ArticleJournal of anxiety disorders2022
Why Sleep is Key: Poor Sleep Quality is a Mechanism for the Bidirectional Relationship between Major Depressive Disorder and Generalized Anxiety Disorder Across 18 Years.
Article in Journal of anxiety disorders, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Comparison of resting-state brain activity between insomnia and generalized anxiety disorder: A coordinate-based meta-analysis.Brain imaging and behavior · 2025Pooled it
- Efficacy of non-pharmacological interventions for alleviating insomnia in individuals with generalized anxiety disorder: systematic evaluation and net meta-analysis.Frontiers in psychiatry · 2025Pooled it
- Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study.BMC complementary medicine and therapies · 2024Trial
- Rest Intolerance, Emotional Distress, Insomnia, and Adaptive Coping Strategies: A Validation and Serial Mediation Analysis Study.The Psychiatric quarterly · 2026Article
- Modifiable cardiovascular risk factors in people with polycystic ovarian syndrome (PCOS): Findings from the endocrine and mental health study.American journal of preventive cardiology · 2026Article
- Child and Family Characteristics Associated with Symptoms of Anxiety in Autistic Children: A Biobank Study.Journal of autism and developmental disorders · 2026Article
- Association Between Internet Addiction and Comorbid Anxiety and Depression in Chinese Children and Adolescents: A Latent Profile Analysis and Network Analysis.Healthcare (Basel, Switzerland) · 2026Article
- Clinical Heterogeneity of Major Depressive Disorder: The Role of Trauma, Dissociation, and Sleep.Journal of clinical medicine · 2026Article
- Gendered Racial Microaggressions and Sleep Quality: Examining the Potential Mediating Role of Mental Health in Asian American Women.Journal of racial and ethnic health disparities · 2026Article
- Evaluating perioperative self-reported sleep quality in patients with a gynecologic malignancy.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Associations Between Religiosity, Spirituality and Depressive Symptoms Among People Experiencing Homelessness in São Paulo, Brazil: An Observational Study.The Psychiatric quarterly · 2026Observational
- Association Between Physical Activity Levels and Sleep Quality Among Saudi Board Trainees: A Cross-Sectional Study.Cureus · 2026Article
- Waking up to the truth: Associations between sleep disorders and multidomain functional outcomes in Alzheimer's disease.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- Article
- Environmental adaptation and sleep disturbance: a cross-sectional study reveals distinct metabolic risk profiles in long-term high-altitude residents versus the general population.Frontiers in psychiatry · 2026Article
- Sleepless hours: the lived experience of chronic insomnia and anxiety across the US care spectrum.Frontiers in public health · 2026Article
- Actigraphy and subjective sleep predictors of nine-year generalized anxiety disorder.Journal of anxiety disorders · 2026Article
- The chain mediating role of physical exercise and anxiety in the relationship between school connectedness and sleep disorders among adolescents.Frontiers in public health · 2026Article
- Acupuncture-Based Interventions for Sleep Outcomes in Patients with Postherpetic Neuralgia: A Systematic Review and Meta-Analysis.Journal of pain research · 2026Review
- Predicting generalized anxiety disorder among Chinese depressed adolescents: an explainable machine learning approach.BMC medical informatics and decision making · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundGeneralized anxiety disorder (GAD) and major depressive disorder (MDD) reliably precede and predict one another. However, there is insufficient data on mediators through which the longitudinal GAD-MDD association unfold. Based on insomnia theories, such as the hyperarousal model of sleep, we tested the degree to which poor global sleep quality functioned as a mediator of the prospective bidirectional anxiety-depression relationship.
methodParticipants were 3,294 community-dwelling adults who partook in three measurement waves nine years apart. The Composite International Diagnostic Interview-Short Form assessed GAD and MDD in-person at baseline (Time 1 [T1]), Time 2 (T2; nine years after T1), and 18 years later (T3). T2 global sleep quality was measured using the multiple-domain Pittsburgh Sleep Quality Index self-report at T2. We used longitudinal structural equation modeling mediation analyses.
resultsAnalyses showed that higher T1 MDD and GAD severity individually predicted lower T2 global sleep quality (Cohen's d = -0.561 to -0.480) and less T2 global sleep quality, thereby forecasted both higher T3 MDD and GAD (d = -0.275 to -0.190). Poorer T2 global sleep quality significantly mediated the T1 GAD-T3 MDD relation, explaining 41% of the association. Worse global sleep quality at T2 also significantly mediated the T1 MDD-T3 GAD association, mediating 11% of the T1 MDD-T3 GAD pathway. The results remained similar after controlling for multiple sociodemographic and clinical variables.
conclusionsFindings offer evidence for transdiagnostic theories of sleep and insomnia. Theoretical and clinical implications, such as prioritizing sleep improvement in cognitive-behavioral therapies, are also discussed.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.