The Mediating and Moderating Role of Sleep Disturbance Between Chronic Pain and Psychological Distress: Evidence from Canadian Community Health Survey

Objective:Chronic pain can result in psychological distress. In addition, sleep disturbance is associated with both chronic pain and psychological distress. However, no study has comprehensively investigated the roles of sleep disturbance in the associations between pain and psychological distress in the general population. Our study aims to explore the mediating as well as the moderating effects of sleep disturbance between chronic pain and psychological distress in a national Canadian sample. Methods: Data were analyzed from the Canadian Community Health Survey-Mental Health (CCHS-MH), a national cross-sectional study comprised of adult respondents who provided information on chronic pain, sleep and psychological distress (N = 25,113). The 10-item Kessler Psychological Distress Scale (K-10) was used to assess psychological distress. Structural equation modeling (SEM) was used to measure the mediating and moderating effects of sleep disturbance on the relationships between chronic pain and psychological distress. Results: Our findings indicated that sleep disturbance had both direct and indirect effects on psychological distress. Sleep disturbance partially mediated the relationships between chronic pain and psychological distress (β = 0.10, p < .05). The model accounts for 30.3% of the variance in psychological distress. Sleep disturbance also played a moderating role in the relationships between chronic pain and psychological distress. The pronounced moderation effect was found in the "no sleep disturbance group" (β = 0.20, p < .05). Conclusions: These results revealed that addressing sleep problems should be one of the targets of intervention and prevention for psychological distress among those individuals suffering from chronic pain.