Sleep quality in the Croatian adult population during the COVID-19 pandemic

Background

The COVID-19 pandemic as a worldwide public health issue is a traumatic event that has affected both the sleep and mental health of the general population. This study aimed to evaluate the quality of sleep in the Croatian adult population during the COVID-19 pandemic.

Methods

This cross-sectional questionnaire study was conducted from February to June 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, as well as Pittsburgh Sleep Quality Index (PSQI) and Coronavirus Anxiety Scale (CAS) was self-administered to a convenient sample of Croatian adults from central and northwestern Croatia.

Results

The study sample included 939 subjects with, median age of 42 years (interquartile range 35-48), 35.4% males, and 64.6% females. At the PSQI 22.6% of subjects presented sleep disturbances while at the CAS 0.4% of subjects presented dysfunctional anxiety associated with the COVID-19 pandemic. Sleep disturbances were more frequent among females (p < 0.001), inhabitants of the Croatian capital Zagreb (p = 0.001), subjects who were not infected with COVID-19 virus (p = 0.042), subjects who had fear of coronavirus infection in the workplace (p < 0.001), subjects who had fear of coronavirus infection during daily life activities (p < 0.001), subjects who had fear of coronavirus infection during daily physical activities (p < 0.001), subjects who worked with limited social contact (p = 0.005), and subjects with dysfunctional anxiety associated with the COVID-19 pandemic (p = 0.003).

Conclusions

Poor sleep quality is common during the COVID-19 pandemic in Croatia. Identifying factors associated with poor sleep would help develop specific intervention programs that enhance mental health and sleep quality during pandemics.

Key messages

• The COVID-19 pandemic has a significant negative influence on the mental health of the Croatian general population.

• Appropriate supportive programs and interventional approaches directed toward the general population are needed to address mental health problems in Croatia during the COVID-19 pandemic.

Mental health outcomes in road traffic accident survivors: prospective cohort study

Background

Mental health outcomes of road traffic accidents (RTAs) are always investigated amongst the injured. The aim of this study was to investigate psychological consequences and associated factors in all RTA survivors irrelevant of their injury status.

Methods

A cohort of 200 Croatian RTA survivors was assessed one month after experiencing a RTA using the posttraumatic stress disorder (PTSD) Checklist for civilians, the Beck Depression Inventory and the Beck Anxiety Inventory. The New Injury Severity Scale was used for the injury severity assessment.

Results

RTA survivors reported substantial rates of PTSD (35.5%) and depression (20.0%) symptoms, and low rates of anxiety (4.5%). Symptoms of depression were associated with under-average self-perceived economic status (SES) (P = 0.001), irreligiousness (P = 0.001), medication use (P < 0.001), injury severity (P < 0.001), self-perceived threat to life (P < 0.022), hospitalization (P = 0.003), hospitalization duration (P = 0.004), surgical treatment of the injury (P < 0.001), unconsciousness in the RTA (P = 0.033) and post-RTA amnesia (0.039). PTSD symptoms were associated with unemployment (P = 0.034), under average SES (P = 0.004), lack of previous RTA experience (P = 0.025), previous psychiatric illness (P = 0.001), medication use (P = 0.001), psychiatric medication use (P < 0.001), injury affliction (P = 0.001), injury severity (P < 0.001), self-perceived threat to life (P < 0.001), pain after RTA (P = 0.009), hospitalization duration (P = 0.017) and claiming compensation (P = 0.008). Anxiety symptoms were associated with previous chronic (P = 0.037) or psychiatric illness (P = 0.010), previous permanent pain (P < 0.001), psychiatric medication use (P = 0.013) and rehabilitation after injury (P = 0.032).

Conclusions

A RTA is a traumatic event that can result in physical injuries, but also with psychological consequences depending on pre-RTA survivor's characteristics. Psychological support to those at risk may prevent psychological disorders after a RTA.

Key messages

Along with evaluation and treatment of road traffic accidents injuries, health care providers should evaluate pre-accident health status of all road traffic accidents victims. Understanding factors that present risk for poor mental health outcomes after the road traffic accidents is the key step in planning and organizing recovery of accidents survivors.