Results from a cross-sectional survey published in Psychiatry Research describe the impact of the coronavirus (COVID-19) pandemic on insomnia symptoms. Approximately 19.1% of surveyed adults met criteria for clinical insomnia. Self reported worry about COVID-19 and comorbid mental health conditions were significant predictors of insomnia symptoms.
The first case of COVID-19 in France was confirmed on January 24, 2020. Nationwide lockdown, social distancing measures, and drastic changes to healthcare infrastructure rapidly followed. An online survey conducted between May 3 and 16 captured the effects of the pandemic on sleep in French adults. Participants provided demographic and clinical data, including information on medical comorbidities and COVID-19-related stressful life events. Participants also completed the Insomnia Severity Index (ISI) and the 4-item UCLA Loneliness scale. Multivariate logistic regression was performed to identify correlates of clinical insomnia, defined by an ISI score ≥15.
The study sample comprised 556 adults, among whom 75.5% were women. The mean age was 30.1 years, with a range from 18 to 87 years. Overall, 48 participants (8.6%) reported prior infection with COVID-19. Mean total ISI score was 9.2 ± 5.66, and 19.1% of the cohort met criteria for clinical insomnia (ISI ≥15).
In regression models, individuals attending college (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.05-5.53) were at significantly greater odds of developing insomnia compared to their peers not enrolled in college. Similarly, individuals with undergraduate levels of education were more likely to meet the threshold for clinical insomnia than patients with postgraduate levels (OR, 2.59; 95% CI, 1.34-5.02). Clinical insomnia was also significantly associated with self-reported worry about COVID-19 (OR, 1.39; 95% CI, 1.09-1.78) and comorbid mental health conditions (OR, 1.22; 95% CI, 1.12-1.33).
By contrast, individuals who had higher scores on the UCLA Loneliness scale were less likely to experience clinical insomnia (OR, 0.41; 95% CI, 0.23-0.72). Individuals who had never been infected with COVID-19 were also less likely to meet the threshold for clinical insomnia (OR, 0.43; 95% CI, 0.19-0.97). A model which incorporated education levels, self-reported worry, mental health comorbidities, loneliness, and prior COVID-19 infection explained 25.1% of the variance in clinical insomnia results. This same model also correctly classified 82.4% of insomnia cases.
Results from this survey identify COVID-19-related stress as a major contributor to insomnia in French adults. Overall, nearly a fifth of the total cohort met the threshold for clinical insomnia. This proportion is similar to that reported in prior studies conducted in Italian and Chinese populations affected by COVID-19. ‘These findings underscore that sleep-related problems should be an important component of mental health interventions during pandemics,” the investigators wrote.
Kokou-Kpolou CK, Megalakaki O, Laimou D, Kousouri M. Insomnia during COVID-19 pandemic and lockdown: Prevalence, severity, and associated risk factors in French population. Psychiatry Res. 2020;290:113128.