Examining the associations of gender minority stressors with sleep health in gender minority individuals

The effects of sexual orientation and adverse childhood experiences on short sleep duration: Evidence from the behavioral risk factor surveillance system (BRFSS)

BACKGROUND

Adverse childhood experiences (ACEs) are associated with an increased risk of short sleep duration in adulthood. This study aims to explore the relationship between sexual orientation, ACEs and short sleep duration.

METHODS

61,323 adults from the Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. We measured sexual orientation, ACEs and short sleep duration with participants' self-report. Multivariate logistic regression analysing the effects of sexual orientation, ACEs and their interactions on short sleep duration.

RESULTS

More sexual minoritized individuals reported short sleep duration compared to heterosexual individuals (32.10 % for heterosexuals; 33.70 % for sexual minoritized individuals). More sexual minoritized individuals reported being exposed to >1 ACE (heterosexual = 62.8 %; sexual minoritized individuals = 82.2 %. P < 0.001) than heterosexuals, especially sexual minorities are about three times more likely than heterosexual to be sexually abused (heterosexual = 11.1 %; sexual minoritized individuals = 31.2 %, P < 0.001). More bisexual women reported sexual abuse than bisexual men (38.2 % for bisexual women; 22.6 % for bisexal men). Positive association between ACEs status and short sleep duration (OR:2.23, 95%CI: 1.36,3.65) was identified among sexual minoritized individuals. Those sexual minorities individuals who experienced sexual abuse in childhood, emotional abuse, and mental illness in the household had 1.72, 1.38, and 1.39 times the risk of having a short sleep duration in adulthood as compared to heterosexual household, respectively. Moreover, there was a significant interaction between sexual abuse and sexual orientation.

LIMITATIONS

The cross-sectional design limited the ability to make causal inference.

CONCLUSION

This study shows that sexual abuse experiences suffered by sexual minority adults during childhood may lead to a higher risk of subsequent short sleep duration as well. Thus, the risk of short sleep duration in sexual minorities is reduced by reducing the occurrence of ACEs.

Is cardiovascular disease risk in transgender, gender-diverse, and non-binary adults associated with autonomic imbalance?

Blood pressure is a key indicator of cardiovascular health with chronically high levels increasing the risk of cardiovascular diseases (CVD) such as heart attack and stroke. Emerging evidence shows that transgender, gender-diverse, and non-binary (TGD) adults tend to have higher blood pressure than age-matched cisgender adults, corresponding to an increased CVD risk in this population. Yet, the mechanisms underlying elevated blood pressure in TGD adults remain unclear, posing challenges to TGD-affirming healthcare. Given the autonomic nervous system's role in CVD - wherein reduced parasympathetic and heightened sympathetic activity are key risk factors for CVD - this review explores the question: "Is cardiovascular disease risk in TGD adults associated with autonomic imbalance?" Limited research exists on autonomic balance within TGD populations. Accordingly, this review considers how TGD-specific factors, such as minority stress, lifestyle behaviors, sex and gender, and hormones (i.e., testosterone, estrogen, progesterone), may impact autonomic balance. Finally, this review aims to underscore the critical need for interdisciplinary research to elucidate these mechanisms and advance TGD-inclusive healthcare in the domains of autonomic control of blood pressure and overall cardiovascular health.

Sleep health among sexual and gender minority people in the United States: A scoping review

Sleep has been found to be essential to physical and mental health. Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender, nonbinary) individuals experience significant health disparities, and emerging research indicates that this includes disparities in sleep health. However, the current literature on sleep health in this population has not previously been rigorously reviewed. This scoping review provides a comprehensive overview and synthesis of the current literature on SGM sleep health in the United States. Following established scoping review methodology, we systematically searched PubMed, CINAHL, PsycINFO, LGBTQ + Source, and Scopus; 76 studies met inclusion criteria. Included studies indicated significant sleep disparities exist for SGM people, particularly sexual minority women and gender minority people. Social determinants of health, including bullying and discrimination, were associated with worse sleep health. Included studies were heterogeneous and had methodological weaknesses, leaving opportunities for future research. Overall, findings point to the need for more rigorous research to advance understanding of sleep health across SGM subgroups and inform interventions to improve sleep health among SGM people, given the known negative impact of poor sleep on overall health.

Influence of Experiences of Discrimination and Anticipated Discrimination on Cardiovascular Health Outcomes

PURPOSE OF REVIEW

This review summarizes recent evidence linking experiences of discrimination and anticipated discrimination with cardiovascular health outcomes.

