Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity.

COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation ("How often have you felt lonely and isolated?"). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.

Chronic sleep disturbance among adult Canadians: Associations and implications to the evaluation of noise impacts under Canada's Impact Assessment Act

The Canadian Perspectives on Environmental Noise Survey was completed online by 6647 randomly selected Canadians 18 years of age and older between April 12 and May 25, 2021. The survey objective was to explore attitudes, perceptions, and expectations toward environmental noise in rural and non-rural Canada. The questionnaire assessed self-reported high sleep disturbance (HSD) in the previous year, at home. The prevalence of HSD was 7.8% overall. A list of potential sources of sleep disturbance was provided to the full sample, where 6.1%, 5.2%, and 3.0% reported HSD by noisy neighbors, road traffic noise and indoor noise, respectively. Stress/anxiety or worrying about something was selected most frequently at 12.9%. Finally, 7.6% and 5.5% reported pain/illness and partner's sleep disturbance, respectively, as sources of HSD. Reported HSD was significantly higher among respondents below 55 years of age, females, lower income groups, unemployed respondents, those on paid leave (sick, maternity, disability), and living in an urban area. Expectations of quiet, perceiving nighttime noise to have increased over time, high noise sensitivity, hearing and being highly annoyed by road traffic noise was also associated with an increased prevalence of reporting HSD. In contrast to hearing impairment and heart disease (including high blood pressure);rated physical health, mental health, anxiety/depression, and reporting a sleep disorder, were associated with increased HSD. The perceived affects of the COVID-19 pandemic on health and annoyance toward environmental and indoor noise also influenced HSD. In the fully adjusted multivariate logistic regression model, the effect of age, gender, changes in nighttime noise, road traffic noise annoyance, noise sensitivity and sleep disorder remained statistically significant. The univariate and multivariate models showed a similar prevalence of HSD between Indigenous Peoples and non-Indigenous Canadians. Results are discussed in relation to the provision of advice on sleep and health under Canada's Impact Assessment Act. © 2023

Brain homeostasis run amok

This chapter elucidates how normal homeostatic brain mechanisms may run amok and how this process explains the presently unexplained symptoms of long-COVID syndrome. It describes how reorganizations in brain connectivity, referred to as neuroplasticity, provide us with a framework for the brain independently perpetuating symptoms such as fatigue, pain, cognitive problems, sleep disturbances, and headaches in the absence of peripheral organ damage, and reviews supporting studies done in chronic fatigue syndrome/Myalgic encephalomyelitis and fibromyalgia. The chapter provides evidence from recent reports that such neuroplasticity is associated with the persistent symptoms of long-COVID syndrome. The brain's automatic responses, those not engaged in consciousness, work via the autonomic nervous system, which controls breathing, heart rate, blood pressure, hormone secretions, and bowel functions, among other things. The human nervous system consists of many, highly interconnected circuits or networks that control everything the body does, from simple reflexes to higher order thinking, and everything in between. © 2023 John Wiley & Sons Ltd. All rights reserved.

Unexplained symptoms: Medicine's blind spot

Long COVID was called the first illness created through patients connecting with each other. Physicians have suggested that these symptoms are "medicine's blind spot". This chapter focuses on the common long COVID symptoms that defy current explanations. Fatigue is one of the most common and poorly understood symptoms that plagues humans. Chronic fatigue is strongly associated with mood disturbances, particularly depression, sleep disturbances, and cognitive disturbances. Cognitive disturbances are common in the general population, increase with aging, and are present in many chronic medical disorders. Unexplained dyspnea is not uncommon in younger individuals and is most often attributed to deconditioning or hyper-ventilation. Chronic pain is the leading cause of work loss in the world. Headaches are the most common chronic pain disorder. Sleep disturbances in the general population are strongly associated with mood disturbances and chronic pain. © 2023 John Wiley & Sons Ltd. All rights reserved.

Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis.

The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.

