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Insomnia, Stigma, and Depression in Tuberculosis Patients: Longitudinal Insights
from a Cross-lagged Model and Growth Models

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X. Liu, X. Bai, Z. Chen, L. Diao, and M. Feng 1
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West China School of Medicine, Sichuan University, China
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Background: Depression is prevalent and severe in tuberculosis (TB) patients. It is often linked to
insomnia, stigma, lack of social support, and other psychological factors. However, most studies are
cross-sectional, which only examine correlations. The longitudinal relationships between depression
and other factors are unclear.

Objective: To export the longitudinal relationships between depression and other factors.

Methods: Through convenience sampling, we selected participants for a 6-month longitudinal
study. Depression, insomnia, stigma, social support, anxiety, and stress were assessed at the start of
treatment (T1), and after one (T2), two (T3), and six months (T4). SPSS 26.0 and Mplus 8.3 were used
for data analysis. A cross-lagged model (CLM) and latent growth models (LGMs) were constructed to
Oral Presentation Abstracts
study longitudinal associations.

Results: In total, 266 TB inpatients were enrolled. The comorbid depression detection rate fell from
23.3% at T1 to 10.1% at T4. The CLM showed insomnia at T1~T3 significantly predicted depression at T2~T4
( P < 0.05). Depression at T1 predicted insomnia at T2 (P < 0.05). Depression at T3 predicted insomnia
at T4 (P < 0.05). The LGM revealed social support as a significant negative predictor of depression
progression (P < 0.05). Stigma from T1 to T4 had a positive effect on depression over the same period
(P < 0.05). Anxiety and perceived stress at T1 positively influenced depression on the same period
(P < 0.05).

Conclusion: Insomnia predicts depression in TB patients, supporting interventions that improve sleep
quality. The impact of perceived stigma on depression remains significant. Enhanced social support
can accelerate recovery, underscoring the need to reduce stigma and increase support in TB
depression management.

Keywords: tuberculosis, depression, insomnia, stigma, social support, cross-lagged model, latent
growth models

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Correspondence: Xiangmin Liu, West China School of Medicine, Sichuan University, China
E-mail: 1046631714@qq.com

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