Tardive dyskinesia-depression association in Chinese patients with chronic schizophrenia: The mediating role of insomnia and gender differences

doi:10.5498/wjp.117824

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World Journal of Psychiatry

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2220-3206

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jul 19, 2026; 16(7): 117824
Published online Jul 19, 2026. doi: 10.5498/wjp.117824

Table 1 Demographic and clinical characteristics of chronic schizophrenia patients with or without tardive dyskinesia, n (%)

		TD (n = 312)	Non-TD (n = 357)	χ²/Z	P value
Gender	Male	202 (64.7)	255 (71.4)	3.438	0.064
Gender	Female	110 (35.3)	102 (28.6)	3.438	0.064
Marital status	Unmarried	186 (59.8)	233 (65.3)	2.604	0.272
	Married	74 (23.8)	68 (19.0)
	Others (divorced or widowed)	51 (16.4)	56 (15.7)
Smoking history	No	187 (59.9)	201 (56.1)	0.298	0.585
Smoking history	Yes	186 (40.1)	157 (43.9)	0.298	0.585
Diabetes	No	260 (83.3)	328 (91.9)	11.420	< 0.001
Diabetes	Yes	52 (16.7)	29 (8.1)	11.420	< 0.001
Hypertension	No	301 (96.5)	345 (96.6)	0.014	0.907
Hypertension	Yes	11 (3.5)	12 (3.4)	0.014	0.907
Family history	No	248 (80.3)	286 (80.6)	0.010	0.921
Family history	Yes	61 (19.7)	69 (19.4)	0.010	0.921
Suicidal ideation	No	243 (82.4)	270 (84.4)	0.445	0.505
Suicidal ideation	Yes	52 (17.6)	50 (15.6)	0.445	0.505
Age		48 (37, 56)	41 (30, 53)	4.028	< 0.001
Education (years)		8 (8, 11)	8 (8, 11)	2.282	0.023
Age of onset		23 (19, 28.3)	23 (19, 28)	0.948	0.343
BMI		23.6 (20.9, 27.0)	23.8 (21.1, 26.8)	0.646	0.518
Positive symptoms		18 (12, 23)	15 (10, 21)	3.704	< 0.001
Negative symptoms		25 (19, 29)	22 (16, 28)	3.616	< 0.001
General psychopathology		38 (29.8, 49)	35 (28, 42)	5.393	< 0.001
Total scores		81.5 (64, 99)	72 (60, 86)	5.465	< 0.001
RBANS		61 (52.8, 72)	64 (54, 76)	2.328	0.020
ISI		2 (0, 5)	1 (0, 4)	3.262	0.001
HAMD total score		7 (3, 12)	6 (2, 10)	2.042	0.041
Anxiety somatization		2 (1, 3)	2 (1, 3)	2.229	0.026
Weight loss		0 (0, 0)	0 (0, 0)	0.685	0.493
Cognitive disturbances		1 (0, 3)	1 (0, 2)	2.682	0.007
Diurnal variation		0 (0, 0)	0 (0, 0)	5.781	< 0.001
Psychomotor retardation		2 (0.75, 3)	1 (0, 3)	2.002	0.045
Insomnia		0 (0, 1)	0 (0, 2)	0.856	0.392
Hopelessness		1 (0, 2)	0 (0, 2)	1.939	0.053

TD: Tardive dyskinesia; BMI: Body mass index; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status; ISI: Insomnia Severity Index; HAMD: Hamilton Rating Scale for Depression.

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Table 2 Mediating effect of insomnia on the relationship between tardive dyskinesia and depression

	Effect¹	Coefficient	SE	t	P value	95%CI
	Effect¹	Coefficient	SE	t	P value	LL	UL
DV: Depression; IV: Tardive dyskinesia; mediator: Insomnia	a	0.245	0.049	5.031	< 0.001	0.150	0.341
	b	0.744	0.059	12.581	< 0.001	0.628	0.860
	c	0.480	0.080	5.994	< 0.001	0.323	0.638
	c’	0.298	0.073	4.081	< 0.001	0.154	0.441
	c-c’	0.183	0.045	-	-	0.099	0.276

¹Coefficients are unstandardized regression coefficients.

a: The effect of tardive dyskinesia on insomnia; b: The effect of insomnia on depression; c: The total effect of tardive dyskinesia on depression; c’: The direct effect of tardive dyskinesia on depression after controlling for insomnia; c-c’: The indirect effect of tardive dyskinesia on depression through insomnia; SE: Standard error; CI: Confidence interval; LL: Lower limit; DV: Upper limit; IV: Independent variable; UL: Dependent variable.

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Table 3 Comparison of Hamilton depression total and index scores in male and female schizophrenia patients with and without tardive dyskinesia

	Male				Female
	TD	Non-TD	Z	P value	TD	Non-TD	Z	P value
Anxiety somatization	2 (0, 3)	2 (0, 3)	1.091	0.275	2 (2, 4)	2 (1, 3.75)	1.803	0.071
Weight loss	0 (0, 0)	0 (0, 0)	0.91	0.927	0 (0, 0)	0 (0, 0)	0.718	0.473
Cognitive disturbances	1 (0, 2)	0 (0, 2)	1.729	0.084	2 (0, 3)	1 (0, 3.75)	1.544	0.123
Diurnal variation	0 (0, 0)	0 (0, 0)	3.259	0.001	0 (0, 1)	0 (0, 0)	4.906	< 0.001
Psychomotor retardation	1 (0, 3)	1 (0, 3)	0.732	0.464	3 (1, 4)	1 (0, 3)	2.496	0.013
Insomnia	0 (0, 1)	0 (0, 2)	0.420	0.674	0 (0, 1)	0 (0, 1)	0.971	0.332
Hopelessness	0 (0, 1.5)	0 (0, 1.75)	1.340	0.180	1 (0, 2.5)	0.5 (0, 2)	1.253	0.210
HAMD total score	6 (3, 11)	6 (2, 10)	0.670	0.503	10 (5, 14)	7 (2, 13)	2.034	0.042

TD: Tardive dyskinesia; HAMD: Hamilton Rating Scale for Depression.

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Citation: Xiao SR, Yin QY, Zhu JM, Liu Y, Tan WZ, Wang T, Zhang XY. Tardive dyskinesia-depression association in Chinese patients with chronic schizophrenia: The mediating role of insomnia and gender differences. World J Psychiatry 2026; 16(7): 117824
URL: https://www.wjgnet.com/2220-3206/full/v16/i7/117824.htm
DOI: https://dx.doi.org/10.5498/wjp.117824

Xiao SR, Yin QY, Zhu JM, Liu Y, Tan WZ, Wang T, Zhang XY. Tardive dyskinesia-depression association in Chinese patients with chronic schizophrenia: The mediating role of insomnia and gender differences. World J Psychiatry 2026; 16(7): 117824 [DOI: 10.5498/wjp.117824]

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