Distinct Associations Between Psychopathological Distress and Sleep Quality in Good and Poor Sleepers
DOI:
https://doi.org/10.13129/2282-1619/mjcp-5513Keywords:
Aging, Clinical psychology, Distress, Psychopathology, Sleep, Sleep qualityAbstract
Background: Sleep quality commonly declines with advancing age and is closely linked to psychological distress through intricate and bidirectional mechanisms. Although this relationship is well established, less is known about whether psychopathological symptoms differentially affect specific dimensions of sleep among individuals with varying levels of sleep impairment. The present study aims to investigate the role of psychopathological distress on multiple components of sleep quality in good and poor sleepers.
Methods: Two hundred and seventy-three participants (aged 50-91) were divided into good sleepers (n = 145) and poor sleepers (n=128) using the Pittsburgh Sleep Quality Index (PSQI) cut-off. Psychological distress was evaluated using the Symptom Checklist-90 (SCL-90).
Results: ANOVAs revealed that poor sleepers reported significantly higher distress across all clinical subscales and global indices of SCL-90 (p<0.001). Correlation analyses revealed different patterns between groups. Among good sleepers, psychological distress was mainly associated with sleep latency, suggesting a circumscribed impact on sleep onset. Conversely, among poor sleepers, psychological distress showed broader correlations with sleep disturbance, daytime dysfunction, and global PSQI scores. Hierarchical linear regressions confirmed that adding the Global Severity Index (GSI) to the model, after controlling for demographic covariates, significantly improved model fit in both groups. However, psychological distress accounted for a higher proportion of variance in Poor Sleepers (R2=0.14, ΔR2=0.10, p<0.001) than in good sleepers (R2=0.05, ΔR2=0.04, p=0.012).
Conclusions: These findings suggest that psychological distress may act as a pervasive perpetuating factor when sleep is already compromised. These findings highlight the importance of considering psychopathological burden when addressing sleep problems in later life and support the development of tailored interventions targeting both emotional distress and sleep dysfunction.
References
1. Alblooshi, S., Taylor, M., & Gill, N. (2023). Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australasian Psychiatry, 31(2), 165-173.
https://doi.org/10.1177/10398562231165439
2. Altena, E., Chen, I. Y., Daviaux, Y., Ivers, H., Philip, P., & Morin, C. M. (2017). How hyperarousal and sleep reactivity are represented in different adult age groups: Results from a large cohort study on insomnia. Brain sciences, 7(4), 41. https://doi.org/10.3390/brainsci7040041
3. Azizi-Zeinalhajlou, A., Mirghafourvand, M., Nadrian, H., Samei Sis, S., & Matlabi, H. (2022). The contribution of social isolation and loneliness to sleep disturbances among older adults: A systematic review. Sleep and Biological Rhythms, 20(2), 153-163. https://doi.org/10.1007/s41105-022-00380-x
4. Bagautdinova, J., Mayeli, A., Wilson, J. D., Donati, F. L., Colacot, R. M., Meyer, N., Fusar-Poli, P., & Ferrarelli, F. (2023). Sleep abnormalities in different clinical stages of psychosis: a systematic review and meta-analysis. JAMA Psychiatry, 80(3), 202-210. https://doi.org/10.1001/jamapsychiatry.2022.4599
5. Baglioni, C., Nanovska, S., Regen, W., Spiegelhalder, K., Feige, B., Nissen, C., Reynolds III, C. F., & Riemann, D. (2016). Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychological Bulletin, 142(9), 969. https://doi.org/10.1037/bul0000053
6. Becker, D., Lomranz, J., Pines, A., Shmotkin, D., Nitza, E., Bennamitay, G., & Mester, R. (2001). Psychological distress around menopause. Psychosomatics, 42(3), 252-257.
