Discrimination stress and sleep disturbance

Tiffany Yip, PhD, is a professor of psychology at Fordham University. She completed an undergraduate degree at Cornell University, earned her MA and PhD at New York University, and completed a postdoctoral fellowship at the University of Michigan. 

Her research on ethnic identity, discrimination, and sleep among ethnic/racial minority adolescents, and young adults has been published in American Psychologist^®, Child Development, Developmental Psychology^®, and Current Directions in Psychological Science. She serves as an associate editor for Developmental Psychology^® and is a former associate editor for Child Development, Cultural Diversity and Ethnic Minority Psychology^®, and the Asian American Journal of Psychology. 

She is a fellow of the American Psychological Association and the Association for Psychological Science, and her research has been funded by the National Institutes of Health and the National Science Foundation. Her research has been featured in outlets such as The Washington Post, Los Angeles Times, and Psychology Today.

“Sticks and stones may break my bones, but names will never hurt me” is a playground rhyme that has undoubtedly conferred resilience for many children. But a growing and increasingly robust literature may call our folk wisdom into question. Science has found that discrimination is harmful for a host of academic, psychological and physical health outcomes.

Recent reviews of how discrimination stress is implicated in health finds consistent linkages among children, adolescents, and adults (Benner et al., 2018; Pascoe and Smart Richman, 2009; Priest et al., 2013; Slopen, Lewis, Williams, 2016). In fact, scientists are drawing connections between the health detriments of discrimination stress and patterns of ethnic/racial health disparities (Williams and Mohammed, 2009). Using theoretical models focused on allostatic stress, ethnic/racial disparities, and constructs such as “embodiment,” scientists aim to unpack how social experiences of discrimination stress and exclusion are experienced "under the skin" physiologically (Gee, Hing, Mohammed, Tabor, Williams, 2019; Krieger, 1999; Levy, Heissel, Richeson, Adam, 2016; McEwen, 1998).

Data collection for this project was recently completed and results from the first year of data are described here. As hypothesized, on days in which adolescents reported experiencing discrimination stress, they also reported more disturbed sleep that same evening, and higher levels of sleepiness and daytime dysfunction (e.g., difficulty staying awake in school) the following day (Yip, Cheon, et al., 2019). These data underscore how daily experiences of discrimination stress impact same-night sleep and next-day functioning among diverse adolescents.

But not all adolescents report discrimination stress. In fact, 44% of adolescents in the study reported discrimination over the two-week period, while the remaining 56% of adolescents did not. To further unpack the daily impact of discrimination, patterns of sleep disturbances before and after the discriminatory event were graphed for adolescents who reported discrimination as compared with those who did not (Figure 2). The figure depicts how a discriminatory event serves as an acute stressor associated with an immediate, and significant, increase in sleep disturbance, which tapers off in subsequent days. Experiencing discrimination has measurable and time-limited effects on adolescent sleep.

Linking daily experiences of discrimination to sleep was a novel and exciting observation, but another goal of the research is to consider how discrimination is related to overall health and adjustment over time. To this end, the data were analyzed to consider whether the daily association between discrimination and sleep was associated with longer-term health and wellness outcomes such as depressive symptoms, self-esteem, and psychological mood. The data suggest that stronger daily associations between discrimination and sleep disturbance were in turn associated with higher levels of anxious mood (Yip, Cham, Wang, El-Sheikh, 2019). Similarly, stronger daily associations between discrimination and daytime dysfunction (e.g., difficulty staying awake in school) were associated with higher negative and anxious mood and depressive symptoms. In other words, the more negative impact discrimination stress had on sleep, the more psychological health was compromised over a six-month period. In contrast, weaker or non-existent associations between discrimination and sleep were not related to longer-term compromises in mental health.

Another focus of this study was to investigate how ethnic/racial identity, both the extent to which an adolescent has explored this identity (i.e., exploration) and how clearly ethnicity/race is integrated into one’s overall identity (i.e., commitment), might influence how strongly discrimination impacts sleep (Figure 3). The data suggested that discrimination had a more negative impact on sleep for adolescents who were still in the process of exploring their ethnic/racial identity. On the other hand, discrimination had a less negative impact on sleep for adolescents who had a clear sense of commitment to their ethnic/racial identity. Taken together, the data suggest that it is important to consider how adolescents feel about their ethnic/racial identity in order to understand the impact of discrimination on sleep.

