Cited by 316Sleep and related disordersCOVID-19 and Mental HealthObstructive Sleep Apnea Research

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Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic

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Zhou, Shuang-Jiang, Wang, Lei-Lei, Yang, Rui, Yang, Xing-Jie, Zhang, Li-Gang, Guo, Zhao-Chang, Chen, Jin-Cheng, Wang, Jing-Qi, Chen, Jing-Xu·2020·Sleep Medicine

DOI 10.1016/j.sleep.2020.06.001PMC PMC7274988

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Abstract

Objective To assess the prevalence and sociodemographic correlates of insomnia symptoms among Chinese adolescents and young adults affected by the outbreak of coronavirus disease-2019 (COVID-19).Methods This cross-sectional study included Chinese adolescents and young adults 12-29 years of age during part of the COVID-19 epidemic period. An online survey was used to collect demographic data, and to assess recognition of COVID-19, insomnia, depression, and anxiety symptoms using the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) questionnaires, respectively. The Social Support Rate Scale was used to assess social support.Results Among 11,835 adolescents and young adults included in the study, the prevalence of insomnia symptoms during part of the COVID-19 epidemic period was 23.2%. Binomial logistic regression analysis revealed that female sex and residing in the city were greater risk factors for insomnia symptoms. Depression or anxiety were risk factors for insomnia symptoms; however, social support, both subjective and objective, was protective factors against insomnia symptoms. Furthermore, anxiety and depression symptoms were mediators of social support and insomnia symptoms.Conclusions Results of this study revealed a high prevalence of sleep problems among adolescents and young adults during the COVID-19 epidemic, especially senior high school and college students, which were negatively associated with students' projections of trends in COVID-19. The adverse impact of COVID-19 was a risk factor for insomnia symptoms; as such, the government must devote more attention to sleep disorders in this patient population while combating COVID-19.

