Beta Fulltext view is in preview — article structure may vary. Browse all articles
Contents
Mental Health & Human Resilience International Journal Research Article 11 min read

Sleep and Mental Health during the COVID-19 Pandemic

Kalcina LL*
* Corresponding author
ISSN: 2578-5095  10.23880/mhrij-16000180  Received: July 29, 2022  Published: August 16, 2022
 — views
 41 references
PDF
Keywords
Sleep Sleep Habits Sleep Disturbances Mental Health COVID-19 Pandemic Restrictions
Abstract

During the COVID-19 pandemic, a number of mental health issues were reported in various populations, including all age groups. In addition, sleep problems and sleep disturbances have been subjectively reported as a symptom in the general population, as well as in specific subgroups recognized in this review. The association of mental health issues and sleep problems is relevant in terms of future interventions that might mitigate the negative effects of pandemic-related restrictions on individuals.

Sleep Habits and Mental Health During COVID-19 Pandemic

A growing concern to global public health exists in terms of sleep disturbances and mental health issues continuously recognized as a consequence of COVID-19 pandemic-related restrictions [1], as well as a consequence of the COVID-19 infection itself [2]. Since an increasing number of review and meta-analysis is being published, during an overall surge in the number of COVID-19 publications, new opportunities emerge for scientists in the field of sleep medicine, aimed at clarifying the aforementioned associations. Review papers and meta-analyses of such findings have been consistently reported in children [3, 4, 5], as well as in adolescents and students [6, 7], the adult population as well as working population [8, 9], and in the elderly [10, 11].

Role of the Pandemic Environment

The ongoing social restrictions and personal life changes during the COVID-19 pandemic disrupted the well-established circadian rhythms of most individuals, thereby affecting even the homeostatic drive to sleep. Since the circadian rhythm is under the influence of both exposures to daylight, activity levels during daytime, as well as social components such as meal times, exercise and interaction with others; it was not a surprise for sleep medicine scientists to discover negative effects of the pandemic on sleep habits. There is no doubt that adequate sleep habits and sleep quality is critical for emotional regulation [12], and that sleep deprivation per se might be a precipitant to the onset of mental illness [13]. Unfortunately, sleep disturbances often accompany various mental health difficulties even at a young age [14]. Psychological symptoms during COVID-19 in children and adolescents have been investigated in different nations [15, 16], and a role of the pandemic restrictions on children’s play has been recognized as a relevant issue [5]. Since the pandemic outbreak, it has been commonly suggested by sleep experts that sleep habits might contribute to or act as a protective factor in mental health issues in all age groups.

Recovery of COVID-19 Infection

Following the recovery of COVID-19 infection, several complications have been underlined, among which psychological symptoms have been described as common [2]. One of the recognized psychological symptoms are insomnia-related symptoms, and it has been highlighted that sleep as a symptom should be even more carefully monitored in the post-COVID-19 recovery than mood symptoms [17]. However, it should be underscored that recently established long-term prevalence of anxiety, depression, post-traumatic stress disorder, and sleep disturbances in patients recovered from COVID-19 infection has been shown to be comparable to general population levels [18].

The Bidirectional Relationship-Sleep and Mental Health

In patients experiencing mental health issues before the pandemic, an increased risk has been recognized for sleep disturbances (ref). Still, the association is bidirectional, since a recent review confirmed that, among other risk factors, sleep quality is also associated with an increase in the risk of adverse mental health outcomes in the COVID-19 aftermath [19]. Similar associations were described even before the pandemic, when reduced night-time sleep quality was associated to some aspects of mental health, particularly externalizing problems [20, 21]. Even twin studies confirmed that late bedtime and short sleep duration could predict depression and anxiety, and even suicidal risk [22]. It is highly problematic that sleep disturbances have been shown to negatively affect mental health issues, thereby highlighting the need for interventions in all populations where such associations were recognized.

