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

  1. Juan González‐Hijón
  2. Anna K. Kähler
  3. Emma M. Frans
  4. Unnur A. Valdimarsdóttir
  5. Patrick F. Sullivan
  6. Fang Fang
  7. Anikó Lovik

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

The emergence of COVID‐19 brought unparalleled changes in people's 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). Data were obtained from the Omtanke2020 study. Participants who completed the baseline survey and each of the 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. Seasonal 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. Sleep 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 was also a weak relationship between COVID‐19 incidence, sleep, and mental health.

Article activity feed

  1. Version published to 10.1002/smi.3223
  2. ScreenIT

    SciScore for 10.1101/2022.03.28.22273027: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: This tool consists of seven validated items to measure symptoms of Generalized Anxiety Disorder on a 4-point Likert scale.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and weaknesses: The large sample size is a strength of this study. Among the 9,035 individuals included in the study, 3,883 had contracted COVID-19. The second strength is the temporal resolution, as we had both baseline survey and eight monthly follow-up surveys covering the second and third epidemic waves as well as the start of vaccination in Sweden. Our study also has limitations. On the one hand, as participation was open to all, our sample is not representative of the general Swedish population. For example, 81% of the participants were women and there was a relatively low proportion of younger people. Selection bias due to the method of recruitment could therefore not be excluded. For instance, it has been shown that people recruited through social media campaigns had higher levels of anxiety and depression, compared with people recruited by invitation, in the Omtanke2020 study (Lovik et al., 2021). To consider these limitations, we adjusted in all analyses for sex, age, and recruitment type. The modification of the PC-PTSD-5 scale to make it specific for the pandemic is another concern as it included three items on thinking and dreaming about COVID-19. As a result, this scale might have evaluated the post-traumatic stress of being in a pandemic rather than contracting the disease. We therefore referred to this outcome as COVID-19-related distress throughout this paper. Finally, the low correlation noted between stress and other mental health measures may be ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.03.28.22273027v2 on medRxiv
  4. Version published to 10.1101/2022.03.28.22273027v1 on medRxiv