Anxiety, depression, and sleep disturbances among people on long-term efavirenz-based treatment for HIV: a cross-sectional study in Beijing, China.

BACKGROUND: Efavirenz (EFV)-induced neuropsychiatric toxicity bothers people living with HIV (PLHIV). Neuropsychiatric adverse effects of EFV may differ by length of time on EFV-based antiretroviral treatment (ART). METHODS: A cross-sectional, single-center study was conducted at Beijing Ditan Hospital in China from June-August 2020 among ART-experienced PLHIV who were on long-term EFV-based ART. 424 eligible virological suppressed participants were enrolled and divided into four groups according to time on EFV-based ART: group A (0.5 ≤ ART < 2 year), B (2 ≤ ART < 4 year), C (4 ≤ ART < 6 year), and D (ART ≥ 6 year). The questionnaires about 12-item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were administered to assess neuropsychiatric adverse events of EFV among different groups. RESULTS: Overall mental component summary scores (MCS) of SF-12 in PLHIV was 50.2, which was lower than general population. Overall prevalence of anxiety, depression and sleep disturbances was 15.6%, 15.3% and 58%, respectively. Prevalence of anxiety, depression and sleep disturbances did not vary significantly between the time-on-ART groups. Anxiety, depression, sleep disturbances had no correlation with time on EFV-based ART or CD4+ T cells counts. CONCLUSIONS: In ART-experienced PLHIV in China, neuropsychiatric adverse events exist persistently and prevalence do not significantly change with prolonged time on EFV-based ART. The prevalence of sleep disturbances was high, suggesting that clinicians should pay more attention to long-standing psychiatric health to perform early and effective interventions.

Persistence of Lockdown Consequences on Children: A Cross-sectional Comparative Study.

Lockdown during the COVID-19 pandemic had a significant psychological impact on children and adolescents. This study compared lockdown effects on children aged 1-10 years in 2020 and 2021. Two structured questionnaires were administered to 3392 parents in 2020, and 3203 in 2021. Outcomes considered for the data analysis included sleep changes, episodes of irritability, attention disturbances, distance learning and number of siblings. For data analysis, children were divided into two groups: pre-scholar (1-5 years old) and older ones. The lockdown was associated with a significant increase in sleep disturbances in 2020 and persisted after a year. The high prevalence of mood changes persisted unchanged in children under the age of 10 in 2020 and in 2021. Even if strengthened family ties seemed to mitigate the negative impact of lockdowns in 2020, this effect appeared absent or at least reduced in 2021. Irritability and rage in children were perceived to have increased in 2021 compared to 2020. A significant reduction in digital device use was observed in 2021 compared to 2020. Overall, the most harmful consequences of the lockdown in 2020 were still observed in 2021. Further studies are needed to analyze possible psychological effects that the generation who experienced the pandemic during early childhood may have, particularly in their future adolescence, in order to identify possible intervention practices to support families.

Psychological and sleep disturbances among first-line, second-line, and at home medical staff during the COVID-19 pandemic in Shanghai, China.

Objectives: Medical workers are prone to psychological and sleep disturbances during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about the varying degrees of influence among vaccinated medical staff working in different positions. The current study is aimed to evaluate and compare depression, anxiety and sleep disturbances among first-line, second-line and at home vaccinated medical staff during the COVID-19 pandemic in Shanghai, China. Methods: A cross-sectional online survey was conducted in May 2022. In addition to demographic data, levels of depression, anxiety, sleep quality, and insomnia were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Athens Insomnia Scale (AIS). Results: A total of 236 vaccinated medical workers completed the questionnaires, including 85 first-line medical staff (FMS), 82 second-line medical staff (SMS) and 69 at home medical staff (HMS). The proportions of depressive symptoms, anxiety symptoms, poor sleep quality, and insomnia were 52.1, 44.1, 55.9, and 49.2%, respectively. Compared with HMS, medical staff at work (FMS and SMS) got significantly higher frequency of poor sleep quality (both p < 0.001), insomnia (both p < 0.001), depressive (p < 0.001 and p = 0.003, respectively) and anxiety symptoms (p < 0.001 and p = 0.002, respectively). Compared with SMS, FMS were more likely to have poor sleep quality (p = 0.020). Besides, nurses got significantly higher percentage of poor sleep quality (OR = 1.352, p = 0.016) and insomnia (OR = 1.243, p = 0.041) than doctors. Whereas, the proportion of anxiety symptoms was increased in females than in males (OR = 2.772, p = 0.008). Conclusions: Psychological and sleep disturbances are common among medical staff at work during the COVID-19 pandemic. More psychological intervention should be administrated for FMS, especially for nurses.

