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Kim AW. Psychosocial stress, adult suicidal ideation, and the mediating effect of poor sleep quality during the COVID-19 pandemic in South Africa. Am J Hum Biol 2024; 36:e24038. [PMID: 38174783 DOI: 10.1002/ajhb.24038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/28/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES South Africa instituted one of the world's strictest lockdowns during the COVID-19 pandemic, which generated heightened conditions of psychosocial stress and posed widespread mental health risks. Despite the elevated burdens of suicidal behaviors and risk of psychiatric disease in the country, few studies have examined the impacts of psychosocial stress from the pandemic on suicidal ideation in South Africa. This study examined the association between psychosocial stress experienced under the COVID-19 pandemic and adult suicidal ideation, as well as degree to which sleep quality and duration mediated this relationship. METHODS An online survey assessed experiences of COVID-19 psychosocial stress, sleep quality and duration, and suicidal ideation in a sample of 189 South African adults during the second and third waves of the COVID-19 pandemic. A causal inference framework for mediation analysis was used to assess the degree to which sleep quality and duration explained the association between COVID-19 psychosocial stress and suicidal ideation. RESULTS Suicidal ideation was reported in 21% of adults. Adults described having moderate sleep quality and an average of 6.9 hours of sleep per night. COVID-19 psychosocial stress significantly predicted adult suicidal ideation in fully adjusted models. Sleep quality, but not sleep duration, significantly mediated the association between COVID-19 psychosocial stress and suicidal ideation, accounting for 25.9% of the total effect. CONCLUSIONS Poor sleep quality may play an important role in exacerbating the alarming stress-induced mental health effects of the COVID-19 pandemic. Further research is necessary to understand the underlying sleep dynamics and associated psychological and neurobiological processes that perpetuate adult suicidal ideation.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gaston SA, Strassle PD, Alhasan DM, Pérez-Stable EJ, Nápoles AM, Jackson CL. Financial hardship, sleep disturbances, and their relationship among men and women in the United States during the COVID-19 pandemic. Sleep Health 2023; 9:551-559. [PMID: 37280141 PMCID: PMC10239652 DOI: 10.1016/j.sleh.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In the United States (US), the health and financial consequences of COVID-19 have disproportionately impacted women and minoritized racial-ethnic groups. Yet, few US studies have investigated financial hardship during the COVID-19 pandemic and sleep health disparities. Our objective was to investigate associations between financial hardship and sleep disturbances during the COVID-19 pandemic by gender and race and ethnicity in the United States. METHODS We used the nationally representative COVID-19's Unequal Racial Burden cross-sectional survey data collected among 5339 men and women from 12/2020 to 2/2021. Participants reported financial hardship (eg, debt, employment/work loss) since the pandemic began and completed the Patient-Reported Outcomes Management Information System Short Form 4a for sleep disturbances. Prevalence ratios (PRs) and 95% confidence intervals were estimated using adjusted, weighted Poisson regression with robust variance. RESULTS Most (71%) participants reported financial hardship. Prevalence of moderate to severe sleep disturbances was 20% overall, higher among women (23%), and highest among American Indian/Alaska Native (29%) and multiracial adults (28%). Associations between financial hardship and moderate to severe sleep disturbances (PR = 1.52 [95% confidence interval: 1.18, 1.94]) did not differ by gender but varied by race and ethnicity: associations were strongest among Black/African American (PR = 3.52 [1.99,6.23]) adults. CONCLUSIONS Both financial hardship and sleep disturbances were prevalent, and their relationships were strongest among certain minoritized racial-ethnic groups, particularly Black/African American adults. Interventions that alleviate financial insecurity may reduce sleep health disparities.
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Affiliation(s)
- Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Dana M Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities and the Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna M Nápoles
- Office of the Scientific Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
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Rice A, Sather O, Wright KP, Vetter C, Martin MA, de la Iglesia HO. COVID-19 stay-at-home restrictions increase the alignment in sleep and light exposure between school days and weekends in university students. Sleep 2023; 46:zsad059. [PMID: 36883614 PMCID: PMC10334482 DOI: 10.1093/sleep/zsad059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
Younger adults have a biological disposition to sleep and wake at later times that conflict with early morning obligations like work and school; this conflict leads to inadequate sleep duration and a difference in sleep timing between school days and weekends. The COVID-19 pandemic forced universities and workplaces to shut down in person attendance and implement remote learning and meetings that decreased/removed commute times and gave students more flexibility with their sleep timing. To determine the impact of remote learning on the daily sleep-wake cycle we conducted a natural experiment using wrist actimetry monitors to compare activity patterns and light exposure in three cohorts of students: pre-shutdown in-person learning (2019), during-shutdown remote learning (2020), and post-shutdown in-person learning (2021). Our results show that during-shutdown the difference between school day and weekend sleep onset, duration, and midsleep timing was diminished. For instance, midsleep during school days pre-shutdown occurred 50 min later on weekends (5:14 ± 12 min) than school days (4:24 ± 14 min) but it did not differ under COVID restrictions. Additionally, we found that while the interindividual variance in sleep parameters increased under COVID restrictions the intraindividual variance did not change, indicating that the schedule flexibility did not cause more irregular sleep patterns. In line with our sleep timing results, school day vs. weekend differences in the timing of light exposure present pre- and post-shutdown were absent under COVID restrictions. Our results provide further evidence that increased freedom in class scheduling allows university students to better and consistently align sleep behavior between school days and weekends.