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Windarwati, H. D., Lestari, R., Supianto, A. A., Wicaksono, S. A., Ati, N. A. L., Kusumawati, M. W., Humayya, A., & Ekawati, D. (2022) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12370 · Cited by 40
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Babicki, M., Piotrowski, P., & Mastalerz–Migas, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12020692 · Cited by 44
“to global reports, every year, there are more and more individuals suffering from sleep disorders, especially young people [5,6].”
Background
Psychiatric morbidity and dietary habits during COVID-19 pandemic: a cross-sectional study among Egyptian Youth (14–24 years)
Alamrawy, R. G., Fadl, N., & Khaled, A. M. S. (2021) · Middle East Current Psychiatry · doi:10.1186/s43045-021-00085-w · Cited by 36
“Previous studies shown that symptoms of anxiety and depression are risk factors for insomnia and are associated and cyclically related [27, 33].”
BackgroundResult
Impact of COVID‐19 pandemic on sleep of undergraduate students: A systematic literature review
Valenzuela, R. L. G., Velasco, R. I. B., & Jorge, M. P. P. C. (2022) · Stress and Health · doi:10.1002/smi.3171 · Cited by 35
Bilateral associations between sleep duration and depressive symptoms among Chinese adolescents before and during the COVID-19 pandemic
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Pre-pandemic sleep behavior and adolescents’ stress during Covid-19: a prospective longitudinal study
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The Impacts of COVID-19 on Collegiate Student-Athlete Training, Health, and Well-Being
Chandler, A. J., Arent, M. A., Cintineo, H. P., Torres-McGehee, T. M., Winkelmann, Z. K., & Arent, S. M. (2021) · Translational Journal of the American College of Sports Medicine · doi:10.1249/tjx.0000000000000173 · Cited by 32
Physical activity, sleep quality and life satisfaction in adolescents: A cross-sectional survey study
Cao, Y., Yang, Z., Yu, Y., & Huang, X. M. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1010194 · Cited by 39
The Association Between Bedtime Procrastination, Sleep Quality, and Problematic Smartphone Use in Adolescents: A Mediation Analysis
Bozkurt, A., Demirdöğen, E. Y., & Akıncı, M. A. (2024) · Eurasian Journal of Medicine · doi:10.5152/eurasianjmed.2024.23379 · Cited by 54
Daily and average associations of physical activity, social media use, and sleep among adolescent girls during the COVID ‐19 pandemic
Hamilton, J. L., Hutchinson, E., Evankovich, M. R., Ladouceur, C. D., & Silk, J. S. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13611 · Cited by 41
Association between quality of sleep and screen time during the COVID‐19 outbreak among adolescents in the United Arab Emirates
Bani‐Issa, W., Radwan, H., Saqan, R., Hijazi, H., Fakhry, R., Alameddine, M., Naja, F., Ibrahim, A., Lin, N., Naing, Y. T., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13666 · Cited by 30
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Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents
Zhou, S., Wang, L., Wang, T., Wang, J., & Chen, J. (2022) · SLEEP · doi:10.1093/sleep/zsac048 · Cited by 28
Self-citation
Sleep quality among undergraduate students of a medical college in Nepal during COVID-19 pandemic: an online survey
Shrestha, D. B., Adhikari, S. P., Rawal, N. M., Budhathoki, P., Pokharel, S., Adhikari, Y., Rokaya, P., & Raut, U. (2021) · F1000Research · doi:10.12688/f1000research.53904.2 · Cited by 30
“In contrast, a previous study in China found that senior high school students had greater sleep problems due to increased academic burden and difficulty compared to junior school students.(27) Though our study shows less number of poor quality sleepers as compared to other studies discussed,(19,24,25) 30.”
Association of Major Disease Outbreaks With Adolescent and Youth Mental Health in Low- and Middle-Income Countries: A Systematic Scoping Review
Kumar, M., Akbarialiabad, H., Kouhanjani, M. F., Kiburi, S., Shidhaye, P., Taghrir, M. H., & Shidhaye, R. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.3109 · Cited by 31
Assessment of Depression, Anxiety, and Sleep Disturbance in COVID-19 Patients at Tertiary Care Center of North India
Yadav, R., Yadav, P., Kumar, S., & Kumar, R. (2021) · Journal of Neurosciences in Rural Practice · doi:10.1055/s-0040-1722811 · Cited by 31
Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic
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Does sleep disturbance predicts posttraumatic stress disorder and depression among college students during COVID-19 lockdown? A longitudinal survey
Wang, D., Zhao, J., Zhai, S., Ye, H., Bu, L., & Fan, F. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.986934 · Cited by 29
Effects of sleep pattern, duration, and quality on premenstrual syndrome and primary dysmenorrhea in korean high school girls
Jeong, D., Lee, H., & Kim, J. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02600-z · Cited by 39
“Similar results were also found in previous studies [51, 52]: Zhou et al. [51] reported that 50.1% of the senior high school students had insufficient sleep ( < 7 h) during the COVID-19 pandemic.”
ResultInfluential
The Impact of the COVID-19 Pandemic on Chinese Postgraduate Students’ Mental Health
Liang, Z., Kang, D., Zhang, M., Xia, Y., & Zeng, Q. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111542 · Cited by 38
