Researchers at University College London warn that the adversities people are facing in the UK as a result of lockdown during the coronavirus disease 2019 (COVID-19) pandemic may be causing sleep problems that could affect mental health.
The findings come from a data analysis of the COVID-19 Social Study – a large, longitudinal study of the psychological and social effects experienced among 50,000 adults in the UK while they cope with lockdown.
The researchers used the data to explore the effects that people’s experiences may be having on sleep quality during the early weeks of lockdown (between April 1st and 11th May).
Daisy Fancourt and colleagues report that both experiences of adversities and worries about adversities were associated with poorer quality of sleep over time.
“Results suggest that poor sleep may be a mechanism by which adversities are affecting mental health and highlight the importance of interventions that seek to reassure individuals and support adaptive coping strategies during the pandemic,” says the team.
A pre-print version of the paper is available in the server medRxiv*, while the article undergoes peer review.
Experiences of adversities are increasing
The COVID-19 pandemic is increasingly leading to experiences of adversities, including those arising from the disease itself, such as infection and illness and those arising from the consequences of lockdown such as financial loss, difficulties obtaining food, and experiences of abuse.
The scale of the lockdown measures implemented and the length of time the pandemic is projected to last has triggered concerns that both experiences of and worries about adversities will have significant effects on physical and mental health that will manifest as a public health crisis in years to come.
“Psychosocial stress can reduce sleep length and increase sleep disturbance, which can, in turn, reduce individuals’ ability to cope and respond to stressors, and worsen health outcomes,” write Fancourt and team.
The researchers also note that while adversity may be associated with lower quality sleep overall, factors such as social support and mental health conditions may buffer or worsen the effect. Social support, for example, has been shown to be associated with improved sleep and better physical and psychological outcomes. In contrast, pre-existing mental health issues such as anxiety and depression have been associated with more significant stress responses and more reduced sleep quality.
What did the study involve?
Now, Fancourt and colleagues have assessed data available for 45,109 adults participating in the COVID-19 Social Study who were interviewed weekly between April 1st and 11th May.
They looked at associations between sleep quality and worries about and experiences of six types of adversity, including being ill with COVID-19, financial problems, loss of income, difficulties acquiring medication, difficulties accessing food, and threats to personal safety.
They also explored whether any associations between adversity and sleep quality were influenced by social support or pre-existing mental health conditions.
The team reports that the overall number of adversity experiences and adversity worries was associated with poorer sleep quality.
Each additional experience of adversity was associated with a 17% greater likelihood of having poor quality sleep, and each additional worry was associated with a 20% greater likelihood.
However, once specific types of adversity were considered, worries and experiences were associated with lower quality sleep across all categories, except for experiences relating to finances and employment such as job loss and reduced household income.
“It is possible that consequences may take time to arise,” suggests the team. “For instance, loss of paid work or cuts in income may impact sleep only following repeated rejections during job search or when reduced incomes begin to impact living standards.”
Having a more extensive social network seemed to buffer some of the associations between poor sleep and adversity experiences and worries. Still, there was less evidence of a moderating effect for other aspects of social support, including perceived social support, living alone, and loneliness.
There was no evidence that pre-existing mental health conditions had a moderating effect on the associations. Both people with and without such conditions were more likely to have poorer quality sleep due to adversity experiences and worries.
“This echoes other research showing how adversities and stresses are affecting not just those at high risk but broad populations,” writes the team.
What are the implications of the study?
Fancourt and colleagues say the findings suggest that poor sleep could be a route through which experiences of and worries about adversities are affecting mental health during the COVID-19 pandemic.
“These results suggest the importance of interventions that seek to reassure individuals and support adaptive coping strategies,” write the researchers.
“Given the challenges in providing mental health support to individuals during the lockdown, these findings highlight the importance of developing online and remote interventions that could provide such support, both as COVID-19 continues and in preparation for future pandemics,” they conclude.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.