Quarantine, Sleep and Mental Health

A large amount of research in this area has been devoted to the understanding of quarantine experience in relation to both sleep habits and mental health issues [4, 7, 23, 24, 25, 26, 27, 28, 29, 30]. A number of reviews and national surveys revealed the overall psychological impact of lockdown-related measures during the COVID-19 pandemic [4, 23, 24, 29, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35], as well as an impact on sleep disturbances and changes in sleep habits [7, 24, 36]. It has been outlined that quarantine itself contributes to numerous psychological problems, as well as social and even financial issues in individuals being quarantined and their family members [29, 30, 37]. A comprehensive overview of possible protective and risk factors for the psychological impact of quarantine during the COVID-19 pandemic has been reported [30]. The aforementioned review emphasized anxiety, distress, and depression as the most common psychological difficulties, and attempted to understand it from a socio-ecological framework. The authors presented an overview of socio- demographic risk factors as well as individual-level factors, among which history of psychiatric disorder, history of cancer or other chronic diseases, self-evaluation on the knowledge about COVID-19, worry related to infection, low perceived health condition, fear of contracting and spreading the virus and poor sleep quality were recognized as risk factors for quarantine related negative psychological impact [30]. In addition to previously mentioned psychological consequences, eating disorders have also been recognized as more common during the COVID-19 pandemic, due to changes in routine and increased levels of stress and trauma in individuals at risk for eating disorders [38].

Health-Care Workers

There is no doubt that health care workers carried a heavy burden of the pandemic, as mental health consequences and sleep-related disturbances have been reported in the aforementioned population, due to both exposure to stress and the atypical working schedules, as well as other factors [9, 31]. Increased frequency of anxiety, depression, stress, and other mental health issues in healthcare workers during the COVID-19 pandemic might have been expected since even before the pandemic both short sleep duration and elevated incidence of sleep disorders has been reported among workers in the healthcare industry [39, 40]. Since the COVID-19 pandemic has taken a heavy toll on health professionals in terms of burnout and associated mental health issues [41], future interventions should appropriately attend to both mental health problems and sleep problems of health-care workers.

Recommendations

Practical recommendations from a task force of the European CBT-i Academy have been published in order to minimize the negative consequences of sleep problems during home confinement due to the pandemic, including recommendations for healthcare staff and those with an increased work burden affecting sleep opportunity as well as for women and children in family contexts, recognizing them as those being at increased risk for such consequences [27]. All of previously mentioned findings are even more relevant since the increase of sleep and mental health problems during the pandemic did not trigger help-seeking, and a recent publication reported help-seeking behavior only in one third of participants with sleep problems and symptoms of mental disorders [39]. It remains to be elucidated if the established effects of COVID-19 related restrictions and the infection itself on sleep and mental health will remain in the following years. It is of even greater importance to understand the mechanisms of such long term effects and therefore pinpoint the risk factors that remain relevant for mental health and sleep issues. Understanding plausible protective factors that promote mental health during stressful life events, such as the pandemics, has implications for future research as well as for focused interventions aimed at vulnerable groups.