Psychological Assessment of Family Caregivers of Patients With COVID-19 in the United States of America and India.

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has highlighted the shortcomings worldwide in terms of preparedness protocols related to epidemics. A key area of research that is evidently overlooked across the globe is the mental health of family caregivers taking care of patients with COVID-19. In light of this, this study aimed to engage in a comparative analysis between the two worst affected countries, India and the United States of America (USA), which differ considerably in their demography, socio-epidemiological factors, and health system efficiency. Methods A cross-sectional study was conducted among 1,250 family caregivers of patients with COVID-19 in India and the USA to assess their stress, anxiety, and sleep disturbance levels using the 10-item Perceived Stress Scale (PSS-10), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Pittsburgh Sleep Quality Index (PSQI), respectively. Psychological assessment questionnaires were administered through online mode, which gathered demographic information and responses on several self-reporting scales. The main outcome measures were self-reported ratings on PSS, GAD-7 scale, and PSQI. Results We found that 75.4% of the family members of COVID-19 patients suffered from mental health issues. The scores of all three scales were higher in caregivers from the USA than in India, more evident and pronounced in caregivers of hospitalized patients. The test scores were statistically significant (p<0.05) indicating a negative impact of having a dependent member in the family, being married, being of younger age, and having a longer duration of COVID-19 infection. Vaccines were found to have a life-enhancing effect. Conclusion Our findings highlight that the mental health of family caregivers is an ignored aspect and must be addressed. We recommend the implementation of well-researched and appropriate legislation, treatment programs, and health policies that involve not only the patients but also their families.

Evaluation of Sleep Disturbances in Patients With Bladder Cancer Scheduled for Local or Loco-regional Radiochemotherapy.

BACKGROUND/AIM: Organ-sparing treatment is increasingly used for bladder cancer, particularly for patients with significant comorbidities or advanced age. The upcoming treatment can cause distress and sleep disturbances. This study investigated pre-radiotherapy sleep disturbances in these patients. PATIENTS AND METHODS: Twenty-two patients with bladder cancer scheduled for local or loco-regional radiotherapy were retrospectively evaluated. Sixteen characteristics were analyzed for sleep disturbances including age, sex, performance score, comorbidities, previous malignancy, distress score, emotional problems, physical problems, treatment situation, treatment intent, current primary tumor and nodal stage, distant metastasis, treatment volume, concurrent chemotherapy, and Coronavirus Disease 2019 pandemic. RESULTS: Eleven patients (50.0%) reported sleep disturbances that were significantly associated with distress scores ≥5 (p=0.035). Trends were found for age ≤75 years (p=0.183), ≥2 emotional problems (p=0.183), ≥5 physical problems (p=0.064), and distant metastasis (p=0.090). CONCLUSION: Half of the patients reported pre-radiotherapy sleep disturbances. Risk factors facilitate identification of patients requiring psychological support.

'COVID-Somnia' in healthcare workers during the pandemic.

