Relationship between stressful life events and insomnia in community-dwelling patients with schizophrenia： path analysis of psychotic symptoms and depression

BackgroundsInsomnia is frequent in schizophrenia and is found to be negatively affected by stressful life events， psychotic symptoms and depressive disorder， while the relationship among the four remains understudied in community-dwelling patients with schizophrenia.ObjectiveTo analyze the effect of stressful life events on insomnia in community-dwelling patients with schizophrenia， and to explore the mediation effect of psychotic symptoms and depression， so as to provide references for the intervention of insomnia in community-dwelling patients with schizophrenia.MethodsFrom April to June 2023， a sample of 1 105 patients with schizophrenia attending 48 community health centers in Chengdu， Sichuan province and fulfilling the International Classification of Diseases， tenth edition （ICD-10） diagnostic criteria were included. All subjects were assessed using Stressful Life Event Scale （SLEs）， Athens Insomnia Scale （AIS）， Psychosis Screening Questionnaire （PSQ）， and Patient Health Questionnaire Depression Scale （PHQ-9）. Spearman correlation analysis was used to determine the correlation among the scales. Then the mediation model was constructed using Smart PLS 4.0， and tested with partial least squares algorithm and Bootstrap techniques.Results332 patients （30.05%） with community schizophrenia were found to have insomnia. AIS scores in patients with schizophrenia were positively correlated with the scores on SLEs， PSQ and PHQ-9 （r=0.165， 0.322， 0.554， P<0.01）. Stressful life events indirectly contributed to insomnia through both separate mediation path and chained mediation path of psychotic symptoms and depressive disorder， and the indirect effect size of 0.102， 0.372 and 0.190 was obtained， accounting for 10.46%， 38.15% and 19.49%， respectively.ConclusionThe stressful life events not only directly exert an impact on insomnia， but also indirectly contribute to insomnia through both the separate and chained mediation effect of psychotic symptoms and depressive disorder.