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World J Psychiatry. Jul 19, 2026; 16(7): 117824
Published online Jul 19, 2026. doi: 10.5498/wjp.117824
Published online Jul 19, 2026. doi: 10.5498/wjp.117824
Tardive dyskinesia-depression association in Chinese patients with chronic schizophrenia: The mediating role of insomnia and gender differences
San-Rong Xiao, Yan Liu, School of Public Policy and Administration, Nanchang University, Nanchang 330031, Jiangxi Province, China
Qiu-Yue Yin, Institute of Education Development, Nanchang University, Nanchang 330031, Jiangxi Province, China
Jing-Min Zhu, Ting Wang, Department of Humanities, Jiangxi University of Chinese Medicine, Nanchang 330004, Jiangxi Province, China
Wen-Zhi Tan, School of Education, University of Queensland, Brisbane 4072, Australia
Xiang-Yang Zhang, Institute of Psychology, CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 100101, China
Co-first authors: San-Rong Xiao and Qiu-Yue Yin.
Co-corresponding authors: Ting Wang and Xiang-Yang Zhang.
Author contributions: Xiao SR and Yin QY contributed equally to this manuscript and are co-first authors. Xiao SR was responsible for the methodology; Yin QY was responsible for writing the original draft; Yin QY and Liu Y were responsible for data curation; Yin QY and Zhu JM were responsible for the formal analysis; Xiao SR and Zhu JM were responsible for validation; Tan WZ and Wang T were responsible for reviewing and editing; Wang T and Zhang XY were responsible for conceptualization, resources, supervision, and project administration as the co-corresponding authors. All authors read and agreed to the published version of the manuscript.
AI contribution statement: ChatGPT or similar AI tools are only used for limited language polishing and grammar correction during the manuscript preparation process. The main text of the manuscript (including the abstract, introduction, and all review sections) is written and revised by the author. No part of the scientific content in the manuscript is generated by AI. The AI tools are only used for language editing and improving readability. They are not used for literature selection, data analysis, content generation or manuscript writing. The AI tools did not participate in the design of the review framework, literature interpretation or the formulation of scientific conclusions. Any images, charts or graphic materials included in the manuscript were not generated by AI. All authors are fully responsible for the originality, accuracy and completeness of the manuscript.
Institutional review board statement: This study was approved by the Institutional Ethical Review Board, Institute of Psychology, Chinese Academy of Sciences (No. H18031).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
Corresponding author: Xiang-Yang Zhang, PhD, Postdoc, Professor, Research Fellow, Institute of Psychology, CAS Key Laboratory of Mental Health, Chinese Academy of Sciences, No. 16 Lincui Road, Chaoyang District, Beijing 100101, China. zhangxy@psych.ac.cn
Received: December 23, 2025
Revised: February 23, 2026
Accepted: April 2, 2026
Published online: July 19, 2026
Processing time: 186 Days and 9 Hours
Revised: February 23, 2026
Accepted: April 2, 2026
Published online: July 19, 2026
Processing time: 186 Days and 9 Hours
Core Tip
Core Tip: This study of 669 Chinese patients with chronic schizophrenia demonstrates that tardive dyskinesia (TD) is associated with increased depressive severity, with insomnia partially mediating this relationship (accounting for 38% of the total effect). Gender differences were identified: Female patients with TD exhibited more severe overall depression, greater diurnal variation, and increased psychomotor retardation, whereas male patients with TD differed from non-TD males only in diurnal variation. These findings point to the critical need for systematic evaluation of insomnia and depression in the TD patient population and highlight the need for gender-specific interventions to optimize care in this vulnerable population.