep disturbance and sleep-related impairment item banks.Behav Sleep Med. 2012; 10: 6-24https://doi.org/10.1080/15402002.2012.636266
PROMIS Health Organization. Sleep disturbance: a brief guide to the PROMIS sleep disturbance instruments. 2021. Available at: https://staging.healthmeasures.net/images/PROMIS/manuals/PROMIS_Sleep_Disturbance_Scoring_Manual.pdf Accessed June 21, 2022.
American Psychiatric Association. Level 2 sleep disturbance adult: PROMIS sleep disturbance short form. 2013. Available at:https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Level-2-Sleep-Disturbance-Adult.pdf Accessed June 21, 2022.
- Perceived stress in a probability sample of the United States.In S. Spacapan & S. Oskamp (Eds.), The Social Psychology of Health. Newbury Park, CA: Sage Publications, Inc., 1988: 31-67
- The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.J Pers Soc Psychol. 1986; 51: 1173-1182https://doi.org/10.1037/0022-3514.51.6.1173
Center for Disease Control and Prevention. CDC - Data and statistics - sleep and sleep disorders. 2021. Available at: https://www.cdc.gov/sleep/data_statistics.html Accessed July 11, 2022.
- Hair cortisol, stress exposure, and mental health in humans: a systematic review.Psychoneuroendocrinology. 2013; 38: 1220-1235https://doi.org/10.1016/j.psyneuen.2012.11.015
- Homonegative microaggressions and their impact on LGB individuals: a measure validity study.J LGBT Issues Counsel. 2012; 6: 34-54https://doi.org/10.1080/15538605.2012.648578
- HIV microaggressions: a novel measure of stigma-related experiences among people living with HIV.J Behav Med. 2020; 43: 34-43https://doi.org/10.1007/s10865-019-00064-x
- Developing mindfulness in college students through movement-based courses: effects on self-regulatory self-efficacy, mood, stress, and sleep quality.J Am Coll Health. 2010; 58: 433-442https://doi.org/10.1080/07448480903540481
- Age and sleep disturbances among American men and women: data from the U.S. Behavioral Risk Factor Surveillance System.Sleep. 2012; 35: 395-406https://doi.org/10.5665/sleep.1704
- Subtle and intersectional minority stress and depressive symptoms among sexual and gender minority adolescents of color: mediating role of self-esteem and sense of mastery.Prev Sci. 2022; 23: 142-153https://doi.org/10.1007/s11121-021-01294-9
- Cortisol profiles differ by race/ethnicity among young sexual minority men.Psychoneuroendocrinology. 2017; 75: 1-4https://doi.org/10.1016/j.psyneuen.2016.10.006
- Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection.J Pers Soc Psychol. 1999; 76: 284-304https://doi.org/10.1037/0022-3514.76.2.284
- Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2018; 14: 1231-1237https://doi.org/10.5664/jcsm.7230
Article info
Publication history
Published online: January 23, 2023
Accepted:
January 2,
2023
Received in revised form:
December 12,
2022
Received:
July 13,
2022
Identification
Copyright
© 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