“For lifestyle, including the reduction in physical activity, more sedentariness [10,11]; a decrease in sleep time [12,13]; changes in dietary behaviors [7]; negative emotions caused by the threat of COVID-19; as well as discomfort caused by lockdown measures, such as fear, frustration, stress, social isolation, anxiet…”
The study of psychological traits among Chinese college students during the COVID-19 campus lockdown
Xu, H., Wang, Z., Peng, L., Mi, Y., Zeng, P., & Liu, X. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1051770 · Cited by 28
The Influencing Factors of Sleep Quality Among Chinese Junior and Senior High School Adolescents During the COVID-19 Pandemic
Zhai, X., Zeng, J., Eshak, E. S., Zhang, Y., Yang, M., Di, L., Xiang, B., & Cao, J. (2021) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmab069 · Cited by 27
Internet addiction and mental health disorders in high school students in a Peruvian region: a cross-sectional study
Perez-Oyola, J. C., Walter-Chavez, D. M., Zila-Velasque, J. P., Pereira-Victorio, C. J., Failoc‐Rojas, V. E., Vera-Ponce, V. J., Valladares-Garrido, D., & Valladares-Garrido, M. J. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04838-1 · Cited by 42
“in their study that included Chinese adolescents and young adults aged 12 to 29 during part of the COVID-19 pandemic, finding in binary logistic regression analysis that depression is significantly associated as a risk factor for insomnia [93].”
Background
Resilience and Prosocial Behavior Among Chinese University Students During COVID-19 Mitigation: Testing Mediation and Moderation Models of Social Support
Xue, S., Kaufman, M., Zhang, X., Xia, S., Niu, C., Zhou, R., & Xu, W. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s364356 · Cited by 31
“A high prevalence of mental, psychiatric, and behavioral health problems, such as PTSD, depressive symptoms, and sleep disturbances has been reported among this community.(4,12) Although the COVID-19 outbreak has been effectively controlled in mainland China, recent outbreaks in South and Southeast Asia, such as India…”
Background
Sleep during COVID‐19‐related school lockdown, a longitudinal study among high school students
Saxvig, I., Pallesen, S., Sivertsen, B., Hysing, M., Evanger, L. N., & Bjorvatn, B. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13499 · Cited by 19
“In line with such notions, studies have indicated an increase in sleep and mental health problems among adolescents during the pandemic (Bhatia, 2020; Magson et al., 2021; Nearchou et al., 2020; Zhou et al., 2020).”
Result
An Explainable Machine Learning Approach for COVID-19’s Impact on Mood States of Children and Adolescents during the First Lockdown in Greece
Ntakolia, C., Priftis, D., Charakopoulou-Travlou, M., Rannou, I., Magklara, K., Giannopoulou, I., Kotsis, K. T., Serdari, A., Tsalamanios, E., Grigoriadou, A., et al. (2022) · Healthcare · doi:10.3390/healthcare10010149 · Cited by 24
“[21] China 11,835 Chinese adolescents and young adults (12–29 years) To identify sleeping problems during COVID-19 Binomial logistic regression analysis”
BackgroundMethodInfluential
Changes in health behaviors and conditions during COVID-19 pandemic strict campus lockdown among Chinese university students
Zhang, B., Lei, S., Le, S., Gong, Q., Cheng, S., & Wang, X. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1022966 · Cited by 26
Psychotic-like experiences during COVID-19 lockdown among adolescents: Prevalence, risk and protective factors
Wang, D., Zhou, L., Chen, C., & Sun, M. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.01.027 · Cited by 25
Investigating sleep quality and sleep hygiene awareness among Chinese adults: an association and network analysis study
Qi, H., Liu, R., Zhou, J. L., Feng, Y., Feng, L., Feng, Z., & Fang, Y. (2023) · Sleep And Breathing · doi:10.1007/s11325-023-02798-0 · Cited by 27
Beyond Screen Time: The Different Longitudinal Relations between Adolescents’ Smartphone Use Content and Their Mental Health
Huang, S., Lai, X., Li, Y., Cui, Y., & Wang, Y. (2023) · Children · doi:10.3390/children10050770 · Cited by 25
“The reliability and validity of CES-D-10, GAD-7, and SSS-8 were confirmed among Chinese adolescents and were widely used by Chinese researchers [30,31].”
Background
A National Survey of U.S. Adolescent Sleep Duration, Timing, and Social Jetlag During the COVID-19 Pandemic
Wesley, K. L., Cooper, E. H., Brinton, J. T., Meier, M. R., Honaker, S. M., & Simon, S. L. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2086871 · Cited by 26
“…for poor sleep (elevated insomnia symptoms, delayed sleep/wake schedule) included depression and anxiety symptoms, including COVID-19 specific sadness, fears, and worries (Becker et al., 2021; Bruni et al., 2021; Lim et al., 2021; López-Bueno et al., 2020; Lu et al., 2020; Zhou et al., 2020).”
BackgroundResultInfluential
The prevalence and association of traditional bullying and cyber bullying with mental health among adolescent and youth students in China: a study after the lifting of COVID-19 restrictions
Wang, Y., Cai, J. C., Wang, C., Mu, Y.-F., Deng, Z.-Y., Deng, A.-P., Song, H.-J., Huang, Y., Yin, L., Zhang, W., et al. (2025) · BMC Public Health · doi:10.1186/s12889-024-20940-9 · Cited by 23
“Furthermore, the results of this study identified that males had significantly lower prevalence of insomnia, anxiety, depression, and PTSD than females, which is consistent with previous study [49].”
Anti-COVID-19 measures threaten our healthy body weight: Changes in sleep and external synchronizers of circadian clocks during confinement
