Understanding the Mediating Role of Anxiety and Depression on the Relationship Between Perceived Stress and Sleep Quality Among Health Care Workers in the COVID-19 Response

Abstract

There is an increasing amount of evidence exploring the adverse effects of perceived stress or anxiety and depression independently on sleep quality during the COVID-19 outbreak, although the underlying mechanisms are unclear. The aim of the current study was to explore the role of anxiety and depression as a potential mediator between perceived stress and sleep quality among health care workers. Methods: Data were collected through an online survey using the snowball sampling method and comprised 588 current health care workers in Zhejiang and Hubei provinces, China, from February to March 2020. We administered the Sleep Quality Questionnaire (SQQ), the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-4) and the sociodemographic characteristics and COVID-19-related characteristics questionnaire. Structural equation modelling (SEM) was used to examine the direct and indirect relationships between perceived stress, anxiety and depression, and sleep quality. Results:The average scores for sleep quality and perceived stress were 16.01 (95% CI [15.40, 16.57]) and 15.46 (95% CI [15.05, 15.87]), respectively. The positive rates of anxiety and depression symptom tests were 9.86% and 10.37%, respectively. The SEM results indicated that the original relationship between perceived stress and sleep quality was beta = 0.52 (P < 0.001) and reduced to beta = 0.25 (P = 0.045) while introducing anxiety and depression as mediating variables. Perceived stress was positively associated with anxiety and depression (beta = 0.78, P = 0.014), and anxiety and depression were positively associated with sleep quality (beta = 0.42, P < 0.001). Conclusion:Poor sleep quality and high perceived stress were common during the COVID-19 crisis. Reducing perceived stress could help reduce anxiety and depression symptoms, thereby improving sleep quality among health care workers. In an attempt to promote psychological resources, we should perhaps take multiple measures, including personal tailored intervention and organizational humanistic concern.

Relationship between perceived stress and depression in Chinese front-line medical staff during COVID-19: A conditional process model

“…Perceived stress is significantly related to depression ( Du et al, 2020 ; Luo et al, 2021 ), which has been proved again in the current study ( Hypothesis 1 ). Moreover, insomnia can be used to explain part of the effect of perceived stress on depression ( Hypothesis 2 ).…”

A mental health survey among young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic in China

“…However, the relationship between insomnia and depression or anxiety may be bidirectional ( 52 ). Many studies point out that depression or anxiety can reduce the quality of sleep, leading to insomnia ( 17 , 55 , 56 ). Serotonergic and dopaminergic dysfunctions may be the common underlying mechanism of insomnia and mental disorders ( 57 ).…”

“…Clinicians may also be worried about becoming infected or infecting their families ( 14 ). Stress from these various sources will increase the risk for depression or anxiety if it cannot be effectively allayed ( 15 , 17 ). Moreover, previous studies have shown that compared with older clinicians, young clinicians' lack of practical experience and confidence in clinical management may lead to insufficient resilience to deal with psychological problems and more serious emotional exhaustion ( 18 , 19 ).…”

“Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic”

“…Sleep; It can be expressed as quality sleep when it is sufficient, quality and regular. In addition, good sleep is vital for health and is one of the most important signs of the transition between health and illness ( Luo et al, 2021 ). The change in sleep quality also directly affects the daily life activities of the individual.…”