How Does Anxiety and Perception of Stress Mediate the Relationship between Minority Stress and Sleep for a Sample of Sexual Minority Men?

Background and Purpose: Sleep has a profound impact on health outcomes. There is growing evidence that sexual minority men (e.g., gay, bisexual) experience lower sleep quality when compared to their heterosexual peers. Minority stress (e.g., discrimination, victimization, internalized stigma) may account for these differences, however little is known about these relationships. Further, the perception of these minority stress experiences and how they may be internalized into generalized anxiety may play roles in sleep disturbance. Therefore, the aims of this study are to (a) understand the relationship between minority stress factors and sleep disturbance in a sample of sexual minority men, and (b) test whether these relationships are mediated by generalized anxiety symptoms and perception of stress.

Methods: In 2020, 239 sexual minority men were recruited across Georgia, using advertisements sent to all users of the three most popular gay dating apps, during the week of recruitment. Potential participants completed an online screener, and if eligible, participated in an online questionnaire (n=239). Participants were asked to respond to demographic items and to scales assessing minority stress factors (i.e., internalized homophobia, experiences of harassment, microaggressions), perception of stress, generalized anxiety symptoms, and sleep disturbance. Linear regressions were used to test the relationship between minority stress and sleep disturbance and to test mediation by generalized anxiety symptoms and perception of stress. Sobel tests for mediation were used to assess significance of indirect relationships.

Results: Participants on average were 35 years old, and represented a diversity of race ethnicities (47% White, 41% Black, and 12% other or multiracial). The majority of the sample identified as gay (83%) or bisexual (12%), and most participants reported at least some college education (83%) All minority stress constructs were found to have a positive relationship with generalized anxiety symptoms. Two minority stress factors (internalized stigma and microaggressions) were positively associated with perception of stress. The final model was significant (F=24.345, p<.001) and accounted for 43% of the variance in sleep disturbance symptoms. Both generalized anxiety symptoms and perception or stress were positively associated with sleep disturbance, while minority stress factors were no longer significantly associated with sleep disturbance. Sobel tests for mediation indicated significant indirect effects of all minority stress factors on sleep disturbance through generalized anxiety and perception of stress. Generalized anxiety symptoms and perception of stress fully mediated the relationships between minority stress and sleep disturbance.

Conclusions and Implications: Because sleep quality has a profound impact on health, findings from this study suggest the need for psychological intervention to improve sleep for sexual minority men. Targeted medically-based anxiety interventions have the potential to reduce sleep disturbance in this population. Further, experience of minority stress may also impact the lens, which sexual minority men use to process their typical stress experiences. As this perception of stress mediates the impact of minority stress on sleep disturbance, future interventions could target stress perception using mindfulness of cognitive-based interventions. Future research should investigate these relationships longitudinally.