Racial Discrimination Shown to Exacerbate Insomnia Among Veterans

Overall, veterans report high rates of insomnia, but when race and ethnicity are considered, Asian and Hispanic/Latino veterans experience the common sleep disorder at even higher rates, according to new research in Journal of Sleep Research.

Military man with emotional distress sitting near door in hallway at home at night | Image Credit: LIGHTFIELD STUDIOS - stock.adobe.com

The study investigators tested racial discrimination as a potential predictor of insomnia, with potential influence from posttraumatic stress disorder (PTSD) symptoms and romantic partners—gathering data on insomnia symptoms, sleep duration, nightmares, bed partners, and sleep treatment preferences—and they found that Asian and Hispanic/Latino veterans were also the least likely to want additional information on treatment for insomnia.

“Insomnia disproportionally affects veterans in comparison to civilian populations. Health disparities also exist across racial/ethnic groups, such that Black, Hispanic/Latino and Asian adults tend to experience worse sleep health than non-Hispanic White individuals,” the study authors wrote. “Thus, racial discrimination may precipitate (and rumination about discrimination may perpetuate) insomnia symptoms in diverse samples of veterans.”

Veterans (N = 325) were recruited in April and May 2021 and invited to complete an online survey, with a goal to have approximately 75% be veterans of color. Ultimately, the investigators recruited a study population comprising 72% veterans of color: 36% were Black or African American, 14% were Hispanic/Latino/Latina, and 12% were Asian or Asian American.

The mean (SD) overall age of the study cohort was 41.5 (14.8) years, but those testing positive for insomnia (n = 221; 68%), were younger, at 40.0 (13.6) years. They were also more likely to be male patients (63.8%), to report a straight sexual orientation (84.1%), to have a romantic partner (59.7%), to have been separated/discharged/retired (57.9%), and to have served in the Army (48.8%) or Air Force (16.2%).

Among those who were positive for clinically significant insomnia, 32.5% reported also experiencing PTSD; 23.5%, military-related trauma; 15.7% (13.5%), racial discrimination; and 16.3% (4.5%), severe insomnia. Ninety percent of the participants who were Asian/Asian American screened positive for clinically significant insomnia, by far the highest percentage of the patients on color in the study, followed by 79% of Hispanic/Latino/Latina participants, 65% of Black/African American veterans, and 58% of White veterans. Insomnia rates also were significantly higher for Asian vs White (χ²[1] = 11.74; P < .001), Asian vs Black (χ²[1] = 8.53; P = .004), and Hispanic/Latino/Latina vs White (χ²[1]= 5.60; P = .02) veterans.

However, compared with these findings, just 68%, 68%, and 77% of Asian/Asian American, Hispanic/Latino/Latina, and Black/African American veterans, respectively, reported an interest in seeking sleep treatment compared with 81% of the White veterans in this analysis.

When PTSD and racial discrimination were considered for their interactions with insomnia, a significant association was seen, but the authors noted, “this was qualified by a significant interaction (B = –0.19; SE = 0.08; 95% CI, 0.34-0.04; P = .01).” Follow-up tests ultimately determined a positive association between racial discrimination and insomnia severity among the veterans testing negative for PTSD (B = 0.18; SE = 0.04; 95% CI, 0.09-0.26; P < .001) and no association among those positive for PTSD (B = –0.02; SE = 0.07; 95% CI, –0.14 to 0.11; P = .81).

Reported racial discrimination was linked with worse insomnia severity (B = 0.18; SD = 0.06; P = .003), while having a romantic partner was not significantly linked to insomnia in a linear regression (B = –0.46; SE = 1.33; P = .73). "Romantic partners may serve as a protective factor in insomnia, but do not seem to mitigate the impact of racial discrimination," the authors wrote.

They noted that strengths of their findings on insomnia and lack of interest in seeking treatment include that few studies have examined trends of racial and ethnic disparities in insomnia among a veteran population and that the percentages of Asian/Asian American and Hispanic/Latino/Latina veterans reporting high rates of insomnia and not seeking treatment echo findings seen among civilian populations.

“Complementing our findings that veterans as a group are least willing to seek treatment for the conditions that are most prevalent in their communities, these data indicate that participants from racial/ethnic groups with the highest need for insomnia treatment are also among the least interested,” the authors concluded. “Given these findings, providers are especially encouraged to screen for sleep problems and offer sleep treatment among veterans of color, as these minoritized groups may not share sleep issues spontaneously or request sleep treatment unprompted.”

Targeted outreach and engagement are vital, they emphasized, to get these veterans the help they need and require.

Reference

Rubi S, Monk JK, Shoemaker S, et al. Perpetuatingand protective factors in insomnia across racial/ethnic groups of veterans. J Sleep Res. Published online October 1, 2023. doi:10.1111/jsr.14063