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Cited by 30Sleep and related disordersSchizophrenia research and treatmentSleep and Wakefulness Research

A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking

Open access
Scott, Alexander J., Rowse, Georgina, Webb, Thomas L.·2017·PLOS ONE
DOI 10.1371/journal.pone.0186233PMC PMC5648154
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Abstract

BACKGROUND: A growing body of evidence points to relationships between insomnia, negative affect, and paranoid thinking. However, studies are needed to examine (i) whether negative affect mediates the relation between insomnia and paranoid thinking, (ii) whether different types of insomnia exert different effects on paranoia, and (iii) to compare the impact of objective and self-reported sleeping difficulties. METHOD: Structural equation modelling was therefore used to test competing models of the relationships between self-reported insomnia, negative affect, and paranoia. n = 348 participants completed measures of insomnia, negative affect and paranoia. A subset of these participants (n = 91) went on to monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights. Associations between objectively recorded sleep, negative affect, and paranoia were explored using linear regression. RESULTS: The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia. There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia. CONCLUSIONS: Taken together, the findings point to an association between perceived (but not objective) difficulties initially falling asleep (but not maintaining sleep) and paranoid thinking; a relationship that is fully mediated by negative affect. Future research should seek to disentangle the causal relationships between sleep, negative affect, and paranoia (e.g., by examining the effect of an intervention using prospective designs that incorporate experience sampling). Indeed, interventions might profitably target (i) perceived sleep quality, (ii) sleep onset, and / or (iii) emotion regulation as a route to reducing negative affect and, thus, paranoid thinking.

AI snapshot

Written from the paper’s full text.

TL;DR

In a general-population cross-sectional study, self-reported difficulty falling asleep—but not difficulty staying asleep or objectively measured sleep—was associated with paranoid thinking, and this relationship was fully mediated by negative affect. Objective sleep measures were not associated with negative affect or paranoia.

Key findings

  • SEM supported a fully mediated model: self-reported delayed sleep onset was indirectly associated with paranoia via negative affect (β = 0.30, p < .001), while sleep maintenance problems were not (β = -0.03, p = .385).
  • In the fully mediated model, sleep onset was associated with negative affect (β = 0.59, p < .001), sleep maintenance was not (β = -0.06, p = .411), and negative affect was associated with paranoia (β = 0.51, p < .001). Neither sleep onset nor sleep maintenance had a direct association with paranoia (β = 0, p = .952 and β = 0.01, p = .864, respectively).
  • Objective sleep measures did not predict paranoia (sleep latency, awakenings, total sleep time: βs = -0.14, -0.16, and 0.01, respectively, p > .05) or negative affect (βs = 0.01, 0.03, and 0.06, respectively, p > .05).
  • Self-report and objective sleep measures correlated weakly (-0.05 < r < 0.32), indicating a discrepancy between perceived and actual sleep.

Methods

  • Cross-sectional exploratory study; N = 348 participants completed self-report measures of insomnia (Sleep-50 insomnia subscale), negative affect (DASS-21), and paranoia (GPTS-B). A subset of n = 91 wore a Zeo sleep monitor for seven consecutive nights.
  • EFA was conducted on one half of the self-report data, CFA cross-validated the factor structure on the other half, and SEM compared fully versus partially mediated models of insomnia, negative affect, and paranoia. Objective sleep data were analyzed separately with linear regression because n = 91 was too low for SEM.
  • Participants were recruited by email at a large UK university; full sample age ranged 18–77 (M = 36.49, SD = 12.76), 76% female. The monitor subset was younger (M = 29.87, SD = 12.95) but did not differ on insomnia, negative affect, or paranoia.