https://doi.org/10.1176/appi.psy.42.3.252
7. Bombois, S., Derambure, P., Pasquier, F., & Monaca, C. (2010). Sleep disorders in aging and dementia. The journal of nutrition, health & aging, 14(3), 212-217. https://doi.org/10.1007/s12603-010-0052-7
8. Bonnet, M. H., & Arand, D. L. (2010). Hyperarousal and insomnia: state of the science. Sleep medicine reviews, 14(1), 9-15. https://doi.org/10.1016/j.smrv.2009.05.002
9. Bryant, C., Judd, F. K., & Hickey, M. (2012). Anxiety during the menopausal transition: a systematic review. Journal of affective disorders, 139(2), 141-148. https://doi.org/10.1016/j.jad.2011.06.055
10. Buysse, D. J. (2014). Sleep health: can we define it? Does it matter?. Sleep, 37(1), 9-17.
https://doi.org/10.5665/sleep.3298
11. Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
10.1016/0165-1781(89)90047-4
12. Casagrande, M., Forte, G., Favieri, F., & Corbo, I. (2022). Sleep quality and aging: a systematic review on healthy older people, mild cognitive impairment and Alzheimer’s disease. International Journal of Environmental Research and Public Health, 19(14), 8457. https://doi.org/10.3390/ijerph19148457
13. Cassano, G. B., Conti, L., & Levine, J. (1999). SCL-90. Repertorio delle scale di valutazione in psichiatria, 325-332.
14. Cho, J. H. J., Olmstead, R., Choi, H., Carrillo, C., Seeman, T. E., & Irwin, M. R. (2019). Associations of objective versus subjective social isolation with sleep disturbance, depression, and fatigue in community-dwelling older adults. Aging & Mental Health, 23(9), 1130-1138.
https://doi.org/10.1080/13607863.2018.1481928
15. Cooke, J. R., & Ancoli-Israel, S. (2011). Normal and abnormal sleep in the elderly. Handbook of Clinical Neurology, 98, 653-665. 10.1016/B978-0-444-52006-7.00041-1
16. Corbo, I., Favieri, F., Forte, G., & Casagrande, M. (2025). Decision-making under uncertainty in healthy and cognitively impaired aging: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 129, 105643. https://doi.org/10.1016/j.archger.2024.105643
17. Corbo, I., Forte, G., Favieri, F., & Casagrande, M. (2023). Poor sleep quality in aging: the association with mental health. International Journal of Environmental Research and Public Health, 20(3), 1661.
https://doi.org/10.3390/ijerph20031661
18. Cox, R. C., & Olatunji, B. O. (2020). Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research. Sleep Medicine Reviews, 51, 101282. https://doi.org/10.1016/j.smrv.2020.101282
19. Curcio, G., Tempesta, D., Scarlata, S., Marzano, C., Moroni, F., Rossini, P. M., Ferrara, M., & De Gennaro, L. (2013). Validity of the Italian version of the Pittsburgh sleep quality index (PSQI). Neurological Sciences, 34(4), 511-519. https://doi.org/10.1007/s10072-012-1085-y
20. Demichelis, O. P., Grainger, S. A., Burr, L., & Henry, J. D. (2023). Emotion regulation mediates the effects of sleep on stress and aggression. Journal of sleep research, 32(3), e13787. https://doi.org/10.1111/jsr.13787
21. Derogatis, L. R., & Cleary, P. A. (1977). Confirmation of the dimensional structure of the SCL‐90: A study in construct validation. Journal of Clinical Psychology, 33(4), 981-989.
https://doi.org/10.1002/1097-4679(197710)33:4<981::AID-JCLP2270330412>3.0.CO;2-0
22. Di Marco, T., Scammell, T. E., Sadeghi, K., Datta, A. N., Little, D., Tjiptarto, N., ... & Dauvilliers, Y. (2025). Hyperarousal features in the sleep architecture of individuals with and without insomnia. Journal of Sleep Research, 34(1), e14256. https://doi.org/10.1111/jsr.14256
23. Eichling, P. S., & Sahni, J. (2005). Menopause related sleep disorders. Journal of Clinical Sleep Medicine, 1(03), 291-300. https://doi.org/10.5664/jcsm.26347
24. Ekström, H., Svensson, M., Elmståhl, S., & Wranker, L. S. (2024). The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project. SAGE Open Medicine, 12, 20503121231222823. https://doi.org/10.1177/2050312123122282
25. Espiritu, J. R. D. (2008). Aging-related sleep changes. Clinics in Geriatric Medicine, 24(1), 1-14.
https://doi.org/10.1016/j.cger.2007.08.007
26. Gosling, J. A., Batterham, P. J., & Christensen, H. (2012). Cognitive-behavioural factors that predict sleep disturbance 4 years later. Journal of Psychosomatic Research, 73(6), 424-429.
