Bidirectional relationship between perceived stress and insomnia symptoms: the role of coping and quality of life

Abstract

Perceived stress is strongly associated with sleep problems. Despite the evidence linking these variables, research examining the reciprocal relationships between them using non-recursive models, which include feedback loop between endogenous variables, is lacking. The main objective was to analyse if there is a bidirectional relation between perceived stress and insomnia symptoms with a model using coping and quality of life as predictors of both variables. This is a cross-sectional study with a sample of 987 adults with insomnia symptoms (M = 40.90 years old; SD = 17.17). An exploratory Canonical Correlation Analysis assessed the interrelationships between a set of perceived stress and insomnia symptoms and a set of coping and quality of life variables. Structural Equation Modelling was used to explore the bidirectional relationships between perceived stress and insomnia symptoms, using coping strategies and quality of life as covariates. The first correlation (0.562), dominated by perceived stress, suggested a direct association with insomnia symptoms. The second correlation (0.146), dominated by insomnia symptoms, suggested a reverse association with perceived stress. The model showed good model fit indices (χ2(6) = 4.505, GFI = 0.999; RMSEA = 0.000 [CI 90% 0.000–0.035]). Self-blame, positive reframing, denial, self-distraction, social relationships, and environment were significant predictors of perceived stress; Denial and environment significantly predicted insomnia symptoms. Regarding the bidirectional relationship only perceived stress was a predictor of insomnia symptoms (β = 0.42, p ≤ 0.001). Insomnia symptoms depend on perceived stress, but no evidence of the direct effect of insomnia symptoms on perceived stress was observed. Although the bidirectional relationship has not been confirmed, this study supports the role of perceived stress in the management of insomnia symptoms.