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Affiliation(s)
- Alicia Rice
- Department of Biology, University of Washington, Seattle, WA, USA
| | - Olivia Sather
- Department of Biology, University of Washington, Seattle, WA, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Melanie A Martin
- Department of Anthropology, University of Washington, Seattle, WA, USA
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis. Behav Sleep Med 2023; 21:208-225. [PMID: 35604338 DOI: 10.1080/15402002.2022.2074996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. PARTICIPANTS/METHODS A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 731 good sleepers), adjusted for demographic differences. RESULTS Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81). CONCLUSION Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Moira F Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Wendy A Finck
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Kuo W, Ersig AL, Kunkul F, Brown RL, Oakley LD. Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic. Res Nurs Health 2023; 46:68-79. [PMID: 36445114 PMCID: PMC9839487 DOI: 10.1002/nur.22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao-Scott χ2 tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era.
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Affiliation(s)
- Wan‐Chin Kuo
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Anne L. Ersig
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Fatih Kunkul
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Roger L. Brown
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Linda D. Oakley
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
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The prevalence of insomnia in different COVID-19 policy phases: Longitudinal evidence from ITA.LI - Italian Lives. BMC Public Health 2022; 22:1657. [PMID: 36050669 PMCID: PMC9434520 DOI: 10.1186/s12889-022-14048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study investigated changes in the prevalence of insomnia in Italy during COVID-19, starting from the first lockdown period (8 March 2020). We hypothesized that lockdown precipitated increased prevalence of insomnia symptoms relative to the pre-pandemic period; b) the gradual relaxation of containment measures - post-lockdown period (Phase 2 and Phase 3) - reduced insomnia severity, leading to a relative recovery of pre-pandemic levels; and c) we tested age-related heterogeneity in sleep responses, with an expected higher increase in insomnia in younger and middle-age groups. METHODS Analyses drew on a subsample (N = 883) of respondents to ITA.LI - Italian Lives, a recently established panel study on a probability sample of individuals aged 16 + living in Italy. To estimate patterns of change in insomnia, we first fitted a random-effects ordered logistic model on the whole sample. We then added an interaction term between policy phases and the respondent age to test whether the relationship between insomnia and policy phases differed across age groups. Analyses accounted for survey non-response weights. RESULTS The fraction of respondents reporting moderate ("somewhat" + 0.159, S.E. 0.017) or severe ("very much" + 0.142, S.E. 0.030) sleep disturbances significantly increased during Phase 1. The prevalence of insomnia followed an inverted U-shaped curve across policy phases, with further increases from baseline levels ("somewhat" + 0.168, S.E. 0.015; "very much" + 0.187, S.E. 0.030) during Phase 2, followed by a relative reduction in Phase 3, although it remained significantly higher than in the pre-pandemic period ("somewhat", + 0.084, S.E. 0.016; "very much", + 0.045, S.E. 0.010). There were significant age-related differences in insomnia patterns, as the discrete change from pre-pandemic levels in the probability of not suffering from insomnia was negative and significant for the younger age group (- 0.269, S.E. 0.060) and for respondents aged 35-54 (- 0.163, S.E. 0.039). CONCLUSION There is reason to believe that the emergency policy response to the COVID-19 crisis may have had unintended and possibly scarring effects in terms of increased prevalence of insomnia. The hardest hit were young adults and, to a lesser extent, the middle-aged; however, older respondents (55 +) remained resilient, and their insomnia trajectory bounced back to pre-pandemic levels.
