Longitudinal associations among insomnia, stigma, social support, and depressive symptoms in tuberculosis: evidence...

Depression is highly prevalent and severe in people with tuberculosis (PWTB), often linked to insomnia, stigma, inadequate social support, and other psychological factors. However, the longitudinal and dynamic relationships between depression and these factors remain unclear, as most existing evidence stems from cross-sectional studies. We therefore examined these associations using random intercept cross-lagged panel model (RI-CLPM) and latent growth curve models (LGCMs).

This study was conducted in three hospitals in China (West China Hospital, Guangyuan Mental Health Center, and the Fourth People's Hospital of Guangxi) from October 2022 to January 2023. Using convenience sampling, we carried out a 6-month longitudinal study with assessments at treatment initiation (T1), one month (T2), two months (T3), and six months (T4). Measures included depressive symptoms, insomnia, stigma, social support, anxiety, and perceived stress. The data were analyzed using SPSS 26.0 and Mplus 8.3. RI-CLPM was used to examine the within-person bidirectional relationship between insomnia and depressive symptoms. LGCMs were used to analyze how stigma, anxiety, stress, and social support were associated with the trajectory of depressive symptoms over time.

The study enrolled 266 participants (166 men and 100 women; mean age 48.1 ± 18.0 years). The RI-CLPM showed significant within-person stability for both insomnia and depressive symptoms across time points (autoregressive paths: β = 0.236-0.458 for insomnia; β = 0.135-0.454 for depressive symptoms; all P < 0.05). The cross-lagged paths revealed mutual associations: higher insomnia was associated with subsequent depressive symptoms at T1→T2, T2→T3, and T3→T4 (β = 0.334, 0.572, 0.209; all P < 0.05), while depressive symptoms were linked to later insomnia at T1→T2 and T3→T4 (β = 0.378 and 0.164; P < 0.05) but not at T2→T3 (β = -0.094, P = 0.086). The LGCMs indicated that higher levels of stigma (across T1-T4), anxiety (at T1, T2, and T4), and perceived stress (at T1) were positively associated with concurrent depressive symptoms (all P < 0.05), and greater social support was associated with a faster decline in depressive symptoms over time (P < 0.05).

Insomnia is associated with subsequent depressive symptoms in PWTB, suggesting sleep-focused interventions as a promising target. Stigma consistently covaries with depressive symptoms, while greater social support is linked to faster recovery, underscoring the need to address both stigma and support in TB depression management.