From the Department of Psychological Science (Williamson), Loyola Marymount University; Departments of Psychology (Williamson, Choi, Stanton) and Medicine, David Geffen School of Medicine (Garon, Irwin, Goldman), Jonsson Comprehensive Cancer Center (Garon, Goldman, Stanton), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Irwin, Stanton), Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior (Irwin, Stanton), University of California, Los Angeles, Los Angeles; and Department of Psychology (Choi), San Diego State University, San Diego, California.
Psychosom Med. 2024 May 1;86(4):334-341. doi: 10.1097/PSY.0000000000001299. Epub 2024 Feb 27.
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.
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.
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).
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.
本研究通过中介检验，检验污名和歧视如何通过睡眠障碍预测癌症患者的心理困扰和身体症状负担。
正在接受癌症治疗（N=108；74.1%为 IV 期）的肺癌患者在入组时以及在 6 周和 12 周时，完成了关于肺癌污名、睡眠、困扰和身体症状的问卷。通过中介分析来研究在入组时和 12 周内，污名和歧视是否通过睡眠障碍预测困扰和身体症状。
较高的歧视（b=5.52，95%置信区间[CI]=2.10-8.94）和受限披露（b=0.45，95%CI=0.05-0.85）与入组时更高的睡眠障碍显著相关。反过来，睡眠障碍与更高的困扰（b=0.19，95%CI=0.09-0.29）和身体症状（b=0.28，95%CI=0.17-0.40）在入组时显著相关。睡眠障碍显著中介了较高歧视与困扰（间接效应=1.04，95%CI=0.13-1.96）和身体症状（间接效应=1.58，95%CI=0.37-2.79）在入组时的关系。睡眠障碍也中介了受限披露与困扰（间接效应=0.85，95%CI=<0.01-0.17）和身体症状（间接效应=0.13，95%CI=0.01-0.25）的关系。
肺癌患者存在明显的睡眠障碍，这在入组时，在肺癌污名的指标与困扰和身体症状之间的关系中起中介作用。需要研究来检验纵向预测这些结果的肺癌污名的其他机制。
