Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: characterization and associated factors

Contacts with health services for COVID-19-related reasons during the first wave of the pandemic in Portugal: a longitudinal study

Introduction

Access to COVID-19-related care during the pandemic deserve attention and study to inform future strategies to deal with similar health emergencies in the future. We aimed to describe access to care for COVID-19-related reasons during the first 9 weeks of the pandemic in Portugal, to quantify the frequency of remote and in-person contacts with healthcare for COVID-19-related reasons and to assess the association between individual and context characteristics and contacts with health services.

Methods

We conducted an internet-based open cohort study with a non-probabilistic sample of 12 006 persons aged 16 years or more. One questionnaire was sent daily from 23 March 2020 for 9 weeks.

Results

General practitioners (GPs) were the main points of contact of patients with health services for COVID-19-related reasons. In our population, the main drivers found for any difference in the probability of contact with health services for COVID-19-related reasons were perceived high-risk contacts, followed by the existence of COVID-19 main symptoms. There were 17% more (0.17, 95% CI 0.15 to 0.18) contacts with health services among participants who reported personal contact with a confirmed case, 7% more (0.07, 95%CI 0.06 to 0.07) contacts if the contact had been with a suspected case and 6% more (0.06, 95%CI 0.05 to 0.07) contacts among participants who reported COVID-19 main symptoms in the previous 24 hours. Sociodemographic and household factors were not associated with major differences in healthcare contacts. The probability of contact with any health service for COVID-19-related reasons was highest at the beginning of the pandemic.

Conclusion

Most contacts with health services for COVID-19-related reasons during the first wave of the pandemic were with GPs, highlighting the role of first-contact care with these clinicians in Portuguese Primary Care, particularly in the context of the COVID-19 pandemic. Sociodemographic and household factors were not associated with major risk differences, suggesting that universal coverage and equity worked in our study sample at this pandemic stage.

Intensity and Network Structure of Insomnia Symptoms and the Role of Mental Health During the First Two Waves of the COVID-19 Pandemic

Purpose

Insomnia, being a mental disorder, is best conceived as a network of symptoms. With the important increase in insomnia prevalence during the COVID-19 pandemic, our aim was to investigate how the structure of insomnia symptoms in the general population has changed due to the pandemic. We also looked at the directional dependencies of nightmares and of covid- and lockdown-related stress/anxiety and depression in insomnia.

Patients and Methods

5986 persons replied to our online questionnaire for the first wave and 2843 persons to our second wave questionnaire. Both questionnaires included the Insomnia Severity Index (ISI). Regularized Gaussian Graphical Models (GGM) and Bayesian Directed Acyclic Graphs (DAG) were estimated.

Results

The pre- and peri-lockdown networks were equally strongly connected (first wave: S = 0.13, p = 0.39; second wave: S = 0.03, p = 0.67), but differed for the first lockdown regarding only six edges (M = 0.13, p < 0.001) and for the second lockdown only five edges (M = 0.16, p < 0.001). These symptoms all worsened during the lockdowns in comparison to before the pandemic (p < 0.001). The diurnal items of the ISI had the highest predictability and centrality values in the GGMs. Lockdown-related stress/anxiety influenced indirectly nightmares through covid-related stress/anxiety, lockdown-related depressive affect and mental fatigue. These reported feelings of stress/anxiety and depression showed an indirect impact on insomnia symptoms through mental and physical fatigue.

Conclusion

Though the lockdown slightly intensified insomnia symptoms, it did not alter their network structure. Despite their differences, both GGMs and DAGs agree that the diurnal symptoms of the ISI, play an essential role in the network structure. Both methods confirm the need for emphasizing the cognitive/affective component in the treatment of insomnia (ie cognitive behavioral therapy).