https://doi.org/10.1016/j.jpsychores.2012.08.011
27. Gulia, K. K., & Kumar, V. M. (2018). Sleep disorders in the elderly: a growing challenge. Psychogeriatrics, 18(3), 155-165. https://doi.org/10.1111/psyg.12319
28. Hagen, E. W., Barnet, J. H., Hale, L., & Peppard, P. E. (2016). Changes in sleep duration and sleep timing associated with retirement transitions. Sleep, 39(3), 665-673. https://doi.org/10.5665/sleep.5548
29. Hall, M., Buysse, D. J., Dew, M. A., Prigerson, H. G., Kupfer, D. J., & Reynolds III, C. F. (1997). Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement‐related depression. Depression and Anxiety, 6(3), 106-112.
https://doi.org/10.1002/(SICI)1520-6394(1997)6:3<106::AID-DA3>3.0.CO;2-B
30. Hamilton, N. A., Nelson, C. A., Stevens, N., & Kitzman, H. (2007). Sleep and psychological well-being. Social Indicators Research, 82(1), 147-163. https://doi.org/10.1007/s11205-006-9030-1
31. Han, E. K., & Son, H. K. (2024). The factors affecting sleep quality in community-dwelling older adults, based on Spielman’s 3P model of insomnia. Iranian Journal of Public Health, 53(12), 2739.
32. https://doi.org/10.3390/ijerph20031661
33. Ionescu, C. G., Popa-Velea, O., Mihăilescu, A. I., Talaşman, A. A., & Bădărău, I. A. (2021, August). Somatic symptoms and sleep disorders: a literature review of their relationship, comorbidities and treatment. Healthcare, 9(9). https://doi.org/10.3390/healthcare9091128
34. Lancel, M., Stroebe, M., & Eisma, M. C. (2020). Sleep disturbances in bereavement: A systematic review. Sleep Medicine Reviews, 53, 101331. https://doi.org/10.1016/j.smrv.2020.101331
35. Lang, X. L., Huang, C. C., Cui, H. Y., Zhong, H. X., Shen, M. Y., & Zhao, F. (2025). From physiology to psychology: an integrative review of menopausal syndrome. World Journal of Psychiatry, 15(11), 108713.
https://doi.org/10.5498/wjp.v15.i11.108713
36. Lavoie, C. J., Zeidler, M. R., & Martin, J. L. (2018). Sleep and aging. Sleep Science and Practice, 2(1), 3.
https://doi.org/10.1186/s41606-018-0021-3
37. Lehti, T. E., Öhman, H., Knuutila, M., Kautiainen, H., Karppinen, H., Tilvis, R., Strandberg, T. E., & Pitkala, K. H. (2021). Symptom burden is associated with psychological wellbeing and mortality in older adults. The Journal of Nutrition, Health & Aging, 25(3), 330-334. https://doi.org/10.1007/s12603-020-1490-5
38. Li, J., Vitiello, M. V., & Gooneratne, N. S. (2022). Sleep in normal aging. Sleep Medicine Clinics, 17(2), 161-171.
https://doi.org/10.1016/j.jsmc.2017.09.001 1556-407X/18/
39. Maki, P. M., Panay, N., & Simon, J. A. (2024). Sleep disturbance associated with the menopause. Menopause, 31(8), 724-733. https://doi.org/10.1097/GME.0000000000002386
40. Mander, B. A., Winer, J. R., & Walker, M. P. (2017). Sleep and human aging. Neuron, 94(1), 19-36.
https://doi.org/10.1016/j.neuron.2017.02.004
41. Monk, T. H., Begley, A. E., Billy, B. D., Fletcher, M. E., Germain, A., Mazumdar, S., Douglas, E. M., Shear, K., Thompson, W. K., & Zarotney, J. R. (2008). Sleep and circadian rhythms in spousally bereaved seniors. Chronobiology International, 25(1), 83-98. https://doi.org/10.1080/07420520801909320
42. Myllyntausta, S., Salo, P., Kronholm, E., Pentti, J., Kivimäki, M., Vahtera, J., & Stenholm, S. (2018). Changes in sleep difficulties during the transition to statutory retirement. Sleep, 41(1), zsx182.