Although the data show consistent negative effects of discrimination for sleep and psychological health, there is a silver lining. Sleep may also serve as a lever for disrupting the negative impact of discrimination. On days when adolescents experienced discrimination, if they slept longer (i.e., high levels of sleep duration) and better (i.e., high levels of sleep quality, measured by fewer wake minutes after sleep onset—WASO) the previous night, they engaged in more active coping strategies (e.g., problem solving, peer support seeking; (Figures 4a-c)). Over the longer term, this resulted in fewer somatic symptoms, more positive mood, and higher life satisfaction (Wang and Yip, 2019). In other words, a better night’s sleep was associated with mitigating the negative health impact of discrimination stress; and this in turn, was associated with better mental health over the longer term.

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Figures 4a-c. Moderating effects of previous-night sleep on same-day associations between ethnic/racial discrimination and coping. Note: X-axis represents adolescents report low versus high levels of discrimination. Y-axis represents active coping strategies measured as problem solving coping (average of 3 items from the Children’s Response Styles Questionnaire (Abela, Aydin et al., 2007) ranging from 0 (no) to 3 (a lot of the time)) and seeking peer support (average of 2 items (Wills, 1986) ranging from 0 (not true at all) to 2 (very true)). Sleep was measured both as duration and as quality (WASO—wake minutes after sleep onset). Source: Wang, Y. & Yip, T. (2019). Sleep facilitates coping with racial discrimination: Moderated mediation of daily sleep, racial discrimination, coping and adolescent well-being. Child Development.

Taken together, there are several key takeaways from this program of research. First, discrimination stress has same-day effects on sleep and next-day functioning. Identifying sleep disturbance as an intermediary pathway connecting discrimination to everyday functioning, begins to elucidate the daily mechanisms through which discrimination impacts health and functioning found in meta-analyses and reviews. Second, not all adolescents respond to discrimination in the same way. Adolescents who have a clear and well-defined sense of their ethnic/racial identity are less impacted by discrimination than adolescents who are still searching for their sense of self. Finally, the data also point to sleep interventions as a possible lever for mitigating or disrupting the negative impact that discrimination has on health. In recent years, there has been increased attention on the importance of sleep and sleep hygiene for a host of psychological and physical health outcomes. This project contributes to that discussion by identifying yet another benefit to ensuring that adolescents and adults are properly rested.

Looking ahead, it is important to consider how this project relates to policy and institutional structures that impact and interfere with sleep. For example, data from the National Sleep Foundation find that 85% of adolescents are not sleeping the recommended 8-10 hours per night (National Sleep Foundation, 2006); and these data have contributed to recent decisions to delay school start times in many areas of the United States. Despite this sobering statistic, there is reason to believe that sleep health further deteriorates in college when students are no longer tethered to a regular start time (Doane, Gress-Smith, Breitenstein, 2015). The data from this project suggest actionable changes: fostering health sleep may be a pathway to mitigating the negative effects of discrimination stress, and perhaps even stress more broadly.

“… but names will never hurt me.” The science to date suggests that it may be time to revisit a popular childhood rhyme. “Sticks and stones may break my bones, and names will also hurt me.” Perhaps we should teach our youth that names, discrimination, and social exclusion can impact our physical and emotional health as much as physical violence—and we can add that getting a good night’s sleep may lessen the blow.

The science reviewed in this brief is supported by the National Science Foundation (BCS—1354134) and the National Institutes of Health (R21MD011388), and I thank co-investigators Warren Tryon, PhD (Fordham University), Mona El-Sheikh, PhD (Auburn University), and Heining Cham, PhD (Fordham University). The brief also includes work described in published and unpublished manuscripts co-authored by Yijie Wang, PhD (Michigan State University), Yuen Mi Cheon, PhD (Myongji University), and Mingjun Xie, PhD (Fordham University).