The impact of social constraints on insomnia among African‐American breast cancer survivors: The mediating role of fear of recurrence

Objective Insomnia is a significant concern among African‐American breast cancer survivors (BCS). Social constraints (SC)—receiving unsupportive or critical responses when expressing trauma‐related emotions—and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediato...

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Published in:	Psycho-oncology (Chichester, England) Vol. 29; no. 8; pp. 1296 - 1302
Main Authors:	Martin, Chloé M., Greene, Danyella, Harrell, Jules P., Mwendwa, Denée Thomas, Williams, Carla D., Horton, Sara, Cradle, Melanie, Hudson, Briana D., Taylor, Teletia R.
Format:	Journal Article
Language:	English
Published:	Chichester, UK John Wiley & Sons, Ltd 01-08-2020 Wiley Subscription Services, Inc
Subjects:	Adult African Americans African Americans - psychology Breast cancer breast neoplasms Breast Neoplasms - etiology Breast Neoplasms - psychology cancer survivors Cancer Survivors - psychology Cognition Emotions Fear & phobias Fear - psychology Female Friendship Humans Insomnia Middle Aged Neoplasm Recurrence, Local - etiology Neoplasm Recurrence, Local - psychology Recurrence Sleep sleep initiation and maintenance disorders Sleep Initiation and Maintenance Disorders - etiology Sleep Initiation and Maintenance Disorders - psychology Surveys and Questionnaires Survivor women Womens health African Americans sleep initiation and maintenance disorders cancer survivors breast neoplasms women
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Summary:	Objective Insomnia is a significant concern among African‐American breast cancer survivors (BCS). Social constraints (SC)—receiving unsupportive or critical responses when expressing trauma‐related emotions—and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African‐American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR. Methods Sixty‐four African‐American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS. Results The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Moreover, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41). Conclusions Experiencing SC from family and friends could produce cognitions that impact sleep for BCS, and FOR could be one of those cognitions. Family‐based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impacts sleep.
Bibliography:	Funding information Health Careers Opportunity Program, Grant/Award Number: D18HP29035; National Cancer Institute, Grant/Award Numbers: CA009461, P30 CA008748, R01 CA207442‐ 03S1; Howard University Frederick Douglass Doctoral Scholars Fellowship; Thelma D. Jones Breast Cancer Fund ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1057-9249 1099-1611
DOI:	10.1002/pon.5435