Maladaptive coping strategies mediate the relationship between perceived differential treatment and sleep health among women.

To investigate whether associations between perceived differential treatment based on race-ethnicity and sleep are mediated by coping strategies. We used data from the nationwide Sister Study. In 2008-2012, participants self-reported perceived lifetime differential treatment and completed adapted Coping Orientation to Problems Experienced Inventory (COPE)/Brief COPE questionnaires which assessed healthy/adaptive (e.g., using emotional support) and maladaptive (e.g., self-blame) coping. Sleep duration, poor sleep quality, and insomnia symptoms were self-reported in 2017-2019. Adjusting for sociodemographic and health characteristics, mediation analysis was performed using the Hayes PROCESS macro. Among 31,443 eligible women (mean ± SD age 55.5 ± 8.6 years), the prevalence of everyday (79% among non-Hispanic [NH]-Black, 30% Latina, and 4% NH-White participants) and major (57% NH-Black, 14% Latina, and 2% NH-White) perceived differential treatment varied by race-ethnicity. Among NH-Black women, only maladaptive coping mediated associations between everyday differential treatment and poor sleep quality (indirect effect b = 0.01, 95% confidence interval [CI] = 0.00, 0.03) and insomnia symptoms (indirect effect b = 0.04, 95% CI = 0.01, 0.07). Neither adaptive nor maladaptive coping mediated (1) associations with major differential treatment among NH-Black women nor (2) associations with differential treatment among Latina women. Among NH-White women, maladaptive coping mediated associations between both everyday and major differential treatment and both poor sleep quality and insomnia symptoms. Associations between everyday differential treatment based on race-ethnicity and insomnia symptoms along with poor sleep quality were stronger among women who reported maladaptive, but not healthy/adaptive, coping strategies. Interventions that address maladaptive coping may mitigate the impact of perceived differential treatment on sleep disturbances.