{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:21:13Z","timestamp":1786116073995,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Gen. Psychiatry"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Major depressive disorder (MDD) and chronic pain (CP) demonstrate marked sex disparities, with higher prevalence and severity in females. However, the underlying mechanisms remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to examine the intricate interplay among anxiety, physical pain and sleep disruptions in inpatients with depression and chronic pain, specifically addressing potential gender differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross\u2010sectional study enrolled 122 participants and split them into three groups: the comorbidity group (inpatients with MDD and CP,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a037), the MDD group (inpatients with MDD without CP,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a037) and the control group (healthy controls,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a048). Sex\u2010stratified piecewise regression tested pain\/latent variable threshold effects in depression\u2010comorbidity subgroups. Generalised additive models (GAMs) with tensor\u2010product smoothing and S\u2010splines were used to model associations between a standardised somatic anxiety subscore and pain intensity, capturing nonlinear patterns and subgroup\u2010specific interactions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The comorbidity group exhibited greater impairments in pain intensity, anxiety and depressive symptoms, and quality of life compared to other groups. Piecewise regression analysis revealed a nonlinear relationship between the somatic anxiety subscore and pain intensity, with female inpatients in the comorbidity group experiencing higher pain intensity and anxiety severity compared to those in the MDD group. The GAM results showed a peak in pain intensity at a moderate\u2013low threshold in the MDD and comorbidity groups, suggesting an optimal clinical breakpoint (8 points on the somatic anxiety subscore of Hamilton Anxiety Rating Scale\u201014) for targeted interventions in females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings offer novel insights into the sex\u2010specific dynamics linking anxiety, somatic pain and sleep disturbances in MDD\u2010CP comorbidity, providing an empirical foundation for personalised therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/gps3.70025","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:42:16Z","timestamp":1779957736000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations between anxiety, somatic pain and sleep disturbances in major depressive disorder and chronic pain: A cross\u2010sectional study with gender\u2010specific insights"],"prefix":"10.1002","volume":"39","author":[{"given":"Cuizhen","family":"Zhu","sequence":"first","affiliation":[{"name":"Brain Neurobiomedical Research Center Hefei Fourth People's Hospital  Hefei Anhui China"},{"name":"Science and Education Department Hefei Fourth People's Hospital  Hefei Anhui China"},{"name":"Psychiatry Department Affiliated Psychological Hospital of Anhui Medical University  Hefei Anhui China"},{"name":"Geriatric Psychology Department Anhui Mental Health Center  Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Cheng","sequence":"additional","affiliation":[{"name":"Psychiatry Department Affiliated Psychological Hospital of Anhui Medical University  Hefei Anhui 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