OBJECTIVES: Sleep disorders associated with COVID-19 pandemic are termed as 'COVID-somnia.' In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms. METHODS: This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants' demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model. RESULTS: A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores. CONCLUSION: Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

Perceived Stress among Medical Students during COVID-19 Pandemic and its Impact on Sleep and Studies - A Cross-sectional Study in South India

Background: COVID-19 pandemic has adversely affected the mental health of medical students due to the lockdown of colleges and educational institutions that had imposed a feeling of uncertainty and insecurity in students. Objectives: The present study aims todetermine the prevalence of stress among medical undergraduate students and its association with sleep and studies during the COVID-19 pandemic. Method: Perceived stress and sleep quality during COVID-19 pandemic was assessed among 446 undergraduate medical students using Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) tools. An online questionnaire containing questions retrieved from PSS and PSQI tools was prepared in Google Forms and was shared by e-mail to the students. The students were classified into three categories based on PSS total scores and compared for differences in sleep quality and learning difficulties. Results: The mean score of PSS was 13.38 ± 6.87. 252 (56.5%) had low perceived stress, 146 (32.7%) had moderate and 48 (10.8%) had high perceived stress. First year and final year medical students perceived more stress when compared with others. Among the 446 study participants, 34 (7.6%) reported poor sleep quality and it was significantly associated with the presence of stress (pvalue<0.001). 215 (48.2%) students had difficulty in concentrating on their studies. Conclusion: The COVID-19 pandemic has resulted in perceived stress among medical undergraduate students of which most of them had moderate perceived stress which warrants immediate action. Copyright (c) 2022: Author(s).

Impact of the COVID-19 pandemic on the physical and psychological health of female college students in Japan.

The spread of COVID-19 has dramatically changed our lives. This study aimed to examine the lifestyles of female college students, focusing on physical activity, sleep status, and anxiety status during the pandemic (while under a state of emergency) in Japan. A total of 184 female college students completed two questionnaires, anthropometric measurements, and daily activity logs and diet records, in groups of 115 and 69 participants recruited before and during the pandemic, respectively. Findings showed a significant decrease in physical activity: Physical activity levels fell from "normal" to "low" and the daily step counts decreased by nearly half, from 8671 to 4640. In addition, the results from the questionnaires revealed that half of the participants were at risk of having sleep disturbances, and their sleep cycles became more nocturnal, which may have caused higher anxiety states and lower sleep quality during the pandemic. Furthermore, anxiety states worsened, with 100% of the participants experiencing high anxiety during the pandemic. Monitoring lifestyle disturbances during the pandemic is needed for the development of interventions to improve health among young women.

Effects of COVID-19 home confinement on sleep in children: A systematic review.

Our main aim was to examine the evidence of the effects of coronavirus disease confinement on the sleep of children aged 12 years and younger. A systematic review was conducted following the recommendations for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, Cumulative Index for Nursing and Allied Health Literature, Excerpta Medica Database, Psychological Information Database, and Web Of Science were systematically searched between the period of January 2020 and March 2021. The quality assessment was analysed with the Newcastle-Ottawa quality assessment scale and the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The appraisal tool for cross-sectional studies was applied to cross-sectional studies and each longitudinal study was assessed with the critical appraisal skills programme. Data analysis was carried out through a narrative review. Eight studies were included in the review. Seven studies reported changes in sleep routines and five studies focused on sleep disturbances during confinement. The most important findings were a longer duration of sleep time, an increase in sleep latency, and daytime sleepiness. Whether or not the adverse changes to sleep patterns and bedtime routines seen during the home confinement period have any long-term consequences for children's sleep and daytime functioning remains unknown.

Melatonin as a complementary and prophylactic agent against COVID-19 in high-risk populations: A narrative review of recent findings from clinical and preclinical studies.

