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This study aims to explore the mediating role of coping strategies in the relationship between death anxiety and Insomnia among patients with NCDs, with a particular focus on gender differences. By examining these dynamics, the research seeks to contribute to more personalized and effective psychological support for patients facing the dual burden of chronic illness and mental health challenges. Cross-sectional research design by using survey method. Death Anxiety Scale, Athens Insomnia Scale, and Brief Coping Inventory were used to gauge the respective variables. A sample of (<jats:italic>n<\/jats:italic> = 264) diagnosed patients with non-communicable diseases (diabetes, hypertension, cardiovascular diseases, and cancer) was selected through purposive sampling. Findings revealed a positive correlation between death anxiety and Insomnia and a negative association with coping strategies in patients with non-communicable diseases. The use of coping strategies as a mediator showed the indirect pathway, which fully mediates the relationship between death anxiety and Insomnia in male (0.57, <jats:italic>p<\/jats:italic> &lt; .05) and female (0.663, <jats:italic>p<\/jats:italic> &lt; .05) respondents. Furthermore, the prevalence of death anxiety and Insomnia was higher in females as compared to males. The use of problem-focused coping strategies was higher in males whereas emotion-focused coping was more in females. It is concluded that the use of coping strategies mediates a significant relationship between death anxiety and Insomnia. Patients with non-communicable diseases experience intrusive thoughts of death anxiety in Insomnia, and coping techniques contribute to a more balanced and resilient approach to handling the difficulty associated with death anxiety and Insomnia. This study will be helpful for the respective specialists to manage the variability of symptoms and maintain the complaints their patients come up with during their treatment.<\/jats:p>","DOI":"10.1038\/s41598-025-99348-3","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T11:03:20Z","timestamp":1746183800000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mediating role of coping strategies in the relationship between death anxiety and insomnia among patients with non-communicable diseases: a gender perspective"],"prefix":"10.1038","volume":"15","author":[{"given":"Arslan","family":"Khalid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Sattar","family":"Ghaffari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khizra","family":"Iqbal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonggang","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"99348_CR1","unstructured":"World Health Organization. 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