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Racial Disparities in Sleep: Potential Mediation by Discrimination and Psychological Distress

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Previous research has demonstrated that experiences of discrimination contribute to racial disparities in sleep, and that psychological distress mediates these relationships. However, previous research has not included race as part of the mediation pathway and has had limited dimensions of sleep health and psychological mediators. In the current study, we examine serial mediation pathways by which race and sleep health are mediated through discrimination and subsequently through psychological distress (i.e., depressive symptoms, chronic stress, and loneliness). Data were from the 2010 wave of the Health Retirement Study (HRS). The analytic sample (n = 7,749) included Black and White participants who were included in the enhanced face-to-face interview in 2010 and who completed the psychosocial questionnaire. Race was reported as either Black or White. Sleep health was assessed with a 4-item questionnaire. Depressive symptoms were assessed with the shortened CES-D, chronic stress via the ongoing chronic stressor scale, and loneliness via the UCLA loneliness scale. Covariates were included in all serial mediation models. Relative to White participants, Black participants reported increased experiences of discrimination, which was associated with increased psychological distress, and poorer sleep health. Findings demonstrate the significant adverse impact that discrimination has on both psychological well-being and sleep health.

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Data Availability

Study data and materials are publicly available on the HRS website.

Code Availability

Code is available upon request.


  1. Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med. 2016;18:7–18.

    Article  PubMed  Google Scholar 

  2. Jackson CL, Redline S, Emmons KM. Sleep as a potential fundamental contributor to disparities in cardiovascular health. Annu Rev Public Health. 2015;36:417–40.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Billings ME, Hale L, Johnson DA. Physical and social environment relationship with sleep health and disorders. Chest. 2020;157(5):1304–12.

    Article  PubMed  Google Scholar 

  4. Slopen N, Lewis TT, Williams DR. Discrimination and sleep: a systematic review. Sleep Med. 2016;18:88–95.

    Article  PubMed  Google Scholar 

  5. Crenshaw K (2018) Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics [1989]. Routledge

  6. Meyer IH (1995) Minority stress and mental health in gay men. Journal of health and social behavior. 38–56.

  7. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fingerhut AW, Peplau LA, Gable SL. Identity, minority stress and psychological well-being among gay men and lesbians. Psychology & Sexuality. 2010;1(2):101–14.

    Article  Google Scholar 

  9. Cheng P, Cuellar R, Johnson DA, et al. Racial discrimination as a mediator of racial disparities in insomnia disorder. Sleep Health. 2020;6(5):543–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Garcini LM, Chirinos DA, Murdock KW, et al. Pathways linking racial/ethnic discrimination and sleep among US-born and foreign-born Latinxs. J Behav Med. 2018;41(3):364–73.

    Article  PubMed  Google Scholar 

  11. Majeno A, Tsai KM, Huynh VW, McCreath H, Fuligni AJ. Discrimination and sleep difficulties during adolescence: The mediating roles of loneliness and perceived stress. J Youth Adolesc. 2018;47(1):135–47.

    Article  PubMed  Google Scholar 

  12. Vaghela P, Sutin AR. Discrimination and sleep quality among older US adults: the mediating role of psychological distress. Sleep Health. 2016;2(2):100–8.

    Article  PubMed  Google Scholar 

  13. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9–17.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lee RT, Perez AD, Boykin CM, Mendoza-Denton R (2019) On the prevalence of racial discrimination in the United States. PloS one. 14(1):e0210698

  15. Sonnega A, Faul JD, Ofstedal MB, Langa KM, Phillips JW, Weir DR. Cohort profile: the health and retirement study (HRS). Int J Epidemiol. 2014;43(2):576–85.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smith J, Ryan L, Fisher G, Sonnega A, Weir D. HRS Psychosocial and Lifestyle Questionnaire 2006–2016. Updated 2017. Accessed.

  17. Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: Socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51.

    Article  CAS  PubMed  Google Scholar 

  18. Russell DW. UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. J Pers Assess. 1996;66(1):20–40.

    Article  CAS  PubMed  Google Scholar 

  19. Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300.

    Article  PubMed  Google Scholar 

  20. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  21. Group HHW. Documentation of Affective Functioning Measures in the Health and Retirement Study. Published 2000. Updated 2000. Accessed.

  22. Pool LR, Burgard SA, Needham BL, Elliott MR, Langa KM, De Leon CFM. Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States. JAMA. 2018;319(13):1341–50.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications

  24. Zhao X, Lynch JG Jr, Chen Q. Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of consumer research. 2010;37(2):197–206.

    Article  Google Scholar 

  25. Fuller-Rowell TE, Curtis DS, El-Sheikh M, Duke AM, Ryff CD, Zgierska AE. Racial discrimination mediates race differences in sleep problems: A longitudinal analysis. Cultur Divers Ethnic Minor Psychol. 2017;23(2):165.

    Article  PubMed  Google Scholar 

  26. Slopen N, Williams DR. Discrimination, other psychosocial stressors, and self-reported sleep duration and difficulties. Sleep. 2014;37(1):147–56.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Johnson DA, Lewis TT, Guo N et al. (2021) Associations between everyday discrimination and sleep quality and duration among African-Americans over time in the Jackson Heart Study. Sleep. 44(12)

  28. Davenport MA, Landor AM, Zeiders KH, Sarsar ED, Flores M (2020) Within‐person associations between racial microaggressions and sleep among African American and Latinx young adults. Journal of sleep research:e13226

  29. Schwarz N. Retrospective and concurrent self-reports: The rationale for real-time data capture. The science of real-time data capture: Self-reports in health research. 2007;11:26.

    Google Scholar 

  30. Lauderdale DS, Knutson KL, Yan LL, et al. Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study. Am J Epidemiol. 2006;164(1):5–16.

    Article  PubMed  Google Scholar 

  31. Adenekan B, Pandey A, McKenzie S, Zizi F, Casimir GJ, Jean-Louis G. Sleep in America: role of racial/ethnic differences. Sleep Med Rev. 2013;17(4):255–62.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26(3):342–92.

    Article  PubMed  Google Scholar 

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Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health T32HL007909, T32HL069771, R01HL141881, and R01AG059291.

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Authors and Affiliations



MPM, EAV, and KLK were all contributed to manuscript development. MPM and EAV conducted statistical analyses and wrote initial draft of manuscript. KLK provided substantial feedback on revisions of the manuscript.

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Correspondence to Michael P. Mead.

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The HRS study was granted approval from the institutional review board (IRB) at the University of Michigan.

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Participants provided consent to participate.

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All authors consent to have this manuscript submitted for publication.

Conflict of Interest

Dr. Knutson reports grants from NIH during the conduct of the study, personal fees from Sleep Research Society Foundation, and personal fees from Onecare Media, outside the submitted work.

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Mead, M.P., Vargas, E.A. & Knutson, K.L. Racial Disparities in Sleep: Potential Mediation by Discrimination and Psychological Distress. J. Racial and Ethnic Health Disparities 10, 573–580 (2023).

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