Family tension and sleep disorders are known to be associated with mental health. The pathways linking these factors are not completely understood. Measures to restrict the COVID-19 virus spread increased mental health disorders in the population. The aim of this study was to evaluate the mediating role of sleep disorders on the association between having increased disputes with a spouse/partner and mental health disorders in a national population-based cohort in France.

From the EpiCoV cohort (ORCHESTRA collaboration) of individuals aged≥15 years, we studied subjects interviewed in May-July 2021 and living with a spouse/partner. Using modified Poisson regressions, we modelled the probability of moderate or severe mental health disorders: anxiety defined by the Generalized Anxiety Disorder scale≥10 and pseudo-depression defined by the 8-item Patient Health Questionnaire scale≥10. With a counterfactual causal mediation analysis, we studied if sleep disorders were a mediator of the increased disputes with a partner/spouse effect on mental health disorders.

Among 50,412 participants (mean age 53.5yrs), 53% were women. Eight percent of women and 4% of men had moderate or severe anxiety. Participants with increased disputes with a spouse/partner had a higher risk of moderate or severe anxiety [Relative risk (RR) 3.84, 95% CI: 3.36-4.40 in women and 5.17, 95% CI: 4.11-6.51 in men]. Participants with sleep disorders had a higher risk of moderate or severe anxiety [Relative risk (RR) 5.65, 95% CI: 4.46-7.15 in women and 8.83, 95% CI: 6.89-11.31 in men]. Sleep disorders mediated 19% of the association between increased disputes with a spouse/partner and moderate or severe anxiety in women, and 27% in men. Results for pseudo-depression followed a similar pattern as for anxiety.

The association between disputes with a spouse and worsened mental health was partly mediated through sleep disorders.