References

  1. Leone MJ, Sigman M, Golombek DA (2020) Effects of lockdown on human sleep and chronotype during the COVID-19 pandemic. Curr Biol 30(16): R930-R931.
  2. Elhiny R, Al-Jumaili AA, Yawuz MJ (2022) What might COVID-19 patients experience after recovery? A comprehensive review. Int J Pharm Pract.
  3. Bussieres EL, Hurtubise CM, Meilleur A, Mastine T, Hérault E, et al. (2021) Consequences of the COVID-19 Pandemic on Children’s Mental Health: A Meta-Analysis. Front Psychiatry 12: 691659.
  4. Viner R, Russell S, Saulle R, Croker H, Stansfield C, et al. (2022) School Closures During Social Lockdown and Mental Health, Health Behaviors, and Well-being Among Children and Adolescents During the First COVID-19 Wave: A Systematic Review. JAMA Pediatr 176(4): 400- 409.
  5. Graber KM, Byrne EM, Goodacre EJ, Kirby N, Kulkarni K, et al. (2021) A rapid review of the impact of quarantine and restricted environments on children’s play and the role of play in children’s health. Child Care Health Dev 47(2): 143-153.
  6. Mulyadi M, Tonapa SI, Luneto S, Lin WT, Lee BO (2021) Prevalence of mental health problems and sleep disturbances in nursing students during the COVID-19 pandemic: A systematic review and meta-analysis. Nurse Educ Pract 57: 103228.
  7. Valenzuela RLG, Velasco RIB, Jorge M (2022) Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review. Stress Health.
  8. Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, et al. (2021) Sleep problems during the COVID-19 pandemic by population: a systematic review and meta- analysis. J Clin Sleep Med 17(2): 299-313.
  9. Power N, Perreault M, Ferrari M, Boudreau P, Boivin DB (2022) Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review. J Biol Rhythms 37(4): 358-384.
  10. Pires GN, Ishikura IA, Xavier SD, Petrella C, Piovezan RD, et al. (2021) Sleep in Older Adults and Its Possible Relations with COVID-19. Front Aging Neurosci 13: 647875.
  11. Parveen S, George SM, Chand S (2021) Was Sleep a Problem for the Elderly During COVID-19?. Sleep Vigil 5(2): 197-203.
  12. Tempesta D, Socci V, Gennaro LD, Ferrara M (2018) Sleep and emotional processing. Sleep Med Rev 40: 183-195.
  13. Pigeon WR, Bishop TM, Krueger KM (2017) Insomnia as a Precipitating Factor in New Onset Mental Illness: a Systematic Review of Recent Findings. Curr Psychiatry Rep 19(8): 44.
  14. Blok E, Verhoeff EK, Dickstein DP, Saletin J, Luik AI, et al. (2022) Sleep and mental health in childhood: a multi- method study in the general pediatric population. Child and Adolescent Psychiatry and Mental Health 16(1): 1-14.
  15. Liu JJ, Bao Y, Huang X, Shi J, Lu L (2020) Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health 4(5): 347-349.
  16. Francisco R, Pedro M, Delvecchio E, Espada JP, Morales A, et al. (2020) Psychological Symptoms and Behavioral Changes in Children and Adolescents During the Early Phase of COVID-19 Quarantine in Three European Countries. Front Psychiatry 11: 570164.
  17. Xu F, Wang X, Yang Y, Zhang K, Shi Y, et al. (2022) Depression and insomnia in COVID-19 survivors: a cross- sectional survey from Chinese rehabilitation centers in Anhui province. Sleep Med 91: 161-165.
  18. Bourmistrova NW, Solomon T, Braude P, Strawbridge R, Carter B (2022) Long-term effects of COVID-19 on mental health: A systematic review. Journal of Affective Disorders 299: 118-125.
  19. Patrono A, Renzetti S, Manco A, Brunelli P, Moncada SM, et al. (2022) COVID-19 Aftermath: Exploring the Mental Health Emergency among Students at a Northern Italian University. Int J Environ Res Public Health 19(14): 8587.
  20. Milojevich HM, Lukowski AF (2016) Sleep and Mental Health in Undergraduate Students with Generally Healthy Sleep Habits. PLoS One 11(6): e0156372.
  21. Medic G, Wille M, Hemels ME (2017) Short- and long- term health consequences of sleep disruption. Nat Sci Sleep 9: 151-161.
  22. Matamura M, Tochigi M, Usami S, Yonehara H, Fukushima M, et al. (2014) Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents. J Sleep Res 23(3): 290-294.
