Unravelling the link between sleep and mental health during the COVID-19 pandemic

BackgroundThe emergence of COVID-19 brought unparalleled changes in peoples lifestyle, including sleep. We aimed to assess the bidirectional association between sleep quality and mental health and describe how sleep and mental health were affected in Sweden during the COVID-19 pandemic (between June 2020 and September 2021). MethodsData were obtained from the Omtanke2020 study. Participants who completed the baseline survey and 8 monthly follow-up surveys were included (N=9035). We described the distribution of sleep and mental health in the different Swedish regions using maps and over the study period with longitudinal graphs adjusting for sex, age, recruitment type (self-recruitment or invitation), and COVID-19 status. The inner relationships between mental health, sleep and covid infection were described through relative importance networks. Finally, we modelled how mental health affects sleep and vice versa using generalized estimating equations with different adjustments. ResultsSeasonal and north-south regional variations were found in sleep and mental health outcomes at baseline and attenuated over time. The seasonal variation of sleep and mental health correlated moderately with the incidence rate of COVID-19 in the sample. Networks indicate that the relationship between COVID-19 incidence and mental health varies over time. We observed a bidirectional relationship between sleep quality and quantity at baseline and mental health at follow-up and vice versa. ConclusionSleep quality and quantity at baseline was associated with adverse symptom trajectories of mental health at follow-up, and vice versa, during the COVID-19 pandemic. There is also a weak relationship between COVID-19 incidence, sleep, and mental health.

Short-term improvement of mental health after a COVID-19 vaccination

ImportanceThe role of COVID-19 vaccination on the mental health of the general population remains poorly understood. ObjectiveTo assess the short-term change of depressive and anxiety symptoms in relation to COVID-19 vaccination among Swedish adults. DesignA prospective cohort study with monthly data collections on self-reported depressive and anxiety symptoms from December 2020 to October 2021 and COVID-19 vaccination from July to October 2021. SettingThe Omtanke2020 Study, Sweden. Participants7,925 participants of the Omtanke2020 study with complete data on depressive and anxiety symptoms and vaccination status. Intervention(s) or Exposure(s)Receiving the first or second dose of a COVID-19 vaccine. Main outcomes(s) and Measure(s)Binary measures of depression (PHQ-9, cut-off [≥]10) and anxiety (GAD-7, cut-off [≥]10) one month before the first dose, one month after the first dose, and, if applicable, one month after the second dose. For individuals not vaccinated or chose to not report vaccination status (unvaccinated individuals), we selected three monthly measures of PHQ-9 and GAD-7 with 2-month intervals in-between based on data availability. Results5,079 (64.1%) individuals received two doses of COVID-19 vaccine, 1,977 (24.9%) received one dose, 305 (3.9%) were not vaccinated, and 564 (7.1%) chose not to report vaccination status. There was a lower prevalence of depression and anxiety among vaccinated, compared with unvaccinated, individuals, especially after the second dose. Among individuals receiving two doses of vaccine, the prevalence of depression and anxiety was lower after both first (aRR=0.82, 95%CI 0.76-0.88 for depression; aRR=0.81, 95%CI 0.73-0.89 for anxiety) and second (aRR=0.79, 95%CI 0.73-0.85 for depression; aRR=0.73, 95%CI 0.66-0.81 for anxiety) dose, compared with before vaccination. Similar results were observed among individuals receiving only one dose (aRR=0.76, 95%CI 0.68-0.84 for depression; aRR=0.82, 95%CI 0.72-0.94 for anxiety, comparing after first dose to before vaccination). These results were independent of age, sex, recruitment type, body mass index, smoking, relationship status, history of psychiatric disorder, number of comorbidities, COVID-19 infection status, and seasonality. Conclusions and RelevanceWe observed a positive short-term change in depressive and anxiety symptoms among adults receiving a COVID-19 vaccine in the current pandemic. Key pointsO_ST_ABSQuestionC_ST_ABSIs COVID-19 vaccination associated with a short-term change in mental health? FindingsThis longitudinal study included 7,925 Swedish adults with self-reported COVID-19 vaccination and symptoms of mental health responding from December 2020 to October 2021. The prevalence of depressive or anxiety symptoms was lower one month after vaccination compared to one month before vaccination. The effect size was greater among individuals receiving two doses of vaccine, compared with those receiving only one dose. MeaningReceiving vaccination against COVID-19 is associated with short-term improvement in mental health.