Limitations

  • The paper states the cross-sectional design limits causal inference and cannot rule out bidirectional relationships; findings are from a general-population sample and may not generalize to clinical groups, whose sleep problems and symptoms may be more severe or complex.
  • The paper notes the objective sleep subsample was small (n = 91) and younger than the full sample.
  • The text makes evident that some sleep-onset items may overlap with negative affect, though a sensitivity analysis removing two such items still found sleep onset predicted negative affect (β = 0.66, t(3, 344) = 5.91, p < .001); the GPTS-B subdomains of conviction, preoccupation, and distress were not replicated due to cross-loading.

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Registry

Crossref · 10.1371/journal.pone.0186233

Cites

122 of 122 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 69 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was no direct association between sleep maintenance problems and paranoia.

    “There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia.”
    Quote in the paperSubstantial claim
  • Findingown data

    Self-reported delayed sleep onset was directly associated with negative affect.

    “The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia.”
    Quote in the paperSubstantial claim
  • Findingown data

    Objective measures of sleep were not directly associated with negative affect.

    “The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no direct association between delayed sleep onset and paranoia.

    “There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia.”
    Quote in the paperSubstantial claim
  • Findingown data

    Negative affect was associated with paranoia.

    “The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia.”
    Quote in the paperSubstantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingown data

    Four DASS-21 items were removed due to substantive cross loadings, leaving 16 items.

    “Four items were removed as they had substantive cross loadings [i.e. cross loadings greater than 0.36 were deemed substantive according to Steven’s criteria, 79] with other factors leaving 16 items.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sleep-50 Factor 1 reflected sleep onset problems and Factor 2 reflected sleep maintenance problems.

    “The items loading on Factor 1 reflected problems related to sleep onset (the time taken to fall to sleep) while the items loading on Factor 2 reflected problems related to sleep maintenance (time spent asleep after sleep onset).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Correlations between GPTS-B items were within the acceptable range (0.30 < r < 0.85), meaning all items were suitable for PCA.

    “Correlations between items in Part B of the Green Paranoid Thoughts Scale were within the acceptable range (0.30 < r < 0.85), meaning that all of the items were suitable for PCA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The DASS-21 factors represented depression, anxiety, and stress.

    “Factor 1 represented levels of depression, Factor 2 represented levels of anxiety, and Factor 3 represented levels of stress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Correlations between Sleep-50 insomnia items were within the acceptable range (0.30 < r < 0.85), meaning all items were suitable for PCA.

    “Correlations between the items in the insomnia subscale of the Sleep-50 questionnaire were within the acceptable range (0.30 < r < 0.85), meaning that all of the items were suitable for PCA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Neither sleep onset nor sleep maintenance was directly associated with paranoia (β = 0, p = .952 and β = 0.01, p = .864, respectively).

    “Neither difficulties falling to sleep (sleep onset) nor problems staying asleep (sleep maintenance) were directly associated with paranoia (β = 0, p = .952, r = 0.06 and β = 0.01, p = .864, r = 0.06, respectively).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Objectively measured sleep latency, average number of awakenings per night, and total sleep time did not predict the experience of paranoia (βs = -0.14, -0.16, and 0.01, respectively, p > .05).

    “Objectively measured sleep latency (the time taken to fall asleep), the average number of awakenings per night (an objective measure of sleep maintenance), and total sleep time did not predict the experience of paranoia (βs = -0.14, -0.16, and 0.01, respectively, p > .05)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The objective sleep monitor (Zeo) provides valid measures of actual sleep.

  • May combine two claims.

    Findingcitation

    Part B of the Green Paranoid Thoughts Scale seemed to be a reliable and valid tool for measuring persecutory thinking.

    “the present research largely replicated previous research using Part B of the Green Paranoid Thoughts Scale [64] in that it seemed to be a reliable and valid tool for measuring persecutory thinking.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] CEL Green, 2008, Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS), Psychological Medicine source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The DASS-21 was found to be a reliable and valid measure of affective experiences.

    “the present study found the DASS-21 to be a reliable and valid measure of affective experiences.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In adolescents, levels of paranoia could be predicted by total time spent asleep on the previous night and frequency of dreaming, partially mediated by affective experiences.