RECENT FINDINGS

Experiences of discrimination were consistently associated with increased risk of nicotine exposure, poor sleep health, obesity, diabetes, hypertension, and subclinical cardiovascular disease. Evidence is mixed for cardiovascular disease diagnoses and cardiovascular mortality. Although research is limited, anticipated discrimination is an independent risk factor for poor sleep health and subclinical cardiovascular disease. Key methodological limitations included the limited use of gold-standard objective measures of health behaviors and well-validated self-report measures, inadequate consideration of intersectionality, and lack of robust examinations of psychological, behavioral, and physiological mechanisms linking discrimination with cardiovascular health outcomes. There is substantial evidence linking experiences of discrimination with cardiovascular outcomes. Yet, before translating these findings into clinical practice, more rigorous studies are needed to address methodological limitations and uncover mechanisms by which discrimination influences cardiovascular health. There is a need for studies to inform the development of evidence-based interventions focused on reducing the influence of discrimination-related stressors on cardiovascular health outcomes. Findings have important implications for future work to advance cardiovascular health equity.

Minority stress in relation to biological outcomes among sexual and gender minority people: a systematic review and update

Here we present an updated systematic review identifying studies published 2019-2024, since our prior systematic review in 2020, that examine the association between minority stress and a biological outcome among sexual and gender minority (SGM) people. Pubmed, Web of Science, and Embase were queried to identify studies that examined an association between minority stress (including prejudice events and conditions, anticipation of rejection and discrimination, concealment or disclosure of SGM identity(ies), internalized stigma, or structural stigma) and a biological health outcome among SGM people. Included studies were coded for methodological approaches, study population, minority stress measure, biological outcomes, count of overall analyses, and count of analyses where an association was detected. Fifty-nine studies met inclusion criteria and included a total of 391 analyses between an element of minority stress and a biological outcome, among which 38% of analyses detected an association (44% detected this association when study outliers were removed). All elements of minority stress demonstrated associations with outcomes: multicomponent measures, prejudice events and conditions, and structural stigma demonstrated the highest proportion of associations. Associations with minority stress were detected for general physical health, sleep, immune, cardiovascular, metabolic, hormonal, brain health, allostatic load, epigenetic and transcriptional regulation. The highest proportion of associations were detected among sleep, immune, cardiovascular, and hormonal outcomes. These studies evidence associations between minority stress and biological outcomes among gender minority people in addition to evidence among sexual minority people. Future research should consider increasing rigor in methodology and expanding our understanding of moderators and mediators of these relationships.

Sleep health among youth outside of the gender binary: Findings from a national Canadian sample

OBJECTIVES

Sleep is important for adolescent health. The unique needs of suprabinary youth (youth with gender identities outside of the gender binary), along with the growing number of youth with these identities, underscores the need to better understand sleep health within this population. The current study's objectives were to (1) examine differences in sleep health between suprabinary and binary youth and (2) explore how social support, peer victimization, and technology use accounted for these differences.

METHODS

Data were drawn from the 2017/2018 Health Behavior in School Aged Children Survey. Adolescents (individuals ages 14 to 17, n = 10,186), indicated whether they were suprabinary (n = 182) or binary (n = 10,004), and completed measures of sleep health (difficulty falling asleep, difficulty staying awake, weekday and weekend sleep length), covariates (age, family affluence, race/ethnicity, depressive symptoms), as well as variables that may account for differences between suprabinary and binary youth (family, friend, and teacher support, as well as peer victimization, and technology use before bed).

RESULTS

Suprabinary youth reported worse sleep health on all outcomes, and differences persisted for both difficulty falling asleep and weekday sleep hours accounting for covariates. Significant indirect effects between suprabinary status were observed across all sleep outcomes for family support and school climate. Indirect effects for sleep quality were also observed via peer victimization.

CONCLUSIONS

Findings support the relevance of looking at basic health processes like sleep to better understand how the stressors associated with suprabinary status impact health outcomes among this vulnerable population.

Sexual and Gender Minority Sleep Health Disparities and Minority Stress in Early Adolescence

PURPOSE

Sleep is essential to adolescent development. Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) adults are at high risk for poor sleep, partially due to minority stress (e.g., discrimination). However, sleep has rarely been studied among SGM adolescents. In a national sample of early adolescents, we analyzed sexual minority (SM) and gender minority (GM) identity, gender incongruence, and gender nonconformity in association with sleep and tested minority and general stressors as mediators.

