Depressive and insomnia symptoms sequentially mediate the association between racism-based discrimination in healthcare settings and clinical pain among adults with sickle cell disease.

Racism-based discrimination in healthcare settings has been associated with clinical pain in adults living with sickle cell disease (SCD); however, no studies have examined depressive and insomnia symptoms as mechanisms that may drive this relationship. This secondary data analysis examined associations between depressive and insomnia symptoms, racism-based discrimination, and clinical pain. Seventy-one adults with SCD (70% female, Mage  = 38.79) provided baseline reports of racism-based discrimination, depressive symptoms, insomnia symptoms, and pain (severity, interference, catastrophizing), and they completed daily diaries of pain severity and interference over three months. In a sequential mediation model, baseline depressive (1st ) and insomnia symptoms (2nd ) significantly mediated the association between racism-based discrimination and baseline pain interference, average daily diary pain severity, and average daily diary pain interference. Although the mediation model with baseline pain severity as the outcome was significant, the total and direct effects were not. Results indicate that discrimination in healthcare settings contributes to depression, which may act on pain through sleep disturbance. Findings support the need for systemic and structural changes to eliminate discrimination in healthcare settings and behavioral mood and sleep interventions to reduce the impact of discrimination on clinical pain.