Title: Depressive Symptoms Help Explain the Relationship Between Experiences of Discrimination and Insomnia Symptoms
Background: People living with HIV and chronic pain (CP) experience discrimination in their daily lives. These experiences may induce depressive symptoms and, ultimately, poor sleep. Given the known associations amongst discrimination and poor mood, as well as depressive symptoms and poor sleep, this study examined the potential causal pathway between experiences of discrimination, depressive symptoms, and symptoms of insomnia in PLWH with chronic pain.
Methods: Participants (N = 85) were recruited from the 1917 Clinic in Birmingham, AL to complete the ISI (Insomnia Severity Index), the Center for Epidemiological Studies Depression Scale (CES-D), the Everyday Discrimination Scale (TEDS) and the Brief Pain Inventory Short Form (BPI-SF). Bivariate correlation and multiple regression analyses were conducted to examine the associations between insomnia symptoms, experiences of discrimination and depression, and pain severity. Additionally, a mediation analysis was conducted using PROCESS macro to determine the potential explanatory pathway between discrimination, depressive symptoms and symptoms of insomnia while controlling for effects of pain severity.
Results: The sample included 85 adults aged 26-67. Greater experiences of discrimination were associated with greater depressive (r =.330, p =.002) and Insomnia symptoms (r =.410, p =.000). Greater symptoms of depression were associated with greater symptoms of Insomnia (r =.624, p =.000), and greater symptoms of Insomnia was associated with greater pain severity (r =.263, p =.015). Lastly, there was a significant indirect effect of discrimination on insomnia symptoms though depressive symptoms, b = 0.152, 95% CI [0.060-0.272]. Experiences of discrimination predicted greater depressive symptoms (t=3.147, p =.002), and greater depressive symptoms predicted greater symptoms of Insomnia (t=6.192, p =.000) while controlling for pain severity.
Discussion/Implications: PLWH and chronic pain who experience discrimination have higher levels of depression and, thus, greater symptoms of insomnia.