METHODS

We cross-sectionally analyzed data from 10,070 adolescents aged 10-14 in the Adolescent Brain Cognitive Development℠ Study. Using logistic regression models, we analyzed associations between identity (SM and GM), sexual identity discrimination, minority and general stressors (sexual identity discrimination, teasing, and conflict with parents) and sleep health (duration, latency, and disturbance). We used Baron and Kenny's method to test for mediation.

RESULTS

Participants reported sexual identity (4% SM, 4% questioning) and gender identity (0.4% GM, 0.6% questioning); 65% were White, 20% were Hispanic, and 52% were assigned male at birth. Compared to heterosexual, SM participants had higher odds of short sleep duration, long sleep latency, and sleep disturbance. GM participants and those reporting gender incongruence and nonconformity had higher odds of long sleep latency and sleep disturbance. Sexual identity discrimination and general social stressors partially mediated some associations.

DISCUSSION

SGM participants reported poorer sleep. Minority and general social stressors partially accounted for some disparities. Policies need to address SGM identity-based discrimination and challenge social norms that produce minority stress for SGM early adolescents.

Day-to-day associations of intersectional minority stressors with sleep health in sexual and gender minority people of color

OBJECTIVE

To determine the day-to-day associations between minority stressors (i.e., anticipated and experienced discrimination) and sleep health outcomes (i.e., total sleep time (TST), sleep disturbances, and sleep-related impairment) among sexual and gender minority (SGM) people of color.

METHOD

An online sample of SGM people of color living in the United States participated in a 30-day daily diary study. Daily anticipated and experienced discrimination as well as subjective sleep outcomes were assessed via electronic diaries using validated measures. Wrist-worn actigraphy was used to objectively assess TST. Multilevel linear models (MLMs) were used to estimate the independent associations of daily intersectional minority stressors with subsequent sleep outcomes, adjusted for demographic factors and lifetime discrimination.

RESULTS

The sample included 43 SGM people of color with a mean age of 27.0 years (± 7.7) of which 84% were Latinx, 47% were multiracial, and 37% were bisexual. Results of MLMs indicated that greater report of daily experienced discrimination was positively associated with same-night sleep disturbances, B (SE) = 0.45 (0.10), p < .001. Daily anticipated discrimination was positively associated with sleep-related impairment on the following day, B (SE) = 0.77 (0.17), p < .001. However, daily anticipated and experienced discrimination were not associated with same-night TST.

CONCLUSIONS

Findings highlight the importance of considering the differential effects of daily intersectional minority stressors on the sleep health of SGM people of color. Further research is needed to identify factors driving the link between daily minority stressors and sleep outcomes to inform sleep health interventions tailored to this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexual minorities and sleep health: How does discrimination and stigma influence a sleep disorder diagnosis?

OBJECTIVES

Sleep difficulties are associated with many physical and mental health problems, such as diabetes, hypertension, and depressive symptoms. Sleep can be affected by stressors such as discrimination and stigma, which are disproportionately experienced by sexual and gender minority (SGM) individuals. This research assesses how different characteristics, including discrimination and stigma, sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, influence a sleep disorder diagnosis among SGMs.

METHODS

We analyzed data from wave 3 of Generations: A Study of the Life and Health of LGB People in a Changing Society. We used bivariate analysis to document the distribution of key variables across SGM status. Next, we conducted logistic regression analyses to measure how each variable influences the likelihood of an SGM individual being diagnosed with a sleep disorder considering experiences of discrimination and stigma.

RESULTS

We found that feeling stigma was statistically significant in predicting a sleep disorder diagnosis among SGM individuals. However, after controlling for sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, SGM individuals only had increased odds of a sleep disorder diagnosis if they reported higher scores on the Internalized Homophobia Scale.

CONCLUSIONS

Variation in having a sleep disorder diagnosis differs based on SGM status and could not be explained away with the inclusion of all covariates. Our findings support the need for more research to compare health outcomes between different sexual and gender identities, rather than comparing them with their nonminority counterparts.

Caring for Sexual and Gender Minority Adults with Cardiovascular Disease

This article summarizes existing evidence on cardiovascular disease (CVD) risk and CVD diagnoses among sexual and gender minority adults and provides recommendations for providing nursing care to sexual and gender minority adults with CVD. More research is needed to develop evidence-based strategies to care for sexual and gender minority adults with CVD.

Association between discrimination in the workplace and insomnia symptoms

Background

In Korea, little research has focused on the relationship between discrimination in the workplace and sleep health. Thus, this study aims to investigate the association between such discriminatory experiences and insomnia, a common sleep disorder, using Korean employees' data.

