Gender-related time course of sleep disturbances and psychological symptoms during the COVID-19 lockdown: A longitudinal study on the Italian population

Abstract

Italy was the first western hotspot of the COVID-19 pandemic. In order to contain the spread of the virus, the Italian Government imposed home confinement to the entire population for almost two months. The present study is the first large-scale longitudinal report of the sleep and mental health changes during the prolonged lockdown due to the COVID-19 outbreak. We focused on the gendered vulnerability in a sample of the Italian population since cross-sectional research identified women to be more at-risk than men during this unprecedented situation. A total of 2701 individuals (mean age ± standard deviation, 32.37 ± 11.62; range, 18-82) participated in a web-based longitudinal survey consisting of two measurements. Participants were first-time recruited on social networks and via telephone messages through a snowball sampling and tested during the third week of the lockdown period. Subsequently, a follow-up evaluation was carried out during the seventh week of restraining measures. The survey assessed sleep quality, insomnia and depression symptoms, perceived stress, and anxiety, using the following questionnaires: the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Beck Depression Inventory-second edition, the 10-item Perceived Stress Scale, and the State-Anxiety Inventory. Female gender showed the worst condition for all the examined dimensions in both the assessments. Nevertheless, at the follow-up women reported a reduction in insomnia and depression severity symptoms, perceived stress, and anxiety. On the other hand, male participants showed a worsening of sleep quality, insomnia symptoms, and perceived stress. Consequently, the gender prevalence gap of clinical conditions such as insomnia and depression was largely reduced under lockdown. Our investigation pointed to a different time course of sleep and mental health between genders during the home confinement period. Women seemed to show greater long-term resilience during the lockdown. Meanwhile, the male gender emerges as the most vulnerable category to the extension of the restraining measures. Our results suggest that there is no "weaker gender" after a prolonged lockdown. Indeed, the Italian population transversely presented signs of psychological suffering and significant sleep disturbances after the protracted and stressful lockdown period due to the COVID-19 pandemic.

Keywords: COVID-19 lockdown; Gender; Longitudinal; Mental health; Sleep disturbances; Stress.

Fig. 1

Interaction between “time” and “gender” factors for the PSQI (sleep quality), ISI (insomnia), BDI-II (depression), PSS-10 (perceived stress), and STAI-X1 (anxiety) questionnaires. Mean (and standard error) of questionnaires scores in the two assessments (Test 1: 25–31 March 2020; Test 2: 21–27 April 2020) for men (in blue) and women (in orange). Bonferroni post hoc results are reported with asterisks (*P < 0.05; **P < 0.001).

Fig. 2

Prevalence rates of men (in blue) and women (in orange) reporting moderate to severe insomnia and severe depression at the two assessments (Test 1: 25–31 March 2020; Test 2: 21–27 April 2020). Logistic regression significance is reported with asterisks (*P < 0.05).