title: Relationship between insomnia symptoms, perceived stress and coping strategies in subjects with arterial hypertension: psychological factors may play a modulating role.
abstract: The aim of the study was to evaluate perceived stress and coping strategies in people with hypertension, according to the presence of insomnia symptoms and by using a set of variables that included anxiety and depressive symptoms evaluation.
  
  
  
  A total of 371 hypertensive patients were enrolled during their first visit to the Hypertension Outpatient Unit. The Perceived Stress Scale (PSS), Brief-COPE, Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Self-rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI) were administered. Patients with other sleep disorders or with incomplete data (n = 41) were excluded.
  
  
  
  Data from 330 hypertensive patients were analyzed (males 51%, mean age 57 ± 13 years). Those with insomnia symptoms (n = 70, 21%) were older (p = 0.02), more frequently females (p = 0.01), and presented with higher PSS (p < 0.001), BDI (p < 0.0001), SAS (p = 0.0003), and STAI (p < 0.0001) scores than those without insomnia symptoms. In a linear regression trait, anxiety (p < 0.0001) and depressive symptoms (p < 0.05) were independent predictors of high PSS. Patients with insomnia symptoms showed lower scores in coping strategies, such as positive reframing (p = 0.03) and emotional support (p = 0.04), and an increased score in behavioral disengagement (p = 0.03). Trait anxiety and insomnia severity were independent predictors of less effective coping strategies.
  
  
  
  People with hypertension and insomnia symptoms showed higher perceived stress and less effective coping strategies than non-insomniacs; psychological factors such as trait anxiety and depressive symptoms may play a modulating role in these relationships. Prevention and treatment of insomnia symptoms and psychological factors should receive high attention for people with hypertension.
authors.affiliation: Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Pisa, Italy. Electronic address: lpalagini@tiscali.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Palagini
authors.affiliation: Institute of Clinical Physiology - CNR, Pisa, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Bruno
authors.affiliation: Sleep Disorders Center Henry Ford Health System, Novi, MI, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Pisa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Mauri
authors.affiliation: Department of Clinical Experimental Medicine, Hypertension Unit, University of Pisa, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Taddei
authors.affiliation: Sleep Disorders Center Henry Ford Health System, Novi, MI, USA; Department of Clinical Experimental Medicine, Hypertension Unit, University of Pisa, Pisa, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ghiadoni
authors.affiliation: Sleep Disorders Center Henry Ford Health System, Novi, MI, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
authors.affiliation: École de Psychologie, Université Laval, Québec City, Québec, Canada.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000523:psychology; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Anxiety; Coping; Depression; Hypertension; Insomnia; Perceived stress