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

BACKGROUND: Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic. METHODS: We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020. RESULTS: A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1% (95% CI 36.2-42.0%); the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1-39.9%) and 41.8% (95% CI 33.6-50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression. CONCLUSIONS: Over one third of our sample present insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustains high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.

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

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.