Stress, coping, resilience, and sleep during the COVID-19 pandemic: A representative survey study of US adults

Psychological resilience to trauma and longitudinal sleep outcomes among current and former nurses

OBJECTIVE

A life-disrupting stressor (e.g. pandemic) may cause or exacerbate poor sleep health; resilience may offset impacts. We assessed relationships between pre-pandemic psychological resilience to trauma and sleep-related outcomes during the first year of the pandemic among current and former nurses.

METHODS

Using data from 18,670 women in the Nurses' Health Study II, we characterized pre-pandemic resilience by cross-classifying experiences of higher versus lower lifetime trauma burden with unfavorable, adequate, and favorable psychological health (through January 2020). Sleep was measured before (2017) and during the pandemic, including: changes, quality, and duration. We modeled trajectories of sleep duration assessed at five time points (pre-pandemic in 2017, and then in four COVID-19-related surveys, 2020-2021) using latent class growth analysis.

RESULTS

We observed four trajectories of sleep duration, all showing stable patterns, with averages ranging from 5.5 to 6 to 8.5-9 h of sleep per 24 h. Women with higher trauma/unfavorable psychological health had the highest risk for all poor sleep outcomes (e.g., RR for being in the shortest sleep trajectory versus healthy sleep duration: 2.53; 95 % CI: 2.21, 2.91). Relative to women categorized as most resilient, only women with lower trauma/favorable psychological health showed lower risk of getting less sleep after the pandemic started compared to no change (RR: 0.76; 95 % CI: 0.70, 0.83). This same pattern was observed for poor sleep quality.

CONCLUSION

Higher pre-pandemic resilience may have protected women against poor sleep outcomes during the pandemic. Findings could have long-term health implications, particularly if they generalize to other stressors.

The CARING study: Examining biological, behavioral, and genetic mechanisms in the intergenerational transmission of toxic stress

When children experience extreme or persistent stressors (e.g., maltreatment, housing insecurity, intimate partner violence), prolonged elevation of the stress-response system can lead to disrupted development of multiple physiological systems. This response, known as toxic stress, is associated with poor physical and mental health across the life course. Emerging evidence suggests that the effects of toxic stress may be transmitted through generations, but the biological and behavioral mechanisms that link caregivers' childhood history with the health of the children they care for remain poorly understood. The purpose of this report is to describe the research protocol for The CARING (Childhood Adversity and Resilience In the Next Generation) Study, a cross-sectional study of caregivers with children aged 3-5 years designed to (1) examine the intergenerational transmission of toxic stress and protective factors; (2) explore three hypothesized pathways of transmission: parenting, daily routines, stressors, and supports; and (3) explore the extent to which genotypic variation in candidate genes related to caregiving and stress contribute to caregivers' and children's susceptibility to the effects of early childhood experiences (i.e., gene × environment interactions). We expect that findings from this study will provide critical data needed to identify targets for precision health interventions, reduce health disparities related to toxic stress, and prevent cycles of adversity among families at risk.

The relationship between self-compassion, coping style, sleep quality, and depression among college students

Background

The prevalence of sleep quality problems and depression in the college student population has attracted widespread attention. However, the factors influencing this are still unclear. The objective of this study was to investigate the associations between self-compassion (S-C), sleep quality (SQ), and depression (DEP) among college students and examine the mediating effects of coping style (CS) between the variables.

Methods

A total of 1,038 Chinese university students were recruited for the study. The study used the Self-Compassion Scale (SCS), Simplified Coping Style Questionnaire (SCSQ), Depression Anxiety Stress Scale 21 (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) to conduct the survey.

Results

The self-compassion and coping style showed significant negative correlations with sleep quality and depression. Coping style partially mediated the relationship between self-compassion and sleep quality. The coping style also fully mediated the relationship between self-compassion and depression.

Conclusion

This study reveals the associations between self-compassion and sleep quality and depression, and the mediating role of coping style among college students. This study provides valuable insights for improving sleep quality and alleviating depression problems among college students. It emphasizes the importance of self-compassion and positive coping style.

Understanding the sleep-pain relationship in patients with interstitial cystitis/bladder pain syndrome

INTRODUCTION

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pelvic pain condition with critical symptoms of urinary urgency and frequency, persistent bladder-related pain, and reduced quality of life. Poor-quality sleep can lead to significant disturbances in daily life and increased pain in IC/BPS patients. Resilience, depressive symptoms, and pain catastrophizing have univariate associations with sleep and pain in IC/BPS, suggesting they may be mechanisms in this sleep and pain relationship.