The coronavirus disease 2019 (COVID-19) pandemic has been going on around the world for more than a year and has cost a lot, as well as affected the quality of life of many. The psychological stress like delirium and sleep disturbances caused by the COVID-19 has affected many people in direct or indirect way by the disease. Insomnia and sleep deprivation have a negative effect on the immune system as well as disorders of the hormonal system, including the production and secretion of melatonin, known as the sleep hormone. Melatonin is a known anti-inflammatory and antioxidant agent in addition to its role in regulating circadian rhythms. In this review, we investigated the relationship between the effect of psychological stress caused by COVID-19 on patients, their families, health care workers, and occupations as well as how melatonin might act as a prophylactic agent with sedative effects and sleep enhancement potential. Search terms "melatonin" and "COVID-19" were manually searched on PubMed or other electronic database and relevant articles were included. Based on the review of scholarly articles, it can be inferred that melatonin, as an endogenous hormone controlling and regulating sleep and wakefulness in various researches, has a good potential due to its antioxidant and anti-inflammatory with minimal side effects. These beneficial effects highlight the impact of melatonin as an adjuvant and a potential alternative for the better management of SARS-CoV-2 infection in high-risk populations.

Sleep reactivity as a potential pathway from childhood abuse to adult insomnia.

BACKGROUND: Survivors of childhood abuse are prone to adult insomnia, but the mechanisms for this development are poorly understood. Abuse that occurs during sensitive developmental periods might affect risk for insomnia by impacting emerging stress regulatory processes. Sleep reactivity refers to the sensitivity of the sleep system to stress and is a robust risk factor for insomnia. Recent evidence shows stress exposure itself worsens sleep reactivity, thereby increasing insomnia vulnerability. In this preliminary study, we hypothesized the association between childhood abuse experiences and adult insomnia would be mediated through greater sleep reactivity. METHODS: Community adults were recruited from the United States during the COVID-19 pandemic between June 2020 and June 2021 (N = 241, 88% female, Mage = 39, SD = 13.40). Participants completed a cross-sectional survey that included the Childhood Trauma Questionnaire, Ford Insomnia Response to Stress Test, Insomnia Severity Index, and a measure of general COVID-19 stress. RESULTS: Reporting more frequent childhood emotional, physical, or sexual abuse was associated with more severe insomnia during the COVID-19 pandemic. Only childhood emotional and physical (but not sexual) abuse histories were associated with greater sleep reactivity, which exerted an indirect effect on the relationships between these two abuse types and insomnia symptoms. These findings were robust to the effects of gender, age, and stress about the COVID-19 pandemic. CONCLUSIONS: This preliminary study suggests recurrent emotional and physical abuse in childhood might promote later insomnia through heightened sleep reactivity. Stress management interventions could be important to prevent insomnia for abuse survivors by bolstering resilience of the sleep system.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children's functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017-2018, n = 1380) and another during COVID-19 pandemic (March-May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child's sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively. CONCLUSION: Home confinement generally affected infant's and toddler's sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. WHAT IS KNOWN: • Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning. • Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak. WHAT IS NEW: • Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants' and toddlers' sleep latency by >30 min during confinement. • Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children's sleep based on the BISQ criteria.

Sleep Disturbances and Their Association With Quality of Life in Older Psychiatric Patients During the COVID-19 Pandemic.

AIMS: The negative effect of the COVID-19 pandemic on sleep quality of clinically stable psychiatric patients is unknown. This study examined the prevalence of sleep disturbances and their association with quality of life (QOL) in clinically stable older psychiatric patients during the COVID-19 pandemic. METHODS: This multicenter, cross-sectional study involved older patients attending maintenance treatment at outpatient departments of four major psychiatric hospitals in China. Patients' socio-demographic and clinical characteristics were collected. Sleep disturbances, depressive symptoms, and QOL were assessed with the Insomnia Severity Index, the 9-item Patient Health Questionnaire, and 2 items of the World Health Organization Quality of Life-Brief version, respectively. Binary logistic regression analysis was conducted to examine the independent associations of socio-demographic and clinical variables with sleep disturbances, while the association between sleep disturbances and QOL was explored with analysis of covariance. RESULTS: A total of 941 patients were recruited. The prevalence of sleep disturbances was 57.1% (95% CI: 53.9-60.2%). Analysis of covariance revealed that QOL was significantly lower in patients with sleep disturbances compared to those without. Multivariate logistic regression analysis showed that sleep disturbances were positively and independently associated with more severe depressive symptoms (OR = 1.32, 95% CI: 1.26-1.37). Compared to patients with major depressive disorder, those with other psychiatric diagnoses had a significantly higher prevalence of sleep disturbances (OR = 1.44, 95% CI: 1.00-2.08). CONCLUSION: Sleep disturbances were common among clinically stable older psychiatric patients during the COVID-19 pandemic. Considering the negative association with QOL, this subpopulation needs regular assessment and timely treatment to reduce their sleep disturbances and improve their QOL.