    “Subsequent research using experience sampling with adolescents has found that levels of paranoia could be predicted by the total time spent asleep on the previous night and the frequency of dreaming; an effect that, again, was partially mediated by affective experiences [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] T Hennig, 2017, Sleeping Paranoia Away? An Actigraphy and Experience-Sampling Study with Adolescents, Child Psychiatry & Human Development

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Insomnia, worry, anxiety, and depression predicted new and persisting paranoid thinking in a longitudinal study.

    “For example, insomnia, worry, anxiety, and depression were all found to predict new and persisting paranoid thinking in a longitudinal study [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] D Freeman, 2012, Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking, Social Psychiatry and Psychiatric Epidemiology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the presence of insomnia, participants were 9.82 and 17.35 times more likely to have clinically meaningful levels of depression and anxiety, respectively.

    “For example, Taylor et al. [27] reported that, in the presence of insomnia, participants were 9.82 and 17.35 times more likely to have clinically meaningful levels of depression and anxiety, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] DJ Taylor, 2005, Epidemiology of insomnia, depression, and anxiety, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sleep restriction produced significant increases in psychosis-like experiences including paranoia and hallucinations, mediated by changes in negative affect and related processes.

    “The authors reported that those in the sleep restriction condition reported significant increases in psychosis like experiences (including paranoia and hallucinations), an effect mediated by changes in negative affect and related processes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] S Reeve, 2017, Disrupting Sleep: The Effects of Sleep Loss on Psychotic Experiences Tested in an Experimental Study With Mediation Analysis, Schizophrenia Bulletin

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The effect of fragmented sleep and poorer self-reported sleep quality on paranoid experiences was mediated by negative affect on awakening.

    “Furthermore, as in previous research, this effect was found to be mediated by negative affect on awakening.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] LD Mulligan, 2016, High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study, Journal of abnormal psychology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More fragmented sleep and poorer self-reported sleep quality were associated with more frequent paranoid experiences in a sample of 22 participants with schizophrenia.

    “For example, Mulligan et al. [24] found that more fragmented sleep and poorer self-reported sleep quality were associated with more frequent paranoid experiences in a sample of 22 participants with a diagnosis of schizophrenia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] LD Mulligan, 2016, High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study, Journal of abnormal psychology source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Problems with sleep onset and sleep maintenance may be differentially related to affective experiences and paranoia.

    “However, problems with sleep onset and sleep maintenance (two distinctive facets of insomnia, [12] may be differentially related to affective experiences and paranoia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] MM Ohayon, 2002, Epidemiology of insomnia: what we know and what we still need to learn, Sleep Medicine Reviews source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Those induced to experience negative affect reported significantly more paranoid thoughts and a more pronounced Jumping to Conclusions bias than those not induced.

    “The typical finding is that those induced to experience negative affect reported significantly more paranoid thoughts and a more pronounced Jumping to Conclusions bias (JTC, for a review see [36] when compared to participants who were not induced to experience negative affect [35, 36].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35] RM Ross, 2015, Jumping to conclusions about the beads task? A meta-analysis of delusional ideation and data-gathering, Schizophrenia bulletin source

      Not checked in the free run.

    • cites [36] R Dudley, 2015, Psychosis, delusions and the “jumping to conclusions” reasoning bias: a systematic review and meta-analysis, Schizophrenia bulletin source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    People with insomnia tend to overestimate how long it takes them to get to sleep and underestimate total time asleep, relative to objective measures.

    “However, discrepancies between self-report and objective measures of sleep are common [38–42] and there is a tendency for people with insomnia to overestimate how long it takes them to get to sleep and also to underestimate the total amount of time that they spend asleep, relative to objective measures [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] AG Harvey, 2012, (Mis)perception of Sleep in Insomnia: A Puzzle and a Resolution, Psychological Bulletin source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sleep problems are often associated with negative affect and have been shown to predict negative affect more generally.