METHODS

This online study recruited patients self-reporting a diagnosis of IC/BPS through support groups, social media posts (Facebook, Reddit, and Instagram), and urology clinic advertisements. Participants completed questionnaires on demographics, urologic symptoms, pain, pain catastrophizing, depressive symptoms, and resilience. Only those participants who met the RAND Interstitial Cystitis Epidemiology (RICE) criteria for IC/BPS diagnosis were included. A multiple mediation model was first examined, followed by a serial mediation model.

RESULTS

Seventy-four participants (Mage= 47.0, standard deviation [SD ] 16.7, range 18-83 years) met inclusion criteria. A multiple mediation model showed greater sleep disturbance was associated with greater pain severity through depressive symptoms and pain catastrophizing, but not resilience (b=0.79, bootSE =0.26, bootCI [0.33, 1.35]). A serial mediation showed that the sleep-to-pain relationship had a significant indirect effect through pain catastrophizing and depressive symptoms (b=0.78, bootSE =0.26, bootCI [0.35, 1.32]).

CONCLUSIONS

Findings suggest depressive symptoms and pain catastrophizing may be important psychosocial mechanisms in the sleep-to-pain relationship. These results help guide future sleep and pain research in IC/BPS and aid in developing and refining treatments.

Extracting Stress-Related EEG Patterns From Pre-Sleep EEG for Forecasting Slow-Wave Sleep Deficiency

Sleep is vital to our daily activity. Lack of proper sleep can impair functionality and overall health. While stress is known for its detrimental impact on sleep quality, the precise effect of pre-sleep stress on subsequent sleep structure remains unknown. This study introduced a novel approach to study the pre-sleep stress effect on sleep structure, specifically slow-wave sleep (SWS) deficiency. To achieve this, we selected forehead resting EEG immediately before and upon sleep onset to extract stress-related neurological markers through power spectra and entropy analysis. These markers include beta/delta correlation, alpha asymmetry, fuzzy entropy (FuzzEn) and spectral entropy (SpEn). Fifteen subjects were included in this study. Our results showed that subjects lacking SWS often exhibited signs of stress in EEG, such as an increased beta/delta correlation, higher alpha asymmetry, and increased FuzzEn in frontal EEG. Conversely, individuals with ample SWS displayed a weak beta/delta correlation and reduced FuzzEn. Finally, we employed several supervised learning models and found that the selected neurological markers can predict subsequent SWS deficiency. Our investigation demonstrated that the classifiers could effectively predict varying levels of slow-wave sleep (SWS) from pre-sleep EEG segments, achieving a mean balanced accuracy surpassing 0.75. The SMOTE-Tomek resampling method could improve the performance to 0.77. This study suggests that stress-related neurological markers derived from pre-sleep EEG can effectively predict SWS deficiency. Such information can be integrated with existing sleep-improving techniques to provide a personalized sleep forecasting and improvement solution.

Predictors of increased affective symptoms and suicidal ideation during the COVID-19 pandemic: results from a large-scale study of 14 271 Thai adults

BACKGROUND

Increasing data suggest emergent affective symptoms during the COVID-19 pandemic.

OBJECTIVES

To study the impact of the COVID-19 pandemic on affective symptoms and suicidal ideation in Thai adults.

METHODS

The Collaborative Outcomes Study on Health and Functioning during Infection Times uses non-probability sampling (chain referring and voluntary response sampling) and stratified probability sampling to identify risk factors of mental health problems and potential treatment targets to improve mental health outcomes during pandemics.

FINDINGS

Analysing 14 271 adult survey participants across all four waves of the COVID-19 pandemic in Thailand, covering all 77 provinces from 1 June 2020 to 30 April 2022, affective symptoms and suicidality increased during COVID-19 pandemic. Affective symptoms were strongly predicted by pandemic (feelings of isolation, fear of COVID-19, loss of social support, financial loss, lack of protective devices) and non-pandemic (female sex, non-binary individuals, adverse childhood experiences (ACEs), negative life events, student status, multiple mental health and medical conditions, physical pain) risk factors. ACEs, prior mental health conditions and physical pain were the top three risk factors associated with both increased affective symptoms and suicidal ideation during the COVID-19 pandemic. Partial least squares analysis showed that ACEs were the most important risk factor as they impacted most pandemic and non-pandemic risk factors.

CLINICAL IMPLICATIONS

Rational policymaking during a pandemic should aim to identify the groups at highest risk (those with ACEs, psychiatric and medical disease, women, non-binary individuals) and implement both immediate and long-term strategies to mitigate the impact of ACEs, while effectively addressing associated psychiatric and medical conditions.

