COVID-19 Uncertainty and Sleep: The Roles of Perceived Stress and Intolerance of Uncertainty during the Early Stage of the COVID-19 Outbreak

Abstract

Background. The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize sleep behaviors among Chinese residents during the early stage of the outbreak and to test the extent to which sleep quality was driven by COVID-19 uncertainty, intolerance of uncertainty, and perceived stress. Methods. A cross-sectional correlational survey was conducted online. A total of 2,534 Chinese residents were recruited from February 7 to 14, 2020, the third week of lockdown. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and sleep quality. Structural equation modeling was applied to test the relationships among uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and sleep quality. Results. Sleep disturbance was common, with approximately half of participants (47.1%) reporting going to bed after 12:00am, 23.0% taking 30 minutes or longer to fall asleep, and 30.3% sleeping a total of 7 hours or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). Uncertainty about COVID-19 had a weak direct effect on poor sleep (β = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty (β = 0.506, p < 0.001) and perceived stress (β = 0.479, p < 0.001). Conclusions. These findings suggest that intolerance of uncertainty and perceived stress are critical targets for reducing sleep disturbance during the COVID-19 pandemic. Given the sustained uncertainties and challenges managing COVID-19, it is likely that, if unmanaged, COVID-19 related uncertainty will persist and continue to impact sleep outcomes.