Longitudinal associations between stress and sleep disturbances during COVID-19
Open accessAbstract
The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8-10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (β = 0.203; p < 0.001), even after controlling for baseline sleep disturbances. Results remained significant even after controlling for the effects of covariates including age, sex, depression and anxiety symptoms, and referring to psychological services (β = 0.179; p < 0.05). Findings confirm the high prevalence of stress symptoms during the COVID-19 pandemic and provide first longitudinal evidence for the effects of perceived stress on sleep disturbances during the pandemic.
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The study demonstrated a higher insomnia persistence rate compared to other pandemic studies, which have ranged from 2% to 37%.
“However, we demonstrated a higher insomnia persistence rate compared to other pandemic studies, which have ranged from 2% to 37% [16, 19, 21–23].”
From Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms (2024) · cites this paper as [21]
The Introduction reports pandemic-era prevalence of sleep disturbances, not insomnia persistence, and the Discussion compares sleep-disturbance prevalence with other reports. Searches for insomnia persistence and the 2%–37% range found no passage supporting that range. The citing authors’ statement about their own higher rate is not a finding attributed to Ballesio. (LLM, conf=0.76)
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- Authors
- Ballesio, A., Zagaria, A., Musetti, A., Lenzo, V., Palagini, L., Quattropani, M. C., Vegni, E., Bonazza, F., Filosa, M., Manari, T., Freda, M. F., Saita, E., Castelnuovo, G., Plazzi, G., Lombardo, C., & Franceschini, C.
- Affiliations
- Sapienza University of Rome (IT)
- University of Parma (IT)
- Università per Stranieri Dante Alighieri (IT)
- University of Pisa (IT)
- University of Catania (IT)
- University of Milan (IT)
- University of Naples Federico II (IT)
- Università Cattolica del Sacro Cuore (IT)
- University of Modena and Reggio Emilia (IT)
- Corresponding author
- Ballesio, Andrea
- ORCID
- Venue
- Stress and Health
- Publisher
- Wiley
- Published
- 2022-03-28
- Volume
- 38
- Issue
- 5
- Pages
- 919-926
- ISSN
- 1532-2998 (ISSN-L)
- 1532-3005
- PMC
- PMC9111163
- OpenAlex
- W4220773840
- Cited by
- 32
- References
- 50
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 10 · 2023: 5 · 2022: 4
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Stress and Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion, other-oa)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, perceived stress, sleep disorders, hypothalamic-pituitary-adrenal axis, anxiety and depressive symptoms, longitudinal associations
- MeSH terms
- COVID-19, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Sleep, Pandemics
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