Acute COVID-19 severity and 16-month mental morbidity trajectories in patient populations of six nations

BACKGROUNDThe aim of this multinational study was to assess the development of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. METHODSParticipants consisted of 247 249 individuals from seven cohorts across six countries (Denmark, Estonia, Iceland, Norway, Scotland, and Sweden) recruited from April 2020 through August 2021. We used multivariable Poisson regression to contrast symptom-prevalence of depression, anxiety, COVID-19 related distress, and poor sleep quality among individuals with and without a diagnosis of COVID-19 at entry to respective cohorts by time (0-16 months) from diagnosis. We also applied generalised estimating equations (GEE) analysis to test differences in repeated measures of mental health symptoms before and after COVID-19 diagnosis among individuals ever diagnosed with COVID-19 over time. FINDINGSA total of 9979 individuals (4%) were diagnosed with COVID-19 during the study period and presented overall with a higher symptom burden of depression (prevalence ratio [PR] 1{middle dot}18, 95% confidence interval [95% CI] 1{middle dot}03-1{middle dot}36) and poorer sleep quality (1{middle dot}13, 1{middle dot}03-1{middle dot}24) but not with higher levels of symptoms of anxiety or COVID-19 related distress compared with individuals without a COVID-19 diagnosis. While the prevalence of depression and COVID-19 related distress attenuated with time, the trajectories varied significantly by COVID-19 acute infection severity. Individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risks of depression and anxiety (PR 0{middle dot}83, 95% CI 0{middle dot}75-0{middle dot}91 and 0{middle dot}77, 0{middle dot}63-0{middle dot}94, respectively), while patients bedridden for more than 7 days were persistently at higher risks of symptoms of depression and anxiety (PR 1{middle dot}61, 95% CI 1{middle dot}27-2{middle dot}05 and 1{middle dot}43, 1{middle dot}26-1{middle dot}63, respectively) throughout the 16-month study period. CONCLUSIONAcute infection severity is a key determinant of long-term mental morbidity among COVID-19 patients.

Mental health indicators in Sweden over a 12-month period during the COVID-19 pandemic

BackgroundThe ongoing COVID-19 pandemic has had an unprecedented impact on the lives of people globally and is expected to have profound effects on mental health. Yet, self-reported large-scale online surveys on mental health are still relatively uncommon. Here we aim to describe the mental health burden experienced in Sweden using baseline data of the Omtanke2020 Study. MethodSelf-reported baseline data collected over a 12-month period (June 9, 2020-June 8, 2021) from the longitudinal online survey of the Omtanke2020 Study including 27,950 adults in Sweden. Participants were volunteers or actively recruited through existing cohorts and after providing informed consent responded to monthly online questionnaires on socio-demographics, mental and physical health, COVID-19 infection, and impact. Poisson regression was fitted to assess the relative risk of high mental health burden (depression, anxiety, and COVID-19 specific PTSD). ResultThe overall proportion of persons with high level of symptoms was 15.6%, 9.5% and 24.5% for depression, anxiety, and COVID-19 specific PTSD, respectively. Overall, 43.4% of the participants had significant, clinically relevant symptoms for at least one mental health outcome and 7.3% had significant symptoms for all three outcomes. We also observed differences in the prevalence of these symptoms across strata of sex, age, recruitment type, COVID-19 status, region, and seasonality. ConclusionWhile the proportion of persons with high mental health burden remains higher than in pre-pandemic publications, our estimates are lower than previously reported levels of depression, anxiety, and PTSD during the pandemic in Sweden and elsewhere.