    “Sleep problems are often associated with negative affect [27] and have been shown to predict negative affect more generally [28].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] DJ Taylor, 2005, Epidemiology of insomnia, depression, and anxiety, Sleep source

      Not checked in the free run.

    • cites [28] C Baglioni, 2011, Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies, Journal of Affective Disorders source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The association between sleep maintenance problems and affective/paranoid experiences is less clear, either weaker or no relationship.

    “The association between sleep maintenance problems and these experiences is less clear (i.e., either a weaker relationship or no relationship, see [49, 51–53]).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [49] PM Nicassio, 1985, The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale, Behaviour research and therapy source

      Not checked in the free run.

    • cites [51] V Pillai, 2015, Sleep and affect: assessment, theory, &amp; clinical implications

      Not checked in the free run.

    • cites [52] V Pillai, 2014, A seven day actigraphy-based study of rumination and sleep disturbance among young adults with depressive symptoms, Journal of Psychosomatic Research source

      Not checked in the free run.

    • cites [53] PM Zoccola, 2009, Rumination predicts longer sleep onset latency after an acute psychosocial stressor, Psychosomatic Medicine source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Delayed sleep onset can provide an opportunity to reflect, ruminate, and worry, which could amplify negative affect and may lead to paranoid thinking.

    “Delayed sleep onset can provide an opportunity for an individual to reflect, ruminate, and worry about their experiences [46–49], which could serve to amplify negative affect (for a review, see [50] and may even lead to paranoid thinking.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [46] AG Harvey, 2002, A cognitive model of insomnia, Behaviour research and therapy source

      Not checked in the free run.

    • cites [47] DK Thomsen, 2003, Rumination—relationship with negative mood and sleep quality, Personality and Individual Differences source

      Not checked in the free run.

    • cites [48] AJ Guastella, 2007, The impact of rumination on sleep quality following a stressful life event, Personality and Individual Differences source

      Not checked in the free run.

    • cites [49] PM Nicassio, 1985, The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale, Behaviour research and therapy source

      Not checked in the free run.

    • cites [50] D Kirkegaard Thomsen, 2006, The association between rumination and negative affect: A review, Cognition and Emotion source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Delayed sleep onset latency was more prevalent than sleep maintenance problems in those at high risk of a mental health problem in a sample of 1403 students.

    “For example, Sheaves et al. [45] reported that delayed sleep onset latency was more prevalent than sleep maintenance problems in those at high risk of a mental health problem in a sample of 1403 students (although onset and maintenance were assessed using only 1 item each).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] B Sheaves, 2016, Insomnia, nightmares, and chronotype as markers of risk for severe mental illness: results from a student population, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Grezellschak et al. did not include an objective measure of sleep nor investigate the independent contribution of sleep onset and maintenance difficulties.

    “However, Grezellschak et al., did not include an objective measure of sleep nor did they investigate the independent contribution of sleep onset and maintenance difficulties.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] S Grezellschak, 2017, Emotion regulation in patients with psychosis: A link between insomnia and paranoid ideation?, Journal of behavior therapy and experimental psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The association between insomnia and paranoid ideation is partially mediated by emotion regulation.

    “There are some exceptions—for example, Grezellschak et al. [15] used multi-item measures of both insomnia (i.e., the Insomnia Severity Index, [44] and paranoid thinking (i.e., the Paranoia Checklist, [16]; reporting that the association between insomnia and paranoid ideation is partially mediated by emotion regulation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] S Grezellschak, 2017, Emotion regulation in patients with psychosis: A link between insomnia and paranoid ideation?, Journal of behavior therapy and experimental psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depressed mood is causally related to paranoid thoughts, mediated by negative cognition, in structural equation modelling of longitudinal data.

