Insomnia, negative affect, and psychotic experiences: modelling pathways over time in a clinical observational study
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Insomnia has been shown to contribute to the development of psychotic experiences, predominantly via increasing negative affect. However, the role of insomnia in the persistence of psychotic experiences is yet to be investigated in a clinical population. Furthermore, other plausible influences, such as psychotic experiences contributing to insomnia, remain to be evaluated. This study tests the role of insomnia as a predictor of persistence of psychotic experiences versus other potential causal routes. Twenty-nine patients aged 18-30 with non-affective psychosis completed three assessments over three months of their insomnia, negative affect, and psychotic experiences. Mixed effect models allowed comparisons between hypothesis-based models (comprising insomnia as predictor, negative affect as mediator, and psychotic experiences as outcome) and oppositional models, where relationships were reversed. The results supported the hypothesised mediation model above models where negative affect was primary. Insomnia was also found to be a stronger predictor of later hallucinations than vice versa, although a bidirectional relationship was indicated between insomnia and paranoia. In conclusion, insomnia predicts persistence of psychotic experiences over time to the same or greater extent than psychotic experiences contribute to insomnia. This supports insomnia as a potential intervention target in psychosis.
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Initial longitudinal evidence in a clinical group suggests that depressive and anxiety symptoms should not be discounted as relevant mediating mechanisms.
“However, initial longitudinal evidence in a clinical group suggests that depressive and anxiety symptoms should not be discounted as relevant mediating mechanisms.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [5]
Depression and anxiety mediated the majority of the path from insomnia to hallucinations in a longitudinal clinical group.
“Depression and anxiety mediated the majority of the path from insomnia to hallucinations in a longitudinal clinical group.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [5]
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- Authors
- Reeve, S., Nickless, A., Sheaves, B., & Freeman, D.
- Affiliations
- Warneford Hospital (GB)
- University of Oxford (GB)
- Oxford Health NHS Foundation Trust (GB)
- Corresponding author
- Reeve, Sarah
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 269
- Pages
- 673-680
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC6215774
- OpenAlex
- W2888507333
- Cited by
- 69
- References
- 40
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 6 · 2023: 11 · 2022: 11 · 2021: 8 · 2020: 11 · 2019: 5
- FWCI
- 7.85
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychiatry Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- Explore Bristol Research (publishedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Wellcome Trust Strategic (098461/Z/12/Z)
- NIHR (RP-2014-05-003)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- insomnia, negative affect, psychotic experiences, mediation, hallucinations, paranoia, non-affective psychosis, young adults, bidirectional relationship
- MeSH terms
- Pessimism, Adolescent, Adult, Affect, Cross-Sectional Studies, Female, Humans, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Models, Psychological, Psychotic Disorders, Time Factors, Young Adult
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