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

• Type of Material: Article
• Authors: Chloé M. Martin, Memorial Sloan Kettering Cancer Center, New York, New York, USA.; Danyella Greene, Howard University; Jules P Harrell, Howard University; Denée Thomas Mwendwa, Howard University; Carla D Williams, Howard University; Sara Horton, Howard University; Melanie Cradle, Health Careers Opportunity Program, Howard University, Washington, DC, USA.; Briana D Hudson, Health Careers Opportunity Program, Howard University, Washington, DC, USA.; Teletia R Taylor, Howard University
• Language: English
• Date: 2020-08
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 John Wiley & Sons, Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1002/pon.5435
• Title of Journal or Parent Work: Psychooncology
• Volume: 29
• Issue: 8
• Start Page: 1296
• End Page: 1302
• Grant/Funding Information: The Thelma D. Jones Breast Cancer Fund, Howard University Frederick Douglass Doctoral Scholars Fellowship, Health Careers Opportunity Program (HCOP Grant # D18HP29035), and NCI (P.I.: Jamie Ostroff; CA009461; R01 CA207442-03S1; P.I.: Craig Thompson; P30CA008748) supported manuscript preparation.
• Keywords: Sleep; Fear; women; Female; Sleep Initiation and Maintenance Disorders; cancer survivors; Adult; Neoplasm Recurrence, Local; Cognition; Breast Neoplasms; African Americans; Surveys and Questionnaires; sleep initiation and maintenance disorders; Humans; Cancer Survivors; Middle Aged; breast neoplasms

Abstract

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.