Exploring the Social Context of Insomnia: A Thematic Content Analysis of the Lived Experiences of Insomnia of Latinx Adults

Background and Purpose: Social ties are important social determinants of overall health.^1,2 However, the social processes through which social ties affect sleep health, a recognized cornerstone of overall health,³ remain understudied, particularly among Latinxs. Identifying factors associated with poor sleep health among Latinxs is a public health priority considering sleep disorders, such as insomnia, have increased significantly in prevalence in this population over the past decade.⁴ Additionally, Latinxs are already disproportionately affected by adverse health conditions associated with poor sleep health, such as depression,^5,6 diabetes,⁷ and cardiovascular disease.^8,9 Importantly, studies suggest there are gender difference in how social ties influence Latinx health.^10–12 However, the social processes that may drive this gender difference are poorly understood. This study qualitatively examines how Latinx women and men with insomnia describe the social processes through which social ties shape their lived experience of this disorder.

Methods: Data from six focus groups conducted in 2017 as part of the Cognitive-Behavioral Therapy for Latinos study were analyzed using thematic content analysis. These focus groups were comprised of 35 Spanish- and English-speaking Latinx adults with insomnia. Focus group participants were 68.57% women, 68.57% Spanish-speaking, and had an average insomnia severity index score of 20.6 (SD=3.44) which indicates clinical insomnia of moderate severity.¹³ Focus groups discussions were facilitated by bilingual (Spanish, English) and bicultural moderators. The focus group discussions were audio-recorded and professionally transcribed. Two bilingual (Spanish, English) and bicultural reviewers coded the transcripts and achieved an average of 94.75% agreement, indicating excellent interrater agreement.¹⁴ Major and minor themes were identified in the transcripts using NVivo.¹⁵ These themes were compared between Latinx women and men. The consolidated criteria for reporting qualitative research¹⁶ was used to present the results.

Results: The most influential social ties were family ties followed by spousal/romantic ties. The influence of social process on the lived experience of insomnia centered on three topics. The first topic identified social processes as predisposing, precipitating, and perpetuating factors of insomnia. Major themes in this topic included social stress (i.e., worrying /ruminating about others’ problems, loneliness, and ethnic discrimination) and social control (i.e., others’ bedtime routines). The second topic related to how social support, through receiving advice from others, shaped participants’ coping behaviors. Lastly, participants described their insomnia symptoms as negatively affecting their social relationships. Specifically, social stress through interpersonal conflict, particularly in spousal/romantic relationships, was the major theme in this topic. The themes were similar between women and men. Notably, however, Latina women attributed their insomnia to the symbolic meaning of their gender identities as women, while men did not.

Conclusions: This paper is among the first to qualitatively examine the social processes through which social ties influence the lived experience of insomnia among Latinxs. Future studies should investigate the potential reciprocal relationships between social processes, mainly social stress and social control, and insomnia symptoms. If these findings are corroborated, adapting psychological treatments for insomnia to address these social processes as key precipitating and perpetuating factors of insomnia may be important when treating this disorder among Latinxs.