RESUMO
Mental health problems, which are associated with sleep difficulties during stressful events, have increased during the coronavirus (COVID-19) pandemic. Insomnia is an important sleep phenomenon that predicts development of depressive and anxiety disorders, though mechanisms explaining this relationship remain unclear. Distress tolerance, the ability to withstand aversive affective experiences, is a transdiagnostic construct that may influence this relationship. It was hypothesized that greater psychological distress would predict more severe insomnia. Further, it was hypothesized that more severe insomnia and poorer distress tolerance would be associated with greater depression and anxiety. Depressive and anxiety symptoms were hypothesized to predict diagnoses of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). Lastly, distress tolerance was hypothesized to mediate the relationship between insomnia and diagnosis of MDD and GAD. Data were obtained from a prospective observational study with three nested samples. The first sample was 5,547 college students who completed a survey study in March-April 2020, the second was 615 college students who completed a survey study in September-October 2020, and the final sample was 100 college students recruited for a clinical interview study between October 2020 and April 2021. Measures included the Kessler Screening Scale for Psychological Distress, Insomnia Severity Index, Distress Tolerance Scale, Patient Health Questionnaire-9, PROMIS Emotional Distress Short Form -- Anxiety, and the Structured Clinical Interview for DSM-5 Disorders. Greater psychological distress predicted more severe insomnia (beta = .29, p < .001). Greater insomnia severity (beta = .49, p < .001) and poorer distress tolerance (beta = .15, p < .001) predicted higher levels of depression but not anxiety. Anxiety symptoms predicted diagnosis of MDD, while both depressive and anxiety symptoms predicted diagnosis of GAD. Distress tolerance did not mediate the relationship between insomnia and diagnosis of MDD or GAD. Longitudinal studies are needed to further clarify the course of insomnia, distress tolerance, and mental health diagnoses, and to explore distress tolerance as a moderating variable. These results imply that it could be beneficial for healthcare providers to treat insomnia when comorbid with depression, which may improve depressed mood more so than improving distress tolerance, though intervention studies are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)