Cancer Survivors’ Beliefs About the Causes of Their Insomnia: Associations of Causal Attributions With Survivor Characteristics

ABSTRACT

Objectives: Insomnia is common among cancer survivors, yet survivors’ beliefs about their insomnia following cancer are largely unknown. This study describes cancer survivors’ causal attributions of insomnia and whether these beliefs differ by sociodemographic characteristics. Participants: 160 cancer survivors meeting diagnostic criteria for insomnia disorder. Methods: Survivors endorsed how likely they believed 12 different factors were causally related to their insomnia and self-reported sociodemographics. Multinomial logistic regression tested associations between attribution endorsement and sociodemographics. Latent class analysis (LCA) examined patterns of attribution endorsement and whether sociodemographics were associated. Results: One hundred fifty-four survivors (96%) endorsed that at least 1 causal attribution was likely related to their insomnia. Most survivors endorsed that emotions (77%), thinking patterns (76%), sleep-related emotions (65%), and sleep-related thoughts (57%) were related to their insomnia, similar to data previously published among healthy persons with insomnia. Younger participants were more likely to endorse that biochemical factors related to their insomnia (ps < .02); females were more likely to endorse that hormonal factors related to their insomnia (ps < .001). LCA identified three classes (AIC = 3209.50, BIC = 3485.13). Approximately 40% of survivors endorsed most of the causal attributions were likely related to their insomnia; 13% frequently endorsed attributions were neither likely nor unlikely to be related. Older survivors were more likely to belong to the 47% who reported most attributions were unlikely related to their insomnia (p = .03). Conclusions: Cancer survivors with insomnia commonly endorsed that thoughts and emotions contributed to their sleep disturbance. Survivors’ sociodemographic characteristics did not meaningfully explain individual differences for most causal attribution beliefs.

Disclosure statement

The authors have no conflicts of interest. Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1403-14292). The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or Methodology Committee.

Clinical Trial Declaration

This manuscript reports data collected from a clinical trial registered with Clinical Trials (service of NIH): http://www.clinicaltrials.gov, Identifier: NCT02356575.

Additional information

Funding

This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1403-14292, PI: Jun Mao) and by the Translational Research and Integrative Medicine Fund at the Memorial Sloan Kettering Cancer Center. Writing of this manuscript was supported by NIH/National Cancer Institute Cancer Center Support Grant P30 CA008748 (PI: Craig Thompson). Dr. Shaffer was supported by the NIH/National Cancer Institute T32 CA009461 (PI: Jamie Ostroff)..