Dysfunctional Sleep Beliefs and Attitudes in Major Depressive Disorder: Dimensional Associations with Clinical Phenotypes and Gut-Neuroimmune-Metabolic-Oxidative Pathways
- 1University of Electronic Science and Technology of China
Abstract
BackgroundInsomnia is highly prevalent in major depressive disorder (MDD), yet the clinical and biological significance of dysfunctional beliefs and attitudes about sleep (DBAS) in MDD remains poorly understood. We examined whether distinct DBAS dimensions are associated with insomnia severity, depressive phenotypes, and neuroimmune-metabolic-oxidative (NIMETOX) biomarkers.
MethodsDBAS-30 dimensions, clinical phenotypes, and NIMETOX biomarkers were assessed in 87 hospitalized patients with MDD and 31 healthy controls. Principal component analysis (PCA) was used to ascertain DBAS cognitive dimensions, and associations were examined using multivariable analyses.
ResultsCompared with controls, MDD patients showed lower scores on "perceived consequences of insomnia," "sleep-related worry and helplessness," and "medication-related beliefs," but higher "causal attributions to aging or biochemical imbalance" scores. A composite DBAS score reflecting these 4 MDD-associated cognitive dimensions was constructed, labeled DBAS dimensional index (DBAS-DI). This score was lower in MDD and inversely associated with Insomnia Severity Index (ISI) scores, overall MDD severity, physiosomatic symptoms, current suicidal ideation, and recurrence of illness. DBAS-DI and the expectations domain jointly explained 35.4% of the variance in ISI scores, with inverse and positive associations, respectively. The DBAS-DI score was inversely associated with indices of the acute-phase inflammatory response, oxidative stress, fecal branched-chain short-chain fatty acids (SCFAs) and positively associated with serum antioxidant capacity and protective SCFAs, such as acetate, propionate, and butyrate.
ConclusionsDBAS abnormalities in MDD extend beyond insomnia-related cognitions and are associated with illness severity, suicidality, recurrence, and NIMETOX alterations. These findings suggest that dysfunctional sleep-related cognitions are embedded within broader immune-oxidative and gut microbial-metabolic processes that may contribute to the insomnia-depression interface.
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BibTeX
@misc{wang2026dysfunctional,
title = {{Dysfunctional Sleep Beliefs and Attitudes in Major Depressive Disorder: Dimensional Associations with Clinical Phenotypes and Gut-Neuroimmune-Metabolic-Oxidative Pathways}},
author = {M. Wang and M. Niu and X. Luo and X. Chen and H. Liu and T. Chen and A. F. Almulla and Y. Zhang and J. Li and M. Maes},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.18.26365736},
url = {https://www.medrxiv.org/content/10.64898/2026.10.18.26365736v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - Dysfunctional Sleep Beliefs and Attitudes in Major Depressive Disorder: Dimensional Associations with Clinical Phenotypes and Gut-Neuroimmune-Metabolic-Oxidative Pathways
AU - M. Wang
AU - M. Niu
AU - X. Luo
AU - X. Chen
AU - H. Liu
AU - T. Chen
AU - A. F. Almulla
AU - Y. Zhang
AU - J. Li
AU - M. Maes
PY - 2026
DA - 2026/10/18
PB - medRxiv
DO - 10.64898/2026.10.18.26365736
UR - https://www.medrxiv.org/content/10.64898/2026.10.18.26365736v1
AB - BackgroundInsomnia is highly prevalent in major depressive disorder (MDD), yet the clinical and biological significance of dysfunctional beliefs and attitudes about sleep (DBAS) in MDD remains poorly understood. We examined whether distinct DBAS dimensions are associated with insomnia severity, depressive phenotypes, and neuroimmune-metabolic-oxidative (NIMETOX) biomarkers. MethodsDBAS-30 dimensions, clinical phenotypes, and NIMETOX biomarkers were assessed in 87 hospitalized patients with MDD and 31 healthy controls. Principal component analysis (PCA) was used to ascertain DBAS cognitive dimensions, and associations were examined using multivariable analyses. ResultsCompared with controls, MDD patients showed lower scores on "perceived consequences of insomnia," "sleep-related worry and helplessness," and "medication-related beliefs," but higher "causal attributions to aging or biochemical imbalance" scores. A composite DBAS score reflecting these 4 MDD-associated cognitive dimensions was constructed, labeled DBAS dimensional index (DBAS-DI). This score was lower in MDD and inversely associated with Insomnia Severity Index (ISI) scores, overall MDD severity, physiosomatic symptoms, current suicidal ideation, and recurrence of illness. DBAS-DI and the expectations domain jointly explained 35.4% of the variance in ISI scores, with inverse and positive associations, respectively. The DBAS-DI score was inversely associated with indices of the acute-phase inflammatory response, oxidative stress, fecal branched-chain short-chain fatty acids (SCFAs) and positively associated with serum antioxidant capacity and protective SCFAs, such as acetate, propionate, and butyrate. ConclusionsDBAS abnormalities in MDD extend beyond insomnia-related cognitions and are associated with illness severity, suicidality, recurrence, and NIMETOX alterations. These findings suggest that dysfunctional sleep-related cognitions are embedded within broader immune-oxidative and gut microbial-metabolic processes that may contribute to the insomnia-depression interface.
ER -