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World J Psychiatry. Jul 19, 2026; 16(7): 117788
Published online Jul 19, 2026. doi: 10.5498/wjp.117788
Correlation of fourteen subjectively reported adverse mental states with insomnia: Gender differences in a cross-sectional study
Bing-Xin Tian, Jie Fang, Ke Ji, Jie Yang, Yun-Xia Tan, Fu-Gui Liu, Ling Liu
Bing-Xin Tian, Ling Liu, The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan 430000, Hubei Province, China
Bing-Xin Tian, Ling Liu, Hubei University of Chinese Medicine, Engineering Research Center of TCM Protection Technology and New Product Development for the Elderly Brain Health, Ministry of Education, Wuhan 430000, Hubei Province, China
Jie Fang, School of Clinical Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan 430000, Hubei Province, China
Jie Fang, Ling Liu, Department of Neurology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan 430000, Hubei Province, China
Ke Ji, Department of Psychiatry, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan 430000, Hubei Province, China
Jie Yang, Department of Oncology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan 430000, Hubei Province, China
Yun-Xia Tan, Hubei Minzu University, School of Medicine, Enshi 445000, Hubei Province, China
Fu-Gui Liu, Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
Co-first authors: Bing-Xin Tian and Jie Fang.
Author contributions: Tian BX was responsible for writing the original draft and visualization; Tian BX and Fang J participated in the formal analysis as co-first authors; Tian BX, Fang J, and Liu L contributed to writing-review and editing; Tian BX, Fang J, Ji K, Yang J, Tan YX, and Liu FG participated in the investigation and data curation; Liu L contributed to conceptualization, funding acquisition, methodology, project administration and supervision; all authors have read and approve the final manuscript.
AI contribution statement: AI-assisted tools (ChatGPT, Deepseek, DeepL, and Grammarly) were used solely for language translation and linguistic refinement to improve the clarity and readability of the manuscript. These tools did not contribute to the generation of the main text of the manuscript. All study design, data collection, data analysis, data interpretation, image creation, and scientific conclusions were completed entirely by the authors.
Supported by Ministry of Science and Technology of the People’s Republic of China, No. 2018YFC1705602.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Affiliated Hospital of Hubei University of Chinese Medicine, No. HBZY2019-C43-01.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Ling Liu, MD, Chief Physician, Professor, Department of Neurology, Affiliated Hospital of Hubei University of Chinese Medicine, No. 4 Garden Hill, Wuchang District, Wuhan 430000, Hubei Province, China.
lingliu07199@aliyun.com
Received: December 16, 2025
Revised: January 26, 2026
Accepted: March 13, 2026
Published online: July 19, 2026
Processing time: 190 Days and 14.1 Hours
BACKGROUND
Although numerous studies indicate that adverse mental states negatively affect sleep, few have systematically analyzed the association between various adverse mental states and insomnia. Furthermore, potential gender differences within such associations remain underexplored.
AIM
To investigate gender differences in correlations between adverse mental states and insomnia, and identify gender-specific risk factors for severe insomnia.
METHODS
A multicenter cross-sectional survey method was employed. A total of 2009 adult participants (2019-2021) completed an insomnia clinical assessment form. The form covered sociodemographic information, 14 subjectively reported adverse mental states, core insomnia symptoms, and the Pittsburgh Sleep Quality Index.
RESULTS
Depression, apathy, fatigue, impatience-irritability, grief, forgetfulness, and slow response were significantly associated with insomnia. Timidity, indecision, suspiciousness, catatonia, decreased willpower, taciturnity, and inattention showed no significant association with insomnia. Grief (r = 0.062, P < 0.05), fatigue (r = 0.065, P < 0.05), and slow response (r = 0.080, P < 0.01) were correlated with increased time to fall asleep in women; no mental factors influencing sleep latency were identified in men. Apathy (r = 0.073, P < 0.05) was associated only with increased nocturnal awakenings in men, but not in women. Impatience-irritability was a risk factor for severe insomnia exclusively in men (odds ratio = 1.62, 95%CI: 1.13-2.32, P = 0.009), while grief was a risk factor specifically for women (odds ratio = 1.83, 95%CI: 1.20-2.80, P = 0.005).
CONCLUSION
Not all adverse mental states are significantly associated with insomnia, and the correlation between adverse mental states and insomnia varies according to gender and specific sleep dimensions.
Core Tip: This cross-sectional study included 2009 adult patients (≥ 18 years old) with insomnia in China. The study used the Pittsburgh Sleep Quality Index and an insomnia clinical assessment form to evaluate the correlation between adverse mental states and insomnia. Results indicated that not all adverse mental states were significantly associated with insomnia. Moreover, the correlation between adverse mental states and insomnia varied significantly by gender and specific sleep parameters. These findings provide valuable insights for developing targeted mental health interventions to manage insomnia.