Sex differences in body temperature and neural power spectra in response to repeated restraint stress

Repeated stress is associated with an increased risk of developing psychiatric illnesses such as post-traumatic stress disorder (PTSD), which is more common in women, yet the neurobiology behind this sex difference is unknown. Habituation to repeated stress is impaired in PTSD, and recent preclinical studies have shown that female rats do not habituate as fully as male rats to repeated stress, which leads to impairments in cognition and sleep. Further research should examine sex differences after repeated stress in other relevant measures, such as body temperature and neural activity. In this study, we analyzed core body temperature and EEG power spectra in adult male and female rats during restraint, as well as during sleep transitions following stress. We found that core body temperature of male rats habituated to repeated restraint more fully than female rats. Additionally, we found that females had a higher average beta band power than males on both days of restraint, indicating higher levels of arousal. Lastly, we observed that females had lower delta band power than males during sleep transitions on Day 1 of restraint, however, females demonstrated higher delta band power than males by Day 5 of restraint. This suggests that it may take females longer to initiate sleep recovery compared with males. These findings indicate that there are differences in the physiological and neural processes of males and females after repeated stress. Understanding the way that the stress response is regulated in both sexes can provide insight into individualized treatment for stress-related disorders.

The COVID-19 Pandemic Impact on the Psychophysical Health of Post-Menopausal Women: A Cross-Sectional Study

Background and Objectives: The aim of this study was to investigate lifestyle, menopausal symptoms, depression, post-traumatic stress disorder (PTSD) and sleep disorders in post-menopausal women throughout the first wave of the COVID-19 pandemic, including the impact of menopause hormonal therapy (HT). Materials and Methods: Post-menopausal women were given the following questionnaires: socio-demographic characteristics; lifestyle; history of COVID-19; menopause-specific quality of life (MENQOL), the first part of which refers to the pre-pandemic period ("pre COVID-19") and the second refers to the current period ("during COVID-19"); Beck's depression inventory (BDI); the impact of event scale-revised (IES-R); and the Pittsburgh sleep quality index (PSQI). Results: One hundred and twenty-six women completed all questionnaires, with a mean age of 55.5 ± 6.0 years. The mean menopause duration was 5.7 ± 5.6 years. Twenty-four women were taking HT. A significant mean weight gain, a reduction in physical activity (respectively p < 0.001) and worsened quality of romantic relationships (p = 0.001) were reported during the pandemic. Menopausal symptoms did not vary significantly throughout the pandemic; however, women taking menopausal HT had lower physical (p = 0.003) and sexual (p = 0.049) MENQOL domain scores, lower depressive symptoms (p = 0.039) and better romantic relationships (p = 0.008). Conclusions: The COVID-19 pandemic caused reduced physical activity, worsened food habits and weight gain in post-menopausal women. They also reported a high rate of severe-moderate PTSD and a negative influence on their romantic relationships. Menopausal HT seems to be a potential protective factor for sexual and physical status and for symptoms of depression.

Resilience as a moderator of role overload and sleep disturbance among caregivers of persons with dementia

The purpose of this study was to examine if resilience moderates the association between role overload and sleep disturbance among caregivers of persons with dementia. This was a secondary analysis of data on 437 informal caregivers (mean age=61.77 years, SD=13.69) of persons with dementia in the United States. Data from the 2017 wave of the National Study of Caregiving were analyzed using multiple regression with interaction terms to evaluate the moderation effect of resilience, while controlling for caregivers' age, race, gender, education, self-rated health, caregiving hours, and primary caregiving status. Higher role overload was associated with greater sleep disturbance and this association was attenuated among caregivers with higher levels of resilience. Our findings highlight the stress-buffering effects of resilience in the context of sleep disturbance in dementia caregivers. Interventions to improve caregivers' ability to recover, resist, and rebound during challenging situations may mitigate role overload and optimize sleep health.

Impacts of COVID-19 Pandemic on Sleep Quality Evaluated by Wrist Actigraphy: A Systematic Review

COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a "serious" risk of bias, two as having "critical" risk, four as having "moderate" risk, and six as having "low" risk. In the selected publications, various populations were evaluated via actigraphy during the COVID-19 pandemic, with reports of "poor" sleep quality. Actigraphy may be a relevant tool to assess individual day-night rhythms and provide recommendations under enduring pandemic conditions. Moreover, as actigraphy presents objective data for sleep evaluations, it is suggested that this method be used in similar pandemics and that actigraphy be included as part of the sleep hygiene strategy.

