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

• 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
• Journal Title: Psychooncology
• Volume: Volume 29, Number 8
• Publisher: Wiley | 2020-08, Pages 1296-1302
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/pon.5435
• Subjects: Health Sciences, Medicine and Surgery; Psychology, General
• Keywords: African Americans; breast neoplasms; cancer survivors; sleep initiation and maintenance disorders; women; Adult; African Americans; Breast Neoplasms; Cancer Survivors; Cognition; Fear; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Sleep; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires

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.