https://doi.org/10.1093/sleep/zsx182
43. Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in Clinical Neuroscience, 10(3), 329-336. https://doi.org/10.31887/DCNS.2008.10.3/dnutt
44. Ohayon, M. M. (2006). Severe hot flashes are associated with chronic insomnia. Archives of Internal Medicine, 166(12), 1262-1268. https://doi.org/10.1001/archinte.166.12.1262
45. Palagini, L., Maria Bruno, R., Gemignani, A., Baglioni, C., Ghiadoni, L., & Riemann, D. (2013). Sleep loss and hypertension: a systematic review. Current Pharmaceutical Design, 19(13), 2409-2419.
https://doi.org/10.2174/1381612811319130009
46. Peng, A., Ji, S., Lai, W., Hu, D., Wang, M., Zhao, X., & Chen, L. (2024). The bidirectional relationship between sleep disturbance and anxiety: sleep disturbance is a stronger predictor of anxiety. Sleep Medicine, 121, 63-68. https://doi.org/10.1016/j.sleep.2024.06.022
47. Reynolds III, C. F., & Kupfer, D. J. (1999). Depression and aging: a look to the future. Psychiatric Services, 50(9), 1167-1172. https://doi.org/10.1176/ps.50.9.116
48. Scullin, M. K., & Bliwise, D. L. (2015). Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research. Perspectives on Psychological Science, 10(1), 97-137.
https://doi.org/10.1177/1745691614556680
49. Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10(1), 45-56. https://doi.org/10.1093/sleep/10.1.45
50. Spira, A. P., Stone, K., Beaudreau, S. A., Ancoli-Israel, S., & Yaffe, K. (2009). Anxiety symptoms and objectively measured sleep quality in older women. The American Journal of Geriatric Psychiatry, 17(2), 136-143.
https://doi.org/10.1097/JGP.0b013e3181871345
51. Steptoe, A., Deaton, A., & Stone, A. A. (2015). Subjective wellbeing, health, and ageing. The lancet, 385(9968), 640-648. https://doi.org/10.1016/S0140-6736(13)61489-0
52. Steptoe, A., O'Donnell, K., Marmot, M., & Wardle, J. (2008). Positive affect, psychological well-being, and good sleep. Journal of Psychosomatic Research, 64(4), 409-415. https://doi.org/10.1016/j.jpsychores.2007.11.008
53. Terauchi, M., Hiramitsu, S., Akiyoshi, M., Owa, Y., Kato, K., Obayashi, S., Matsushima, E., & Kubota, T. (2013). Associations among depression, anxiety and somatic symptoms in peri‐and postmenopausal women. Journal of Obstetrics and Gynaecology Research, 39(5), 1007-1013.
https://doi.org/10.1111/j.1447-0756.2012.02064.x
54. Vahtera, J., Westerlund, H., Hall, M., Sjösten, N., Kivimäki, M., Salo, P., Ferrie, J. E., Jokela, M., Pentti, J., Singh-Manoux, A., Goldberg, M., & Zins, M. (2009). Effect of retirement on sleep disturbances: the GAZEL prospective cohort study. Sleep, 32(11), 1459-1466. https://doi.org/10.1093/sleep/32.11.1459
55. Yu, J., Mahendran, R., Rawtaer, I., Kua, E. H., & Feng, L. (2017). Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety. Aging & Mental Health, 21(8), 823-828. https://doi.org/10.1080/13607863.2016.1161007
56. Zhai, L., Zhang, H., & Zhang, D. (2015). Sleep duration and depression among adults: A meta‐analysis of prospective studies. Depression and Anxiety, 32(9), 664-670. https://doi.org/10.1002/da.22386
57. Zhu, J., Huang, Y., Yuan, J., Du, L., Huang, L., Li, X., & Qi, W. (2026). Recent advances in the relationship between mental symptoms in postmenopausal women and estrogen fluctuations. Journal of Psychosomatic Obstetrics & Gynecology, 47(1), 2666107. https://doi.org/10.1080/0167482X.2026.2666107
Downloads
Published
Issue
Section
License
Articles and conference papers published in Mediterranean Journal of Clinical Psychology are distributed under the terms and conditions of a Creative Commons Attribution 4.0 International License. Correspondingly, authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).