Rumination and Insomnia in Chinese Adolescents with Mood Disorders: The Mediating Role of Anxiety

Abstract Objective Insomnia is the most common complaint in adolescents with mood disorders (MD). However, the psychopathological mechanisms associated with insomnia remain unclear. Therefore, we aimed to explore anxiety’s mediating role in the effect of rumination on insomnia in MD adolescents. Methods A total of 569 MD patients were recruited. Participants completed the Patient Health Questionnaire-9 (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7) scale, and Insomnia Severity Index (ISI) to self-assess their mood and insomnia symptoms. In addition, the 21-item Chinese version of the Ruminative Response Scale (RRS) was used to assess rumination specifically. Results The prevalence of insomnia in MD patients was 60.63%, with a higher prevalence in females (63.32%) vs. male patients(54.39%). MD patients with insomnia symptoms also scored higher on depression and anxiety symptom scales, as well as rumination, when compared to MD patients without insomnia. Depression-related rumination and anxiety were correlated with insomnia in MD patients. The AUCROC showed that the combination of depression-related rumination and anxiety could effectively distinguish patients with and without insomnia in MD adolescents. Furthermore, in adolescents with MD, depression-related rumination positively predicted anxiety and insomnia, and anxiety positively predicted insomnia. Finally, anxiety partially mediated the association between depression-related rumination and insomnia. Conclusion Our results suggest that depression-related rumination and anxiety are key riskfactors for insomnia in adolescents with MD. Furthermore, anxiety can exacerbate the effects of depression-related rumination on insomnia, suggesting that clinical interventions to reduce depression-related rumination and anxiety may be a viable consideration for insomnia in adolescents with MD.