The Impact of Social Constraints on Insomnia Among African-American Breast Cancer Survivors: The Mediating Role of Fear of Recurrence.

OBJECTIVE Insomnia is a significant concern among African-American breast cancer survivors (BCS). Social constraints (SC)- receiving unsupportive or critical responses when expressing trauma-related emotions- and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African-American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR. METHODS 64 African-American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS. RESULTS The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Also, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41). CONCLUSIONS Experiencing SC from family and friends could produce cognitions that impact sleep for BCS and FOR could be one of those cognitions. Family-based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impact sleep. This article is protected by copyright. All rights reserved.