Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden - PubMed (original) (raw)

Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden

Timothy J Williamson et al. Psychosom Med. 2024.

Abstract

Objective: This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer.

Methods: Lung cancer patients on active oncological treatment ( N = 108; 74.1% stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep.

Results: Higher discrimination ( b = 5.52, 95% confidence interval [CI] = 2.10-8.94) and constrained disclosure ( b = 0.45, 95% CI = 0.05-0.85) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress ( b = 0.19, 95% CI = 0.09-0.29) and physical symptoms ( b = 0.28, 95% CI = 0.17-0.40) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI = 0.13-1.96) and physical symptoms (indirect effect = 1.58, 95% CI = 0.37-2.79) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI = < 0.01-0.17) and physical symptoms (indirect effect = 0.13, 95% CI = 0.01-0.25).

Conclusions: Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.

Copyright © 2024 by the American Psychosomatic Society.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Mediation Analysis of Lung Cancer Stigma, Subjective Sleep Disruption, and Psychological Distress at Study Entry Note: N = 108; Global sleep impairment significantly mediated the relationship between higher perceived discrimination and psychological distress as well as between higher constrained disclosure and psychological distress, as indicated by the indirect effects; X = predictor variable; M = mediator variable; Y = outcome variable; a = statistical estimate for the a path (X-M relationship); b = statistical estimate for the b path (M-Y relationship); Subjective sleep disturbance is calculated as the global sleep impairment score from the Pittsburgh Sleep Quality Index; Age, gender, race, income, and smoking status were entered as covariates; * = p < .05; ** = p < .01; *** = p <.001; Solid paths indicate coefficients significant at p < .05; Dotted paths indicate non-significant relationships (at p > .05).

Figure 2

Figure 2

Mediation Analysis of Lung Cancer Stigma, Subjective Sleep Disruption, and Physical Symptom Burden at Study Entry Note: N = 108; Global sleep impairment significantly mediated the relationship between higher perceived discrimination and physical symptom burden as well as between higher constrained disclosure and physical symptom burden, as indicated by the indirect effects; X = predictor variable; M = mediator variable; Y = outcome variable; a = statistical estimate for the a path (X-M relationship); b = statistical estimate for the b path (M-Y relationship); Subjective sleep disturbance is calculated as the global sleep impairment score from the Pittsburgh Sleep Quality Index; Age, gender, race, income, and smoking status were entered as covariates; * = p < .05; ** = p < .01; *** = p <.001; Solid paths indicate coefficients significant at p < .05; Dotted paths indicate non-significant relationships (at p > .05).

References

    1. Hamann HA, Ostroff JS, Marks EG, Gerber DE, Schiller JH, Lee SJC. Stigma among patients with lung cancer: A patient-reported measurement model. Psycho-Oncology. 2014;23:81–92. -PMC -PubMed
    1. Ostroff JS, Banerjee SC, Lynch K, Shen MJ, Williamson TJ, Haque N, et al. Reducing stigma triggered by assessing smoking status among patients diagnosed with lung cancer: De-stigmatizing do and don’t lessons learned from qualitative interviews. PEC Innovation. 2022;1:100025. -PMC -PubMed
    1. Hamann HA, Shen MJ, Thomas AJ, Lee SJC, Ostroff JS. Development and preliminary psychometric evaluation of a Patient-Reported Outcome measure for lung cancer stigma: The Lung Cancer Stigma Inventory (LCSI). Stigma and Health. 2018;3:195–203. -PMC -PubMed
    1. Williamson TJ, Kwon DM, Riley KE, Shen MJ, Hamann HA, Ostroff JS. Lung cancer stigma: Does smoking history matter? Annals of Behavioral Medicine. 2020;54:535–40. -PMC -PubMed
    1. Acevedo-Garcia D, Rosenfeld LE, Hardy E, McArdle N, Osypuk TL. Future directions in research on institutional and interpersonal discrimination and children’s health. American Journal of Public Health. 2013;103:1754–63. -PMC -PubMed

Publication types

MeSH terms

LinkOut - more resources