Face mask use and effects on the ocular surface health: A comprehensive review

In the COVID-19 period, face masks increased exponentially. Several studies suggest that the rise in ocular discomfort symptoms during the pandemic is mostly part of dry eye disease and that these are due to the effect of face masks, resulting in the newly described term MADE, for "mask-associated dry eye". The most commonly proposed mechanism states that wearing a face mask creates an unnatural upward airflow towards the ocular surface during expiration, although the increased temperature, humidity and levels of carbon dioxide of the exhaled air, stress, increased use of video display terminals, as well as changes in the ocular microbiota may contribute. Evidence supports that the use of face masks causes an increase in dry eye disease symptoms, a decreased tear break-up time, corneal epithelial trauma, periocular temperature changes and inflammatory markers secretion. Given that the use of masks may be frequent in some settings in the near future, it is important to establish its effects and consequences on the ocular surface.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

OBJECTIVE

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.

METHODS

Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.

RESULTS

A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality.

CONCLUSIONS

We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

Sleep disruption as a potential contributor to the worsening of eating disorder pathology during the COVID-19-pandemic

The acute phase of the COVID-19 pandemic was associated with significant increases in the prevalence and severity of eating disorders (EDs). Studies also highlighted changes to sleep quality and duration in many individuals throughout this period. Although these two phenomena have been examined separately, here we highlight the need to investigate the potential link between these outcomes. Sleep dysregulation and EDs have previously been hypothesized to interact via a positive feedback loop, wherein poor sleep exacerbates ED symptomatology which, in turn, further worsens sleep. Thus, we speculate that the aggravation of sleep disturbances and EDs during COVID-19 lockdowns may have been somewhat interdependent. We further hypothesize that the worsening of depression and anxiety symptomology during the acute phase of the pandemic may have served as an additional mediating variable. Altogether, in our view, these observations highlight a need for future work to examine the possible causal relationship between sleep and ED pathology, which may ultimately lead to improved clinical management of disordered eating.

Gender Differences in Burnout Among Endocrinologists in China

Objective

To survey the prevalence of burnout in a national sample of endocrinologists in China and to examine its correlates, with a special focus on gender differences.

Methods

An anonymous online survey was conducted among endocrinologists in 31 provincial government-owned “People’s Hospitals” of each province in mainland China. Demographic and work-related factors were collected from participants. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to assess burnout, including emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA).

Results

A total of 711 endocrinologists (72.1% were female and mean age was 39.63 ± 8.51 years old) completed the survey. Burnout was reported by 32.8% of the participants. There were no significant gender differences in the overall prevalence of burnout or EE, DP, and PA (all p > 0.05). A multi-level linear regression revealed: (1) In male participants, PA was significantly associated with age (β = 0.03, p = 0.003), DP was inversely associated with age (β = −0.06, p = 0.005), EE was significantly associated with shorter sleep duration (β = −0.25, p = 0.006), and longer work hours (β = 0.01, p = 0.016). (2) In females, PA was significantly associated with age (β = 0.01, p = 0.038), EE and DP were both significantly associated with shorter sleep duration (β = −0.19, p = 0.001; and β = −0.15, p = 0.011, respectively). EE and DP were also associated with work hours (β = 0.02, p < 0.001; and β = 0.01, p < 0.001, respectively).

Conclusion

Nearly one-third of endocrinologists in China experienced burnout. Although there were no significant gender differences in the prevalence of overall burnout or EE, DP, and PA scores, male and female participants differed in factors associated with EE, DP, and PA. Interventions need to be tailored to target different aspects in male and female endocrinologists and target different subgroups.

Psychological Wellbeing, Worry, and Resilience-Based Coping during COVID-19 in Relation to Sleep Quality

The current study evaluated the impact of psychological wellbeing on sleep quality during the onset of the COVID-19 pandemic. A novel empirical model tested variables that mediate and moderate this impact. First, a relationship was established between psychological wellbeing during the COVID-19 pandemic and sleep quality. Second, resilience-based coping associated with the COVID-19 pandemic was tested as a mediator of the impact of psychological wellbeing on sleep quality. Third, dispositional rumination, mindfulness, and worry were compared as moderators of the impact of psychological wellbeing on sleep quality. Fourth, a moderated mediated model was tested for each moderator. Online survey data was collected from 153 adults in the United States. Results demonstrated that coping with the COVID-19 pandemic partially mediated the impact of psychological wellbeing on sleep quality. Worry, but not rumination or mindfulness, moderated the impact. A moderated mediation model failed to demonstrate significance, indicating that the data are best represented by distinct mediation and moderation models. Thus, interventions aimed at improving sleep quality should prioritize concurrent reduction in worry and increase in resilience-based coping strategies. This study provides practical and theoretical contribution to the literature by demonstrating relationships between key variables and contextualizing how the model can be used for assessments and interventions during widespread crises.