1 - (SYM 33) The Role of Racial Discrimination in Medical Care: A Secondary Analysis into the Effect of Culturally Tailored, Internet-delivered CBT for Insomnia in Black Women

Background: Insomnia is associated with higher incidence of medical illnesses, including psychiatric diagnoses. Women are 40% more likely than men to develop insomnia during their lifetime. Black individuals are more likely to experience poor sleep than other racial groups. Consequently, insomnia and its negative effects may disproportionately affect Black women. Unfortunately, Black women are less likely to begin and continue with insomnia treatment when compared to women of other races, including when treatment is delivered digitally. One hypothesized reason for these lower rates of treatment uptake is previous experiences of racial discrimination when receiving medical care, which predicts lower trust in providers and non-adherence to treatment.

Methods: In collaboration with Black women with insomnia, we developed a culturally tailored version of an efficacious 6-session, online cognitive-behavioral therapy for insomnia (CBT-I) for Black women (Zhou et al., 2022). In a clinical trial, Black women with insomnia (N = 218) were randomized to either tailored or untailored CBT-I. We tested if intervention engagement and use, as well as likelihood for insomnia symptoms to remit following treatment, differed between the treatments as a function of previous racial discrimination when receiving medical services.

Results: Over 38% of participants endorsed experiencing medical racial discrimination. All participants benefited comparably from the tailored/untailored programs. Contrary to hypotheses, women who endorsed experiencing medical racial discrimination were not more likely to reach insomnia symptom remission (b = -.77, p = .335), adhere to treatment (b = .08, p = .883), or login to the program more often (b = -.04, p = .826) when randomized to the tailored (vs. untailored) program. However, participants randomized to the tailored (vs. untailored) program were more likely to complete the full intervention by the 6-month follow-up (p < .05).

Conclusions: Findings suggest that both versions of the intervention are comparably effective at a group level. As such, offering Black women choice in which program they enroll in may support the best outcomes for each individual. However, unique aspects of our sample may have suppressed the hypothesized moderation effect of past medical racial discrimination. Namely, all participants were recruited from a longitudinal cohort first enrolled in 1995. Nearly 30 years of contact with the research team may have increased trust in both interventions beyond that which would likely be generalizable.