    “Finally, structural equation modelling of longitudinal data has found that depressed mood is causally related to paranoid thoughts; an effect that is mediated by negative cognition [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] D Fowler, 2012, Negative Cognition, Depressed Mood, and Paranoia: A Longitudinal Pathway Analysis Using Structural Equation Modeling, Schizophrenia Bulletin source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Insomnia has so far been conceptualised as a single construct in research on the relationship between sleep problems and paranoia.

    “Third, as suggested above, insomnia has so far been conceptualised as a single construct in research on the relationship between sleep problems and paranoia.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Increases in negative affect were associated with increases in paranoia in experience sampling.

    “For example, Kramer et al. (2014) used experience sampling to examine the moment-to-moment interplay between negative affect and the experience of paranoia, reporting that increases in negative affect were associated with increases in paranoia (see also, [34]).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kramer et al. (2014) source

      Not checked in the free run.

    • cites [34] V Thewissen, 2011, Emotions, self-esteem, and paranoid episodes: An experience sampling study, British Journal of Clinical Psychology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants who wore a sleep monitor were younger than those who provided self-report data only (M = 29.87 vs. 36.49).

    “In short, the subset of participants who agreed to wear a sleep monitor tended to be younger than those who provided self-report data only (M = 29.87 vs. 36.49); however, the samples did not differ in terms of their gender, experiences of insomnia, negative affect, or paranoid thinking.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of 389 recruited participants, 41 (11%) did not complete baseline measures, leaving 348 complete responses.

    “Consequently, N = 389 participants were recruited via an email to a list of volunteers at a large University in the UK. Of these, N = 41 (11%) did not complete the baseline measures, leaving N = 348 complete responses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The minimum sample size required to detect medium-sized relationships with 80% power using linear regression was N = 54.

    “Based on the recommendations of Cohen, Cohen, West, and Aiken [58], a minimum sample size of N = 54 would be required to detect medium-sized relationships with 80% power using linear regression (our intended method for assessing the impact of objectively measured sleep problems on negative affect and paranoia).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cohen, Cohen, West, and Aiken [58]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Scores on the shortened DASS-21 are highly correlated with scores on the longer version of the scale.

    “The DASS-21 has been found to be a valid and reliable measure of negative affect in both clinical and general population samples and scores on the shortened form have been found to be highly correlated with scores on the longer version of the scale [62, 63].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [62] MM Antony, 1998, Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample, Psychological assessment source

      Not checked in the free run.

    • cites [63] JD Henry, 2005, The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample, British Journal of Clinical Psychology source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The 2-step EFA/CFA process reduces measurement error, creates more accurate SEM models, and allows greater confidence in the resulting analyses.

    “This procedure is routinely adopted, reduces measurement error, creates more accurate SEM models, and allows for greater confidence in the resulting analyses [65–68].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [65] AL Pai, 2007, Exploratory and confirmatory factor analysis of the child uncertainty in illness scale among children with chronic illness, Journal of Pediatric Psychology source

      Not checked in the free run.

    • cites [66] DM Dimitrov, 2014, Statistical methods for validation of assessment scale data in counseling and related fields

      Not checked in the free run.

    • cites [67] FJ Floyd, 1995, Factor analysis in the development and refinement of clinical assessment instruments, Psychological assessment source

      Not checked in the free run.

    • cites [68] J-W Van Prooijen, 2001, Confirmatory analysis of exploratively obtained factor structures, Educational and Psychological Measurement source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Problems initially falling to sleep (sleep onset), but not staying asleep (sleep maintenance), were associated with both negative affect and paranoid thinking.

    “The findings suggested that problems initially falling to sleep (sleep onset), but not staying asleep (sleep maintenance), were associated with both negative affect and paranoid thinking.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Previous research on the relationship between sleep problems and paranoid experiences has not differentiated between problems falling asleep (sleep onset) versus staying asleep (sleep maintenance).

  • May combine two claims.