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Did Mindful People Do Better during the COVID-19 Pandemic? Mindfulness Is Associated with Well-Being and Compliance with Prophylactic Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095051. [PMID: 35564450 PMCID: PMC9105751 DOI: 10.3390/ijerph19095051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
This paper investigates the relationship between mindfulness and well-being within the context of compliance with prophylactic measures in the time of COVID-19. We conducted a large-scale survey among a representative sample of the French population. We measured mindfulness, using the Mindful Attention Awareness Scale, and the extent to which respondents were impacted by COVID-19 in terms of their mood and quality of sleep, as well as how they complied with prophylactic measures. Our results suggest that more mindful individuals were less negatively impacted by COVID-19 with regard to their sleep and mood. Concerning the prophylactic measures, we obtained mixed results: more mindful participants were more likely to respect lockdowns, physical distancing and to cough in their sleeves, but did not wash their hands, wear masks or avoid touching their face more often than less mindful individuals.
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Zerbini G, Taflinger S, Reicherts P, Kunz M, Sattler S. Perceived risk of COVID-19 exposure and poor COVID-19 prognosis impair sleep: The mediating and moderating roles of COVID-19-related anxiety and knowledge. J Sleep Res 2022; 31:e13569. [PMID: 35238104 PMCID: PMC9115167 DOI: 10.1111/jsr.13569] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/26/2023]
Abstract
The ongoing COVID‐19 pandemic has been linked to increased levels of stress, depression, and anxiety in many people around the world. Therefore, identifying individuals at risk of psychosocial burden during this unprecedented crisis is essential for developing prevention measures and treatment options for mental health issues. To this aim, we investigated two risk groups: individuals at higher risk of exposure to the virus and individuals at higher risk of poor prognosis if they contract the virus. We conducted a survey (N = 4167) with a representative sample of the German population and assessed perceived risk of COVID‐19 exposure and poor prognosis if infected, COVID‐19‐related anxiety, problems with sleep and daytime functioning, as well as self‐reported knowledge about the disease. Results showed that perceived risk group membership was linked to increased problems with sleep and daytime functioning via elevated levels of COVID‐19‐related anxiety. This mediated effect was further moderated by self‐reported COVID‐19 knowledge, but only for individuals who rated themselves at higher risk of COVID‐19 exposure. Thus, knowledge buffered the negative effect of exposure risk on anxiety and ultimately on sleep in this risk group. Reaching individuals at increased risk of exposure with clear information about the disease, how to prevent infection, and treatment options could be an effective strategy to contain anxiety levels and promote good sleep, which is important for general well‐being.
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Affiliation(s)
- Giulia Zerbini
- Department of Medical Psychology and Sociology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Shannon Taflinger
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Philipp Reicherts
- Department of Medical Psychology and Sociology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Miriam Kunz
- Department of Medical Psychology and Sociology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Sebastian Sattler
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany.,Faculty of Sociology, Bielefeld University, Bielefeld, Germany.,Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montréal, Germany
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Wu M, Li SX, Xue P, Zhou J, Tang X. COVID-19 Vaccine Could Trigger the Relapse of Secondary Hypersomnia. Nat Sci Sleep 2021; 13:2267-2271. [PMID: 35002346 PMCID: PMC8721156 DOI: 10.2147/nss.s345801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023] Open
Abstract
The coronavirus disease (COVID-19) has brought significant social and economic disruptions and devastating impacts on public health, and vaccines are being developed to combat the disease. Timely vaccination may prevent complications and morbidity but may also potentially result in unforeseen outcomes in some special clinical populations. We report on a case of hypersomnia relapse after the COVID-19 vaccination, with the aim of informing the development of the guideline on vaccination in specific groups. A 19-year old female presented with persistent daytime sleepiness after receiving the COVID-19 vaccine. She had a known history of hypersomnia secondary to infectious mononucleosis but has fully recovered for 8 months. A series of examinations were performed on this patient. Neurologic and psychiatric examinations were unremarkable. Despite normal nocturnal subjective sleep quality (Pittsburgh Sleep Quality Index score = 5, Insomnia Severity Index score = 7), her Epworth sleepiness scale score (15) suggested an abnormal level of subjective sleepiness. Consistent with the subjective report, the objective assessment by Multiple Sleep Latency Test found mean sleep latency was 1.3 min with no sleep onset rapid-eye-movement (REM) period. We speculate that COVID-19 vaccine may potentially trigger the relapse of hypersomnia. The immune memory could be an explanation for the increased response to vaccine in patients with secondary hypersomnia. Caution should be warranted when administering COVID-19 vaccine in patients with hypersomnia secondary to infections.
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Affiliation(s)
- Min Wu
- West China School of Nursing, Sichuan University/Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Shihezi University School of Medicine, Shihezi University, Shihezi, Xinjiang Province, People’s Republic of China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Pei Xue
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Junying Zhou
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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