Discrimination's Relationship with Sleep: What Are the Roles of Self-Esteem and Depression for Sexual Minority Men

Background: Sexual minority men (SMM) experience higher rates of mental health issues compared to their heterosexual counterparts, which can be explained in large part by experiences of minority stress. Minority stress theory suggests that the unique stressors of sexual minority individuals contribute to mental health disparities. Sexual orientation harassment (SOH) is defined as verbal or physical aggression that is directed toward an individual due to their sexual orientation. Research indicates that SOH is associated with mental health issues. Recent literature also finds that mental health issues are highly associated with sleep disturbance for SMM. However, few studies have focused on the effect of SOH on sleep disturbance among SMM. Therefore, this study aims to 1) investigate the effect of lifetime SOH on sleep disturbance, and 2) explore the path through which SOH sequentially affects self-esteem and depression and leads to sleep disturbance among SMM.

Methods: This study included 158 sexual minority men who were recruited through geospatial networking applications and who responded to all questions in the study model. Lifetime SOH was measured with 6 items (e.g., How often in your lifetime have you been physically threatened or attacked because of your sexual orientation?; α=.760). Self-esteem was assessed using Rosenberg’s self-esteem scale (α=.916), and depression was measured with the Center for Epidemiological Studies-Depression scale (CES-D), consisting of 20 items (α=.907). Sleep disturbance was assessed with the adult 8-item of the Patient-Reported Outcomes Measurement Information System (α=.921). This score was then converted to the t-score for comparison across different versions of the scale. A sequential mediation model was analyzed to test the mediation effect of self-esteem and depression in sequence between lifetime SOH and sleep disturbance. Age, race, employment, education level, and household income were included as control variables.

Results: Participants’ age was 35.04 on average (SD=11.44). Of them, 53.2% were White identified. Approximately 32% of the participants reported mild-to severe sleep disturbance (mild: 15.8%, moderate: 13.3%, severe: 3.2%). Our total model explained 36.2% of variance of sleep disturbance. Lifetime SOH had a direct effect on self-esteem (β=-.304, p<.001), depression (β=.141, p<.05), and sleep disturbance (β=.341, p<.001). Depression mediated the relationship between lifetime SOH and sleep disturbance (β=.069, 95% CI [.003, .034]); meanwhile, self-esteem does not have a significant mediating effect. However, the relationship between Lifetime SOH and sleep disturbance was sequentially mediated by the path by which self-esteem leads to depression (β=.104, 95% CI [.034, .201]).

Conclusion: When SMM experience overt discrimination because of their sexual minority status, it has an enduring impact on their sleep. Specifically, we found that depression and the path between self-esteem and depression partially mediate the relationship between lifetime SOH and sleep disturbance. The current study builds evidence for interventions to improve sleep by intervening to either reduce experiences of discrimination or following these experiences by promoting wellness. Interventions focused on promoting self-esteem may not have a direct impact on mitigating sleep disturbance; however, they may still contribute to ameliorating sleep disturbance by mitigating depression.