Self-Esteem and Depression's Role in the Relationship between Discrimination and Sleep Deprivation Among Primary School-Aged Children

Background: The Centers for Disease Control recommend 10 hours of sleep for school-aged children, yet only 15% of teenagers manage to get at least 8.5 hours of sleep on school nights. The sleep deprivation observed in school-aged children is reported to be associated not only with health issues but also with learning and behavioral problems. Societal discrimination is recognized as a significant contributor among the various factors investigated as root causes of sleep problems. While research on discrimination has established links with a range of mental and physical health outcomes, its impact on sleep is still relatively understudied compared to other social determinants. To address this gap, this study aims to elucidate the mechanism by which discrimination experiences lead to sleep deprivation, focusing on psychological factors such as self-esteem and depressive mood.

Methods: For this purpose, 2,723 elementary students, ranging from 4th to 6th grade, were included from the 2022 Children and Adolescent Human Rights Status Survey. Sleep deprivation was measured by a binary item asking about perceived lack of sleep. Discrimination experiences were categorized into two types: discrimination based on individual characteristics (DEI) and discrimination experience based on family background (DEF), each consisting of four items. Three items were utilized as indicators for the latent variables of self-esteem and depressive mood, respectively. School years, sex, GPA, and subjective household income were used as control variables. Structural equation model was used to confirm the interplay between variables, employing the weighted least squares mean and variance adjusted estimator.

Results: Our measurement model demonstrated good fit indices (CFI=.920, TLI=.900, RMSEA=.035). The results of the path analysis showed that DEI showed significant associations with self-esteem (β= -.288, p<.001), depression (β= .261, p<.001), and sleep deprivation (β= .254, p<.001). DEF was not associated with any of our study variables. Upon examining the indirect effects between these variables, depressive mood mediated the relationship between DEI and sleep deprivation (β=.048, p=.001), while self-esteem did not show a significant indirect effect. However, the effect of DEI indicated a partial sequential mediation effect (β= .014, p<.001), influencing sleep deprivation through self-esteem and depression sequentially.

Conclusion: This study examined the impact of two types of discrimination – based on individual characteristics versus family background. While no significant effects were found for discrimination tied to family factors, discrimination based on individual characteristics emerged as a significant factor influencing children's sleep patterns. Specifically, discrimination based on individual characteristics was strongly associated with lower self-esteem, increased depressive mood, and higher levels of sleep deprivation among children. These findings underscore the importance of interventions aimed at addressing discrimination and fostering mental well-being to mitigate sleep-related issue. Although interventions targeting self-esteem alone may not directly alleviate sleep deprivation, they could indirectly contribute by mitigating depressive symptoms. Further research is necessary to understand the mechanisms through which various types of discrimination experiences and intersecting discriminations impact sleep deprivation.