Intrafamilial and Extrafamilial Acculturation Stress and Insomnia Among U.S.-Born and Immigrant Latina/o Adults

Background: Insomnia, a psychiatric disorder, is associated with high economic burden, poor mental health, and increased risk of cardiovascular disease. The prevalence of insomnia increased in the Latino population from 16.6% to 19.3% between 2002-2012. Among Latinos, acculturation stress has been associated with increased insomnia symptoms, but the relationship between acculturation stress subtypes, intrafamilial and extrafamilial stress, and insomnia remains understudied. Additionally, previous studies have demonstrated that U.S.-born Latinos have worse sleep outcomes than immigrant Latinos, yet few studies have examined how the relationship between the subtypes of acculturation stress and insomnia may differ among these groups. The aims of this study were to examine the relationship between intrafamilial and extrafamilial stress and insomnia among Latino adults and to explore the moderating role of immigration status on this relationship. Given that familialismo is a prevalent cultural value among Latinos that highlights the importance of family loyalty and connectedness, we hypothesized that intrafamilial stress would be more strongly positively associated with insomnia symptoms than extrafamilial stress. In an exploratory hypothesis, we proposed that the relationship between intrafamilial and extrafamilial stress and insomnia symptoms would be stronger among U.S.-born Latinos than among immigrant Latinos.

Methods: Using data from the Hispanic Community Health Study/Study of Latino (HCHS/SOL) Sueño Ancillary Study (N=1,805), we conducted preliminary unadjusted and adjusted weighted linear regressions to examine the association of intrafamilial and extrafamilial stress with insomnia symptoms. Survey weights were used to account for selection probabilities in HCHS/SOL Sueño Ancillary Study. Final adjusted models controlled for age, gender, education, income, and immigrant, employment and marital status. We conducted moderation analyses using cross-products (intrafamilial stress*immigration status; extrafamilial stress*immigration status) in separate models adjusted for age, gender, and immigration status to test the moderating effect of immigrant status on the relationship between intrafamilial and extrafamilial stress and insomnia symptoms. Intrafamilial and extrafamilial stress scores were derived from the respective response items of the Hispanic Stress Inventory. Insomnia symptoms were measured using the Insomnia Severity Index (ISI).

Results: Participants had a mean age of 40.76(SD=12.96), mean ISI was 7.12(SD=6.39), and 26.89% were U.S.-born. A unit increase in intrafamilial stress (β=0.05;SE=0.01,p<0.001) and extrafamilial stress (β=0.02;SE=0.01,p<0.001) was associated with a 0.05 and 0.02 unit increase in insomnia symptoms in adjusted models. There was a statistically significant interaction between intrafamilial stress and immigrant status (p for interaction=0.001), but not with extrafamilial stress in adjusted models (p for interaction = 0.06). The relationship between intrafamilial stress and insomnia symptoms was stronger among U.S.-born Latinos (β=0.09;SE=0.02,p<0.001) than immigrant Latinos (β=0.03;SE=0.01,p<0.001).

Conclusions: As hypothesized, intrafamilial stress was more strongly associated with insomnia symptoms than extrafamilial stress. Among U.S.-born Latinos, the relationship between intrafamilial acculturation stress and insomnia symptoms was stronger than among immigrant Latinos. These preliminary results suggest that reduction of intrafamilial stress may be an especially important intervention target for psychological treatments for insomnia, particularly among U.S.-born Latino adults. Future studies should explore the influence of cultural values, such as familismo, on the relationship between intrafamilial and extrafamilial stress and insomnia symptoms among Latino adults.