Daily Worry in Trauma-Exposed Afghan Refugees: Relationship with Affect and Sleep in a Study Using Ecological Momentary Assessment

Abstract Background Repetitive negative thinking—and worry as a common variant—have been suggested to be transdiagnostic maintaining factors of psychopathology in refugees. Using an ecological momentary assessment (EMA) approach, this study tested the feasibility of EMA and the hypothesis of a self-reinforcing relationship (a) between worry and affect and (b) between worry and sleep in refugees. Additionally, we examined whether worry interacts with postmigration stress to impact on affect and sleep. Methods For 1 week, 45 trauma-exposed Afghan refugees received five prompts per day asking them to report on momentary levels of worrying and negative as well as positive affect. In addition, sleep quality was assessed in the morning and the occurrence of postmigration stress at night. Results Our findings did not indicate a bidirectional relationships (a) between worry and affective experiences and (b) between worry and poor sleep quality. However, worry experienced on a given day predicted increased negative affect on the next day; in turn, positive affect predicted decreased worrying on the next day. Hypotheses on the interaction between worry and stress in predicting affect and sleep were not supported. Conclusion These preliminary findings suggest unidirectional effects of daily worry on negative affect and positive affect on daily worry. However, the low compliance rate and the small sample size precludes drawing firm conclusions. Implications for further EMA research among refugees are discussed.