General psychiatry · 2026
Associations between anxiety, somatic pain and sleep disturbances in major depressive disorder and chronic pain: A cross-sectional study with gender-specific insights.
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Zhu Cuizhen, Cheng Jian, Chen He, Yan Junwei, Li Chao, Kong Xiaoming, Hu Jiayi, Gao Jianliang, Zhang Loufeng, Ju Peijun, Xia Qingrong
Аннотация
BACKGROUND: Major depressive disorder (MDD) and chronic pain (CP) demonstrate marked sex disparities, with higher prevalence and severity in females. However, the underlying mechanisms remain poorly understood.
AIMS: We aimed to examine the intricate interplay among anxiety, physical pain and sleep disruptions in inpatients with depression and chronic pain, specifically addressing potential gender differences.
METHODS: This cross-sectional study enrolled 122 participants and split them into three groups: the comorbidity group (inpatients with MDD and CP, n = 37), the MDD group (inpatients with MDD without CP, n = 37) and the control group (healthy controls, n = 48). Sex-stratified piecewise regression tested pain/latent variable threshold effects in depression-comorbidity subgroups. Generalised additive models (GAMs) with tensor-product smoothing and S-splines were used to model associations between a standardised somatic anxiety subscore and pain intensity, capturing nonlinear patterns and subgroup-specific interactions.
RESULTS: The comorbidity group exhibited greater impairments in pain intensity, anxiety and depressive symptoms, and quality of life compared to other groups. Piecewise regression analysis revealed a nonlinear relationship between the somatic anxiety subscore and pain intensity, with female inpatients in the comorbidity group experiencing higher pain intensity and anxiety severity compared to those in the MDD group. The GAM results showed a peak in pain intensity at a moderate-low threshold in the MDD and comorbidity groups, suggesting an optimal clinical breakpoint (8 points on the somatic anxiety subscore of Hamilton Anxiety Rating Scale-14) for targeted interventions in females.
CONCLUSIONS: Our findings offer novel insights into the sex-specific dynamics linking anxiety, somatic pain and sleep disturbances in MDD-CP comorbidity, providing an empirical foundation for personalised therapy.
AIMS: We aimed to examine the intricate interplay among anxiety, physical pain and sleep disruptions in inpatients with depression and chronic pain, specifically addressing potential gender differences.
METHODS: This cross-sectional study enrolled 122 participants and split them into three groups: the comorbidity group (inpatients with MDD and CP, n = 37), the MDD group (inpatients with MDD without CP, n = 37) and the control group (healthy controls, n = 48). Sex-stratified piecewise regression tested pain/latent variable threshold effects in depression-comorbidity subgroups. Generalised additive models (GAMs) with tensor-product smoothing and S-splines were used to model associations between a standardised somatic anxiety subscore and pain intensity, capturing nonlinear patterns and subgroup-specific interactions.
RESULTS: The comorbidity group exhibited greater impairments in pain intensity, anxiety and depressive symptoms, and quality of life compared to other groups. Piecewise regression analysis revealed a nonlinear relationship between the somatic anxiety subscore and pain intensity, with female inpatients in the comorbidity group experiencing higher pain intensity and anxiety severity compared to those in the MDD group. The GAM results showed a peak in pain intensity at a moderate-low threshold in the MDD and comorbidity groups, suggesting an optimal clinical breakpoint (8 points on the somatic anxiety subscore of Hamilton Anxiety Rating Scale-14) for targeted interventions in females.
CONCLUSIONS: Our findings offer novel insights into the sex-specific dynamics linking anxiety, somatic pain and sleep disturbances in MDD-CP comorbidity, providing an empirical foundation for personalised therapy.