  23. Chen J, Zhang SX, Yin A, Yáñez JA (2022) Mental health symptoms during the COVID-19 pandemic in developing countries: A systematic review and meta-analysis. J Glob Health 12: 05011.
  24. Casagrande M, Favieri F, Tambelli R, Forte G (2020) The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med 75: 12-20.
  25. Alkhamees AA, Aljohani MS, Alghesen MA, Alhabib AT, et al. (2020) Psychological Distress in Quarantine Designated Facility During COVID-19 Pandemic in Saudi Arabia. Risk Manag Health Policy 13: 3103-3120.
  26. Aquila I, Sacco MA, Ricci C, Gratteri S, Ricci P (2020) Quarantine of the Covid-19 pandemic in suicide: A psychological autopsy. Med Leg J 88(4): 182-184.
  27. Batra K, Morgan AE, Sharma M (2020) COVID-19 and Social Isolation Endangering Psychological Health of Older Adults: Implications for Telepsychiatry. Signa Vitae 16(2): 14-19.
  28. Benke C, Autenrieth LK, Asselmann E, Pane Farre CA (2020) Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Research 293: 113462.
  29. Brooks SK, Webster RK, Smith LE, Woodand L, Wessely S, et al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395(10227): 912-920.
  30. Rajkumar E, Rajan AM, Daniel M, Lakshmi R, John R, et al. (2022) The psychological impact of quarantine due to COVID-19: A systematic review of risk, protective factors and interventions using socio-ecological model framework. Heliyon 8(6): e09765.
  31. Dragioti E, Li H, Tsitsas G, Lee KH, Choi J, et al. (2022) A large-scale meta-analytic atlas of mental health problems prevalence during the COVID-19 early pandemic. Journal of Medical Virology 94(5): 1935-1949.
  32. Browning MHEM, Larson LR, Sharaievska I, Rigolon A, McAnirlin O, et al. (2021) Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States. PLoS One 16(1): e0245327.
  33. Burke T, Berry A, Taylor LK, Stafford O, Murphy E, et al. (2020) Increased Psychological Distress during COVID-19 and Quarantine in Ireland: A National Survey. J Clin Med 9(11): 3481.
  34. Canet JL, Andres ML, Del VM, Lopez MH, Poo F, et al. (2020) A Longitudinal Study on the Emotional Impact Cause by the COVID-19 Pandemic Quarantine on General Population. Frontiers in Psychology 11: 565688.
  35. Đogas Z, Lusic KL, Pavlinac DI, Demirovic S, Madirazza K, et al. (2020) The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study. Croat Med J 61(4): 309-318.
  36. Neculicioiu VS, Colosi IA, Costache C, Sevastre BA, Clichici S (2022) Time to Sleep?-A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health. Int J Environ Res Public Health 19(6): 3497.
  37. Shigemura J, Takahashi S, Komuro HPHN, Suda T, Kurosawa M (2022) Mental health consequences of individuals affected by the 2022 invasion of Ukraine: Target populations in Japanese mental healthcare settings. Psychiatry and Clinical Neurosciences 76(7): 342-343.
  38. Cooper M, Reilly EE, Siegel JA, Coniglio K, Sadeh SS, et al. (2022) Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Eat Disord 30(1): 54-76.
  39. Shockey TM, Wheaton AG (2017) Short Sleep Duration by Occupation Group - 29 States, 2013-2014. MMWR Morb Mortal Wkly Rep 66(8): 207-213.
  40. Kim MS, Kim T, Lee D, Yook JH, Hong YC, et al. (2018) Mental disorders among workers in the healthcare industry: 2014 national health insurance data. Ann Occup Environ Med 30: 31.
  41. Mehta S, Machado F, Kwizera A, Papazian L, Moss M, et al. (2021) COVID-19: a heavy toll on health-care workers. Lancet Respir Med 9(3): 226-228.
More from this journal

Cite this article

BibTeX
APA
RIS
@article{kalcina2022,
  title   = {Sleep and Mental Health during the COVID-19 Pandemic},
  author  = {Kalcina LL},
  journal = {Mental Health & Human Resilience International Journal},
  year    = {2022},
  volume  = {6},
  number  = {2},
  doi     = {10.23880/mhrij-16000180}
}
Kalcina LL (2022). Sleep and Mental Health during the COVID-19 Pandemic. Mental Health & Human Resilience International Journal, 6(2). https://doi.org/10.23880/mhrij-16000180
TY  - JOUR
TI  - Sleep and Mental Health during the COVID-19 Pandemic
AU  - Kalcina LL
JO  - Mental Health & Human Resilience International Journal
PY  - 2022
VL  - 6
IS  - 2
DO  - 10.23880/mhrij-16000180
ER  -