title: Moderators and mediators of the relationship between stress and insomnia: stressor chronicity, cognitive intrusion, and coping.
abstract: OBJECTIVE
  To assess moderators, such as stressor chronicity, and mediators, including stress response in the form of cognitive intrusion and coping behavior, of the prospective association between naturalistic stress and incident insomnia.
  
  
  METHODS
  Longitudinal.
  
  
  METHODS
  Epidemiological.
  
  
  METHODS
  A community-based sample of good sleepers (n = 2,892) with no lifetime history of insomnia.
  
  
  METHODS
  None.
  
  
  RESULTS
  Participants reported the number of stressful events they had encountered at baseline, as well as the perceived severity and chronicity of each event. Similarly, volitional stress responses such as coping, as well as more involuntary responses such as cognitive intrusion were assayed for each stressor. Follow-up assessment 1 y hence revealed an insomnia incidence rate of 9.1%. Stress exposure was a significant predictor of insomnia onset, such that the odds of developing insomnia increased by 19% for every additional stressor. Chronicity significantly moderated this relationship, such that the likelihood of developing insomnia as a result of stress exposure increased as a function of chronicity. Cognitive intrusion significantly mediated the association between stress exposure and insomnia. Finally, three specific coping behaviors also acted as mediators: behavioral disengagement, distraction, and substance use.
  
  
  CONCLUSIONS
  Most studies characterize the relationship between stress exposure and insomnia as a simple dose-response phenomenon. However, our data suggest that certain stressor characteristics significantly moderate this association. Stress response in the form of cognitive intrusion and specific maladaptive coping behaviors mediate the effects of stress exposure. These findings highlight the need for a multidimensional approach to stress assessment in future research and clinical practice.
  
  
  BACKGROUND
  Pillai V, Roth T, Mullins HM, Drake CL. Moderators and mediators of the relationship between stress and insomnia: stressor chronicity, cognitive intrusion, and coping.
authors: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors: Vivek
authors: V
authors: Pillai
authors: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors: Thomas
authors: T
authors: Roth
authors: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors: Heather M
authors: HM
authors: Mullins
authors: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors: Christopher L
authors: CL
authors: Drake
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology* / Q000523:psychology*; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: coping; insomnia; mediator; moderator; stress