The correlations of insomnia symptoms with psychopathology and hematological parameters as well as gender differences in patients with schizophrenia

Patients with schizophrenia are at high risk for insomnia, but the associated influencing factors in this population have not been fully elucidated. Therefore, this study aimed to investigate the associations between insomnia symptoms and psychopathological indicators and hematological parameters in patients with schizophrenia, as well as to analysis the gender differences. From October 2022 to December 2024, this study recruited 184 patients with schizophrenia. The Insomnia Severity Index Scale (ISI), Brief Psychiatric Rating Scale (BPRS), Calgary Depression Scale (CDSS), and Modified Overt Aggression Scale (MOAS) were used to assess insomnia symptoms, psychotic symptoms, depressive symptoms, and aggressive behaviors, respectively. In addition, this study examined a range of blood parameters including leukocytes, neutrophils, lymphocytes, monocytes, platelets, total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH); and calculated the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and monocyte to lymphocyte ratio (MLR). Finally, independent factors of insomnia symptoms were identified using stepwise logistic regression, and the predictive value of each factor was evaluated via ROC curve analysis. The prevalence of insomnia symptoms in patients with schizophrenia was 34.8%, with 29.1% in males and 42.0% in females. Regression analysis showed that the independent influences of insomnia symptoms in the total sample were BPRS total score, CDSS total score, NLR (Ln) and T3. In male patients, BPRS total score, CDSS total score, and NLR (Ln) remained significant independent predictors. In contrast, only CDSS total score emerged as a statistically significant independent predictor in female patients. Furthermore, ROC curve analysis further demonstrated that the four-item combination of BPRS total score, CDSS total score, NLR (Ln), and T3 (AUC = 0.825, 95% CI = 0.766-0.885, P < 0.001) had a better ability to identify symptoms of insomnia in the total sample. Meanwhile, the three-item combination of BPRS total score, CDSS total score and NLR (Ln) (AUC = 0.850, 95% CI = 0.773-0.926, P < 0.001) had a better ability to identify insomnia symptoms in male patients. Patients with schizophrenia exhibited a relatively high risk of insomnia (29.1% in males vs. 42.0% in females); however, this difference was not statistically significant. Insomnia symptoms may be associated with psychotic symptoms, depressive symptoms, NLR, and T3. And there may be some gender differences in these correlations, with psychotic symptoms and NLR being independently linked to insomnia only in males.