    Interpretationown data

    The present research found no evidence of a direct relationship between insomnia and paranoia; instead, the relationship was fully mediated by negative affect.

    “The present research found no evidence of a direct relationship between insomnia and the experience of paranoia; instead, the relationship was fully mediated by negative affect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Perceived, rather than actual, sleep problems are associated with negative affect and the experience of paranoia.

    “These findings suggest that perceived, rather than actual, sleep problems are associated with negative affect and the experience of paranoia.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The objective sleep monitor (Zeo) provides valid measures of actual sleep.

  • May combine two claims.

    Study design and conductown data

    The findings are based on a sample drawn from the general population; caution must be taken if seeking to generalise the findings to clinical groups.

    “The findings reported in the present research are also based on a sample of people drawn from the general population; therefore, caution must be taken if seeking to generalise the findings to clinical groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The present research found that only difficulties falling to sleep are associated (indirectly) with paranoid thinking; problems staying asleep were not associated with either negative affect or the experience of paranoia.

    “The present research found that only difficulties falling to sleep are associated (indirectly) with paranoid thinking. Problems staying asleep were not associated with either negative affect or the experience of paranoia.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Previous research on the relationship between sleep problems and paranoid experiences has not differentiated between problems falling asleep (sleep onset) versus staying asleep (sleep maintenance).

  • May combine two claims.

    Interpretationown data

    Problems with sleep onset were not directly associated with paranoid thoughts; instead, the effects were mediated by negative affect.

    “However, problems with sleep onset were not directly associated with paranoid thoughts; instead, the effects were mediated by negative affect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    These relations only held for perceived sleep (self-reported measures), and objective indicators of sleep were not associated with negative affect or paranoia.

    “Furthermore, these relations only held for perceived sleep (i.e., self-reported measures of sleep) and objective indicators of sleep were not associated with negative affect or the experience of paranoia”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The objective sleep monitor (Zeo) provides valid measures of actual sleep.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The associations described do not preclude the presence of bidirectional relationships whereby paranoid thinking exacerbates sleep problems and/or negative affect that, in turn, increases paranoid thoughts.

    “the associations described here do not preclude the presence of bidirectional relationships whereby paranoid thinking exacerbates sleep problems and / or negative affect that, in turn, increases paranoid thoughts.”
    Quote in the paperNot a substantial claim
40 of 40

  • The paper relies on this without support.

    The volunteer sample recruited from a University email list is representative of the general population.

    “N = 389 participants were recruited via an email to a list of volunteers at a large University in the UK.”
    “the present research reports a cross-sectional, exploratory investigation into the associations between insomnia, negative affect, and paranoia in a sample drawn from the general population.”

  • The paper relies on this without support.

    Cross-sectional SEM associations can be interpreted as a fully mediated relationship, with negative affect mediating the effect of sleep onset on paranoia, without temporal ordering.

    “The self-report data on levels of insomnia, negative affect and paranoia (N = 348) was analysed using SEM.”
    “the present research reports a cross-sectional, exploratory investigation into the associations between insomnia, negative affect, and paranoia”

  • The paper relies on this without support.

    Seven consecutive nights of objective sleep monitoring are sufficient to characterize habitual sleep.

    “monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights.”
    “Mean values for each sleep parameter were calculated over the 7 nights and used in the subsequent analysis.”

  • The paper relies on this without support.

    Previous research on the relationship between sleep problems and paranoid experiences has not differentiated between problems falling asleep (sleep onset) versus staying asleep (sleep maintenance).

    “Previous research on the relationship between sleep problems and paranoid experiences has not differentiated between problems falling asleep (sleep onset) versus staying asleep (sleep maintenance).”

  • The paper relies on this without support.

    The present research is the first to explore the relationships between different sleep difficulties and paranoid thinking.

    “To our knowledge, the present research is the first to explore the relationships between different sleep difficulties and paranoid thinking”

  • The paper relies on this without support.

