Psychological reactions and insomnia in adults with mental health disorders during the COVID-19 outbreak

Abstract

Background The 2019 coronavirus disease (COVID-19) has disrupted millions of lives and commerce. We investigated psychological reactions and insomnia during the COVID-19 outbreak in adults with mental health disorders (MDs). Methods A self-reported psychological and sleep online survey was conducted in China between February 5th to 19th, 2020. A total of 244 adults with MDs and 1116 controls matched for age, gender and sites were included. Worsened symptoms of anxiety, depressive and insomnia were defined when severity levels shifted to a more severe category compared to pre-COVID-19. Results During the COVID-19 outbreak, we found significantly increased prevalence of anxiety (MDs: 54.9% vs. 49.6%, controls: 25.5% vs. 14.3%), depression (MDs: 63.9% vs. 61.5%, controls: 29.9% vs. 21.2%) and insomnia (MDs: 66.0% vs. 57.8%, controls: 31.5% vs. 24.8%) compared to pre-COVID-19 period (all P-value < 0.001). Furthermore, adults with MDs had higher odds for developing COVID-19-related stress (OR = 3.41, 95% CI 2.49 ~ 4.67), worsened anxiety (OR = 1.95, 95% CI 1.38 ~ 2.76), depression (OR = 2.04, 95% CI 1.43 ~ 2.93) and insomnia (OR = 2.22, 95% CI 1.53 ~ 3.21) during the COVID-19 outbreak compared to controls. Moreover, higher COVID-19-related stress and lower levels of pre-COVID-19 anxiety, depressive and insomnia symptoms were predictors for worsened anxiety, depression and insomnia in adults with MDs, respectively. Conclusions Our findings suggest that adverse psychological reactions and insomnia are more pronounced in adults with mental health disorders during the COVID-19 outbreak, thus more attention need to be provided.

Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis

“…During the early stage, insomnia symptoms have been reported to be mainly associated with acute psychological reactions due to the rapid spread of the disease (i.e., fear of getting SARS-CoV-2 infected) and the strict implementations for controlling the COVID-19 pandemic (i.e., quarantine, social distancing, lockdown, school and factory shut-down, limited access to hospitals, and traffic restrictions) [ 14 , 15 ], as well as poor sleep hygiene [ 5 , 16 ]. During the late stage of the COVID-19 pandemic, insomnia symptoms are associated with long-term effects of the COVID-19 pandemic on economic stress [ 17 , 18 ] and mental health problems [ [19] , [20] , [21] ]. Before the COVID-19 pandemic, the prevalence of insomnia symptoms in China was 15% in the adult general population [ 22 ] and 35.9% among older adults [ 23 ].…”

“…The reasons for higher prevalence of insomnia symptoms among patients with mental disorders may be associated with increased vulnerability to stress among patients with mental disorders [ [48] , [49] , [50] , [51] ], resulting in relapses or deterioration of an already existing mental issue. For example, in a nationwide survey which was conducted during the acute phase of the COVID-19 pandemic, we found that adults with mental disorders had higher odds for developing COVID-19 stress, worsened anxiety, and depressive and insomnia symptoms compared to individuals without mental disorders [ 21 ]. Furthermore, nationwide travel restrictions and quarantine during the acute phase of COVID-19 pandemic resulted in suspended hospital visits, which prevented patients with mental disorders from attending regular outpatient visits for evaluations and medication prescriptions.…”

Sleep in Older Adults and Its Possible Relations With COVID-19

“…A few studies have compared the prevalence of insomnia before and during the pandemic. Two studies have demonstrated that the prevalence of insomnia has increased by about 7% during the pandemic (Lin et al, 2021;Sun et al, 2021). However, the quality of the current evidence is low, as most studies are simple cross-sectional surveys on insomnia symptoms or retrospective studies subjected to recall bias (Morin and Carrier, 2021).…”

When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic

“…Early on, mental health experts predicted negative effects for people with mental disorders in accordance with the diathesis-stress model ( Pfefferbaum and North, 2020 , Yao et al, 2020 ), for example, because of the increase of stressors such as social isolation with a simultaneous decrease in psychiatric care. These predictions have largely been fulfilled, and negative effects on people with mental disorders, such as symptom aggravation and increased risk of a COVID-19 diagnosis, have been reported ( Fancourt et al, 2020 , Sun et al, 2021 , Taquet et al, 2020 ). However, the pandemic likely exerts heterogeneous effects.…”