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.