RESUMO
Objectives: The COVID-19 crisis caused unparalleled uncertainty stress and health-related symptoms among Chinese residents. This study aimed to characterize stress status during the early stage of the pandemic and explore the inner mechanism between uncertainty stress and self-rated health. Setting/participants: A cross-sectional design was conducted online from February 7 to 14, 2020. A total of 2534 Chinese participants were surveyed. Main outcome measures: Uncertainty stress, negative affect, sleep quality, and health status were measured by self-report. A sequential mediation model using bootstrapping method was applied to test these relationships. Results: Age, place of residence, marital status, occupation, household annual income, infection, and quarantine status significantly correlated with uncertainty stress. Higher uncertainty stress was negatively related with self-rated health (r = -0.256, p < 0.01) and positively associated with higher negative emotions (r = 0.646, p < 0.01). The sequential mediation model found total indirect effect (ß = -0.014, 95%C.I. = -0.017-0.010) and direct effect (ß = -0.010, 95%C.I. = -0.015-0.005) were significant in the relationship between uncertainty stress and self-rated health with mediating by negative affect and subjective sleep quality. Conclusions: Findings provided evidence-based information for stakeholders designing and implementing intervention strategies by providing psychological consultation services and public education to manage uncertainty stress and minimize the damage of negative affect and poor sleep.
RESUMO
BACKGROUND: The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. METHODS: A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. RESULTS: The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (ß = 0.015, 95%C.I. = 0.009-0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (ß = 0.009, 95%C.I. = - 0.002-0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (ß = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. CONCLUSIONS: These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.