Persistence of sleep disturbance among post-COVID patients: Findings from a 2-month follow-up study in a Bangladeshi cohort.

To evaluate the persistence and factors associated with sleep disturbances among COVID-19 patients with a history of sleep disturbances 2 months after discharge from the hospital. A total of 400 patients admitted at Dhaka Medical College Hospital during July and August were diagnosed as suffering from sleep disturbances during their hospital stay using a standardized scale. They were followed up 2 months later through telephone, and a total of 322 participants were interviewed (excluding 63 nonresponders and five deceased) regarding the persistence of disturbances in sleep through a structured questionnaire. Patient demographic, clinical, and epidemiological data including history regarding in-hospital sleep disturbance were retrieved from hospital treatment sheets. Results revealed, 35% of study participants (n = 113) were still experiencing symptoms of sleep disturbances during the interview by telephone. Age (p = 0.015), diabetes mellitus (relative risk [RR]: 1.21; confidence interval [CI]: 1.02-1.42, p = 0.022), on admission SPO2 (p = 0.009), C-reactive protein (CRP) (p = 0.025), serum ferritin (p = 0.014), and d-dimer (p = 0.030) were independently associated with sleep disturbances among participants (p < 0.05). Binary and fitting logistic regression through repeated K folds cross-validation revealed 1.65 (CI: 1.02-2.66), 1.07 (CI: 1.01-1.14), and 1.07 (CI: 1.00-1.15) times higher odds of persistence of sleep disturbances among patients with diabetes mellitus, increased neutrophil, and lymphocyte percentages, respectively. Findings of this study need to be validated and patients should be further followed up with more in-depth studies conducted 6 or 12 months after initial infection, possibly with the help of higher sample size and in-person interview.

A longitudinal comparison of college student mental health under the COVID-19 self-restraint policy in Japan.

BACKGROUND: The coronavirus-19 (COVID-19) pandemic has resulted in substantial mental health problems. In addition to the fear of infection, prevention policies that result in isolation such as lockdowns or, in Japan, "self-restraint," are associated with psychological symptoms. University students are vulnerable to emotional disorders because of the psychological challenges associated with the transition to adulthood. Therefore, we investigated changes in the mental health of university students before and during the COVID-19 pandemic. METHODS: We used data from depression screening conducted by the University of Tsukuba, Japan, during student health examinations. Students completed the Patient Health Questionnaire-9 (PHQ-9) and an open-ended question on stress self-coping. RESULTS: In 2020, 9.6% of students were depressed, approximately twice as many as in previous years. The paired samples Wilcoxon test showed that PHQ-9 scores were significantly higher in 2020 than in 2019; the largest effect size was for sleep difficulties. Analysis of the open-ended responses for stress coping strategies showed that physical activity and online communication were most frequently used. LIMITATIONS: The 2020 survey was web-based, whereas the surveys in previous years were completed in person. Only approximately one-sixth of participants answered the open-ended question. CONCLUSIONS: The percentage of students with mental health problems has doubled, and more attention to student mental health is needed. However, many students seem to be using appropriate coping measures. Education about best practices and raising awareness about establishing and maintaining sleep-wake rhythms may be useful.