Worry about COVID-19 as a predictor of future insomnia

Abstract

The coronavirus disease 2019 (COVID-19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID-19 are more strongly associated with insomnia. Using a three-part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID-19 exposures, COVID-19 worries, and insomnia. We hypothesised that COVID-19-related worries and exposure to risk of COVID-19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time-points indicating their exposures to COVID-19 risk factors, COVID-19-related worries, and insomnia. COVID-19 worry variables were consistently associated with greater insomnia severity, whereas COVID-19 exposure variables were not. COVID-19 worries decreased significantly over time, and there were significant interactions between change in COVID-19 worries and change in insomnia severity over time. Individuals who experienced increases in COVID-19 worries also experienced increases in insomnia severity. Changes in worry during the COVID-19 pandemic were associated with changes in insomnia; worries about COVID-19 were a more consistent predictor of insomnia than COVID-19 exposures. Evidence-based treatments targeting virus-related worries may improve insomnia during this and future calamities.

Keywords: anxiety; health-anxiety; psychology; sleep.

FIGURE 1

(a) Change in Insomnia Severity Index (ISI) by change in worries about getting COVID‐19. Lines indicate participants who were at the mean in change in worries about getting COVID‐19 over time (“Mean Worries‐Getting”), 1 standard deviation (SD) below the mean in changes in worries about getting COVID‐19 over time (“−1 SD Worries‐Getting”), or 1 SD above the mean in changes in worries about getting COVID‐19 over time (“+1 SD Worries‐Getting”). (b) Change in ISI by change in worries about Family contracting COVID‐19. The lines indicate participants who were at the mean in change in worries about family getting COVID‐19 over time (“Mean Worries‐Family”), 1 SD below the mean in changes in worries about family getting COVID‐19 over time (“−1 SD Worries‐Family”), or 1 SD above the mean in changes in worries about family getting COVID‐19 over time (“+1 SD Worries‐Family”)

FIGURE 2

Results of a cross‐lagged panel analysis to directly test directionality between Worry (calculated as a total score, a sum of all Worry variables to reduce the number of analyses) and Insomnia Severity Index severity. (a) Model 1 includes only the autoregressive paths. (b) Model 2 adds paths from one construct (sleep at baseline) to the second construct at the subsequent time‐point, worry at one‐month. (c) Model 3 adds paths in the opposite direction to the autoregressive model: worry at baseline predicting sleep at one‐month. (d) Model 4 is the full model including bidirectional paths (essentially a combination of Models 2 and 3)