    The objective sleep monitor (Zeo) provides valid measures of actual sleep.

    “b Objective measure of sleep assessed by the Zeo sleep monitor”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(3, 344) = 0.82reported p = .482 · recomputed p = .484

    “F(3, 344) = 0.82, p = .482”

  • ConsistentF(4, 434) = 4.84reported p = .001 · recomputed p < .001

    “F(4, 434) = 4.84, p = .001”

  • ConsistentF(1, 437) = 19.24reported p = .001 · recomputed p < .001

    “F(1, 437) = 19.24, p = .001”

    The paper prints p at a floor (such as p < .001)

  • Consistentχ²(1) = 0.43reported p = .514 · recomputed p = .512

    “X2(1) = 0.43, p = .514”

  • Consistentχ²(120) = 1493.39reported p < .001 · recomputed p < .001

    “X2(120) = 1493.39, p < .001”

  • Consistentχ²(28) = 407.58reported p < .001 · recomputed p < .001

    “X2(28) = 407.58, p < .001”

  • Consistentχ²(45) = 1027.81reported p < .001 · recomputed p < .001

    “X2(45) = 1027.81, p < .001”

7 of 7

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Group-comparison degrees of freedom exceed the sample size

    Major

    The 91 sleep-monitor participants were a subset of the 348 participants, so comparing monitor wearers with nonwearers gives two disjoint groups totalling 348 people. The reported univariate denominator of 437 degrees of freedom implies 439 people in a two-group comparison-exactly 348 plus 91, as though the subset had been counted twice. This calls the reported group-comparison results into question.

  • Reported minimum age differs between text and table

    Minor

    The prose gives 18 as the minimum age for both the full sample and the sleep-monitor subset, whereas Table 1 gives 17 for both.

  • Full-sample age mean is presented as the nonwearers' mean

    Minor

    The comparison identifies 36.49 as the mean age of participants who supplied self-report data only. Table 1 instead identifies 36.49 as the mean for the full sample, which includes the younger sleep-monitor participants; it cannot also be the nonwearers' mean.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. S Grezellschak, 2016, Emotion regulation in patients with psychosis: A link between insomnia and paranoid ideation, Journal of Behavior therapy and Experimental Psychiatry
  2. RJ Linscott, 2010, Annual Review of Clinical Psychology, Vol 6. Annual Review of Clinical Psychology, 6, 391
  3. VI Spoormaker, 2005, Initial validation of the SLEEP-50 questionnaire, Behavioral Sleep Medicine, 3, 227, 10.1207/s15402010bsm0304_4 · DOI
  4. R Manber, 2008, Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disor-der and insomnia, Sleep, 31, 489, 10.1093/sleep/31.4.489 · DOI · Paper page
  5. AG Harvey, 2015, Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: A pilot randomized controlled trial, Journal of consulting and clinical psychology, 83, 564, 10.1037/a0038655 · DOI

Cited by

Sorted by citations

Related

Authors
Scott, A. J., Rowse, G., & Webb, T. L.
Affiliations
University of Sheffield (GB)
Corresponding author
  • Scott, Alexander J.
  • Rowse, Georgina
  • Webb, Thomas L.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-10-19
Volume
12
Issue
10
Pages
e0186233
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0186233
PMC
PMC5648154
OpenAlex
W2766489239
Semantic Scholar
a52307837aaa0d4350dc82b78f68a75cb3ad1972
Cited by
30
References
122
Citations by year
2026: 2 · 2025: 6 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 3 · 2019: 8 · 2018: 1
FWCI
5.30
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
insomnia, negative affect, paranoid thinking, sleep onset delay, mediation, objective sleep monitoring, paranoia
MeSH terms
Factor Analysis, Statistical, Humans, Sleep Initiation and Maintenance Disorders, Models, Psychological, Paranoid Disorders, Mood Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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