Exploring the Mediating Role of Insomnia in the Relationship Between Fibromyalgia, Depression, and Anxiety in Lebanese Adults

Open Access Rheumatol. 2025 Sep 12;17:203-219. doi: 10.2147/OARRR.S530912. eCollection 2025.

ABSTRACT

BACKGROUND: Several studies have emerged to understand the relationship between insomnia and mental health issues like depression and anxiety from a causative perspective. Lebanon is a small country tormented by war, social insecurities and economic challenges, making it the fertile ground to understand the interaction between these variables in this population, especially with chronic pain. This study aims to better understand the relationship between insomnia, depression and anxiety in fibromyalgia patients in the Lebanese context.

METHODS: This cross-sectional study was conducted from October to November 2024 and involved participants from all over Lebanon. The questionnaire included sociodemographic questions and scales including the Widespread pain index (WPI), Symptom severity scale (SSS), Patient Health Questionnaire (PHQ-4) and Insomnia Severity Index (ISI).

RESULTS: The analysis showed that Insomnia mediated the association between fibromyalgia and depression; higher fibromyalgia was significantly associated with higher insomnia severity, whereas higher insomnia severity was associated with higher depression. Also, Insomnia mediated the association between fibromyalgia and anxiety; higher fibromyalgia was significantly associated with higher insomnia severity, whereas higher insomnia severity was associated with higher anxiety. However, depression and anxiety did not mediate the association between fibromyalgia and insomnia severity.

CONCLUSION: This study focused on the mediating role of insomnia between fibromyalgia and development of depression and anxiety on a sample of 641 Lebanese individual. With the use of specific scales and guidelines of the American College of Rheumatology, we were able to clearly elucidate the relationship between the selected variables. These findings underscore the importance of addressing issues such as insomnia in chronic pain as well as the associated comorbidities which have been proven to play an important role in the course of the disease. Future research should further explore targeted interventions that could enhance overall wellbeing in individuals with FM, considering the multiple factors influencing one’s condition.

PMID:40964456 | PMC:PMC12439707 | DOI:10.2147/OARRR.S530912