Mediating effect of suicidality on influence of insomnia on favorable attitude to taking hypnotics among people in the general population complaining of insomnia

Abstract

Objective: Although cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia, pharmacological treatment remains common in clinical practice. This study aimed to examine factors associated with favorable attitudes toward hypnotic use in patients with insomnia and to investigate whether suicidality mediates this relationship. Methods: An online survey was conducted during June 18–25, 2025. We collected the demographic information of 548 individuals currently experiencing insomnia and their responses to questionnaires including sleep indices, the discrepancy between desired time in bed and desired total sleep time (DBST) index, attitude toward hypnotic use, the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16), and Depressive Symptoms Inventory–Suicidality Scale (DSI-SS). Logistic regression and Pearson’s correlation were performed to explore the factors contributing to favorable attitudes toward hypnotic use. Mediation analysis was implemented. Results: Logistic regression analysis adjusted for age and sex revealed that longer time in bed per day (odds ratio [OR] = 1.06, 95% confidence interval [CI] = 0.001–0.12, p = 0.046) and higher scores on the DSI-SS (OR = 1.09, 95% CI = 0.01–0.16, p = 0.037) were significantly associated with favorable attitudes toward hypnotic use. Mediation analysis indicated that suicidality mediated the relationship between the insomnia severity and favorable attitudes toward hypnotics. Conclusion: Suicidality mediates the association between insomnia severity and favorable attitudes toward hypnotic use, suggesting it may be a relevant psychological factor in this relationship.