Methods

This study used data from the 6th Korea Working Conditions Survey. Discrimination experiences due to age, ethnic background, nationality, race, sex, religion, disability, sexual orientation, educational level, hometown, and employment status were investigated. The Minimal Insomnia Symptom Scale estimated insomnia symptoms. The association between discrimination experience and insomnia symptoms were analyzed using survey-weighted logistic regression analysis.

Results

Based on experiences of discrimination over the past 12 months, insomnia symptoms were associated with discrimination experience due to religion (odds ratio [OR]: 3.70; 95% confidential interval [CI]: 1.58-8.69), sex (OR: 2.51; 95% CI: 1.87-3.37), age (OR: 2.30; 95% CI: 1.88-2.81), hometown (OR: 2.07; 95% CI: 1.44-2.97), employment status (OR: 1.69; 95% CI: 1.37-2.10), and educational level (OR: 1.67; 95% CI: 1.31-2.14). Furthermore, the prevalence of insomnia symptoms increased with the number of discrimination experiences.

Conclusions

In this study, discrimination experiences due to religion, sex, age, hometown, employment status, and educational level were significantly associated with insomnia symptoms. Furthermore, as the number of discrimination experiences increased, so did the prevalence of insomnia. Preventing workplace discrimination may improve workers' sleep health.

Examining the role of problematic drug use in the relationship between discrimination and sleep disturbance in transgender and nonbinary individuals

OBJECTIVE

Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. In this study, we investigated the role of problematic drug use (PDU) in the relationship between discrimination and sleep disturbance in TGNB individuals.

METHODS

The study sample included 194 TGNB participants from Wave 5 (2021) of Project AFFIRM, a multi-site longitudinal study of transgender health. Discrimination, PDU, and sleep disturbance were measured using the Everyday Discrimination Scale, Drug Use Disorders Identification Test (DUDIT), and PROMIS Sleep Disturbance measures, respectively. Individuals were classified as having PDU using established DUDIT criteria that were applied based on sex assigned at birth. Regression analyses were used to estimate the associations of study variables, and subsequently, mediation analysis was used to determine whether PDU partially mediated the association between discrimination and sleep disturbance.

RESULTS

Nearly half of participants reported PDU, of which 83.2% reported cannabis use. Higher levels of discrimination were associated with worse self-reported sleep disturbance scores. Additionally, participants with greater discrimination were more likely to have PDU. Surprisingly, participants with PDU had lower sleep disturbance scores.

CONCLUSIONS

Our cross-sectional findings suggest that PDU partially suppressed the association between discrimination and sleep disturbance in TGNB people. Efforts to address PDU in TGNB adults may consider assessing sleep disturbance as a motivating factor for drug use and the potential role of discrimination in perpetuating PDU.

Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea

OBJECTIVES

We sought to investigate the association between transgender identity discrimination and sleep problems among transgender people in South Korea (hereafter, Korea), and whether family support for transgender identity plays a protective role in the association.

DESIGN & SETTING

We analyzed a nationwide cross-sectional survey of 583 Korean transgender adults which was anonymously conducted through an online platform.

MEASUREMENTS

Transgender identity discrimination was assessed using a single-item question. Sleep problems were defined as having any of the following problems: poor sleep quality, short sleep duration, and use of alcohol or sleep medications to fall asleep. Family support for transgender identity was classified into 3 groups as follows: not supportive, supportive, and unaware of participants' transgender identity.

RESULTS

Of 583 participants, 383 (65.7%) experienced transgender identity discrimination over the past 12 months. Participants who experienced transgender identity discrimination were 1.48 times (95% confidence intervals [95% CI] = 1.19-1.83) more likely to have any sleep problems, compared to those who never experienced transgender identity discrimination. When stratified by family support level, the associations between transgender identity discrimination and sleep problems remained statistically significant only among those with a family unsupportive (adjusted prevalence ratio [aPR] = 1.64; 95% CI = 1.16-2.31) or unaware (aPR = 1.60; 95% CI = 1.01-2.52) of participants' transgender identity. However, the association was not statistically significant among those with a supportive family (aPR = 1.41; 95% CI = 0.96-2.07).

CONCLUSION

Given transphobic environments in Korea, legal and institutional efforts are required to reduce transgender identity discrimination (eg, anti-discrimination laws) as well as to build trans-specific family resources.

Sleep disturbance and suicide risk among sexual and gender minority people

Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.