A path model of associations between war-related exposure to trauma, nightmares, fear, insomnia, and posttraumatic stress among Ukrainian students during the Russian invasion

The present study examined the associations between war-related exposure, nightmares, fear, insomnia, and PTSD symptoms among university students from Western Ukraine. An online cross-sectional study was performed among 1,072 university students (80% of whom were women) during the war. Eight questions were developed to assess exposure to war, and seven items were designed regarding nightmares of war. War-related PTSD symptoms were assessed using an abbreviated six-item PTSD checklist (PCL-6), insomnia was measured using the Athens Insomnia Scale (AIS), and to examine fear of war, the Fear of COVID-19 Scale (FoCV-19S) was adopted. Positive correlations were found between exposure to war, nightmares of war, fear of war, insomnia, and war-related PTSD. The path model using structural equation modelling (SEM) analysis showed that the chain mediation partially explains the relationship between war exposure and war-related PTSD symptoms via nightmares of war, fear of war, and insomnia among university students during the Russian invasion of Ukraine. Women scored significantly higher than men in fear of war and symptoms of insomnia and PTSD, but the path model was invariant across genders. Young adults require treatment focused primarily on nightmares, insomnia, and fear of war to prevent PTSD symptoms.

An observatory on changes in dreaming during a pandemic: a living systematic review (part 1)

A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus disease 2019 (COVID-19), many studies have investigated dream-related phenomena and dreaming functions. Considering the constant and rapid emergence of new results on this topic, the main aim of this study was to create an 'observatory' on the short- and long-term consequences of the COVID-19 pandemic on dreaming, by means of a living systematic review. The baseline results are presented, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, to identify and discuss existing studies about dreams and dreaming during the COVID-19 pandemic published until February 2022. Web of Science, Embase, EBSCO, and PubMed were used for the search strategy, yielding 71 eligible papers included in the review. Our results show: (a) a more intense oneiric activity during lockdown; (b) changes in dreaming components (especially dream-recall and nightmare frequency); (c) a particular dreaming scenario ('pandemic dreams'); (d) an alteration of the dreaming-waking-life continuum and a specific function of dreaming as emotional regulator. Findings suggest that monitoring changes in dreaming provides important information about psychological health and could also contribute to the debate on the difficulties of dreaming, as well as sleeping, in particular during and after a period of 'collective trauma'.

Shades of Fear-Mental and Physical Health Reactions to the COVID-19 Pandemic: A Representative Study of Polish Society

The study was carried out one year after the establishment of the pandemic state in the European Union (EU), the situation at the end of the next wave of the COVID-19 pandemic in Poland. The survey was conducted on a representative sample of Polish people using Computer Assisted Web Interviewing (CAWI), considering several demographic categories, such as sex, age, place of residence, education, and monthly income. The survey's main objective was to find out whether the respondents feel fear related to pandemics and living in a pandemic, and if so, what the psychological and physiological symptoms of this fear are. Half of the respondents (50.2%) declared that they felt fear about what their life would look like after the pandemic, and every tenth person (10.1%) marked the highest level of fear on the scale. The respondents felt the psychological symptoms of the pandemic much more often than they felt the physical ones. The most common psychological symptoms were fear of the future (38.5% of them gave "often" and "very often" responses, together), despondency (29.2% of them gave "often" and "very often" responses), and mental tension (28.9% of them gave "often" and "very often" responses). A detailed analysis of data from representative studies showed that the responses in a pandemic are strongly determined by demographic categories, mainly sex and age, and they differ depending on the social group to which a person belongs.

Dreaming during the COVID-19 pandemic: A narrative review

According to several influential models, dreams can be affected by state- and trait-like factors, sleep features, and diurnal experiences. The COVID-19 pandemic globally affected daily habits, emotional experiences, and sleep. Previous studies suggested an influence of collective traumatic events on dreaming. Starting from these premises, several studies assessed the effect of the pandemic on dreams. This paper aims to review findings concerning the oneiric activity during the COVID-19 pandemic. We report pandemic-related changes in dreams and nightmares, and we consider the possible factors associated with dreaming. Moreover, we provide results about changes in the oneiric activity in different phases of the pandemic. The reviewed findings suggest a pandemic-related enhancement of dream and nightmare frequency, emotional intensity, and distressing contents, modulated by modifications in restrictive measures and associated with diurnal experiences, emotional status, and sleep pattern. We highlight several methodological issues and a large heterogeneity in the present literature, limiting results' generalizability. However, we provide possible interpretations of the most consistent findings in light of the main theoretical frameworks about dreaming.