Baquerizo-Sedano, L., Chaquila, J. A., Aguilar, L. A., Ordovás, J. M., González‐Muniesa, P., & Garaulet, M. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.06.019 · Cited by 23
Narrative review: COVID-19 and pediatric anxiety
Walsh, K., Furey, W. J., & Malhi, N. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.10.013 · Cited by 24
“Anxiety during the pandemic is having a negative effect on sleep.(19,20) A study found that 41.”
Background
Sleep quality among undergraduate students of a medical college in Nepal during COVID-19 pandemic: an online survey
Shrestha, D. B., Adhikari, S. P., Rawal, N. M., Budhathoki, P., Pokharel, S., Adhikari, Y., Rokaya, P., & Raut, U. (2021) · F1000Research · doi:10.12688/f1000research.53904.1 · Cited by 34
A network analysis of the long-term quality of life and mental distress of COVID-19 survivors 1 year after hospital discharge
Peng, P., Wang, Y., Li, Z., Zhou, Y., Wang, J., Qu, M., & Liu, T. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1223429 · Cited by 21
Self-citation
The mutual overlapping impact of stress and infection on mental health problems in adolescents and youths during and after COVID-19 pandemic in China
Ran, M., Wang, C., Cai, J., Deng, Z.-Y., Mu, Y.-F., Huang, Y., Zhang, W., Song, H.-J., Deng, A.-P., Qiu, C., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.12.009 · Cited by 23
Self-citation
Is decreasing problematic mobile phone use a pathway for alleviating adolescent depression and sleep disorders? A randomized controlled trial testing the effectiveness of an eight-session mindfulness-based intervention
Liu, Q., Yang, X., Zhang, C., & Xiong, J. (2024) · Journal of Behavioral Addictions · doi:10.1556/2006.2024.00034 · Cited by 28
“The reliability and validity of this scale have been extensively validated through numerous studies in the population of Chinese adolescents (e.g., Ren et al., 2021; Zhou et al., 2020).”
BackgroundSelf-citation
An analysis of business students’ stressors and their coping strategies in the post-pandemic era
Akram, H., Bhutto, M. H., & Chughtai, M. S. (2022) · DECISION · doi:10.1007/s40622-022-00319-8 · Cited by 21
“Furthermore, Zhou et al. (2020) also found sleep problems among adolescents, especially in college students during the COVID-19 pandemic, which further investigated that sleep problems mediate the impact of the pandemic on mental health.”
Background
Smartphone Usage and Sleep Quality in Korean Middle School Students During the COVID-19 Pandemic
Chi, S., Ko, M., Lee, J., Yi, H.-S., & Lee, M. (2022) · Psychiatry Investigation · doi:10.30773/pi.2022.0032 · Cited by 20
Anxiety and depression played a central role in the COVID-19 mental distress: A network analysis
Fico, G., Oliva, V., Prisco, M. D., Fortea, L., Fortea, A., Giménez‐Palomo, A., Anmella, G., Hidalgo‐Mazzei, D., Vázquez, M., Gómez-Ramiro, M., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.034 · Cited by 19
“19 might worsen previous psychiatric symptoms or conditions, and treatment for COVID-19 may have adverse effects on mental health and contribute to problems such as anxiety and insomnia (Zhou et al., 2020).”
Mediation effect of perceived social support and psychological distress between psychological resilience and sleep quality among Chinese medical staff
Wu, N., Ding, F., Ai, B., Zhang, R., & Cai, Y. (2024) · Scientific Reports · doi:10.1038/s41598-024-70754-3 · Cited by 21
“…have indicated that higher levels of social support are beneficial in reducing symptoms of anxiety and depression, thus leading to better sleep quality and fewer sleep problems in various population groups, including adolescents and young adults 43 , stroke patients 35 , and medical staff 29 .”
Background
Family stress during the pandemic worsens the effect of adverse parenting on adolescent sleep quality
Zhang, L., Cui, Z., Sasser, J., Carvalho, C., & Oshri, A. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105390 · Cited by 19
Self-citation
Impacts of COVID-19 crisis and some related factors on the mental health of 37150 Vietnamese students: a cross-sectional online study
Duong, C. B., Tran, V. N., Nguyen, H. A., Le, T. N., Ha, B. H., Phuc, C. N., Huynh, K., Le, T. M., Nguyen, T. P., & Nguyen, T. T. H. (2023) · BMC Public Health · doi:10.1186/s12889-023-15317-3 · Cited by 18
Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine
Helito, A. C., Lindoso, L., Sieczkowska, S. M., Astley, C., Queiroz, L. B., Rose, N., Santos, C. R. P., Bolzan, T. S., Peralta, R. M. I. A., Franco, R. R., et al. (2021) · Clinics · doi:10.6061/clinics/2021/e3501 · Cited by 18
“…juvenile systemic lupus erythematosus, and juvenile dermatomyositis), kidney conditions (glomer-ulopathies, chronic kidney disease stages 4 and 5, and kidney transplant), and gastrointestinal and liver conditions (eosinophilic esophagitis, inflammatory bowel disease, celiac disease,…”
Influential
A Feasibility Study of a Remotely-Delivered Mindfulness-Based Training for Adolescents During the COVID-19 Pandemic
Tymofiyeva, O., Hu, M. Y., Sipes, B. S., Jakary, A., Glidden, D. V., Jariwala, N., Bhandari, S., Parks, K. C., Nguyen, C., Henje, E., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.838694 · Cited by 15

Authors: Zhou, S.-J., Wang, L.-L., Yang, R., Yang, X.-J., Zhang, L.-G., Guo, Z.-C., Chen, J.-C., Wang, J.-Q., & Chen, J.-X.
Affiliations: Peking University (CN)
Capital Medical University (CN)
Corresponding author: Chen, Jing-Xu
ORCID: Zhou, Shuang-Jiang
Yang, Rui
Chen, Jing-Xu
Venue: Sleep Medicine
Publisher: Elsevier BV
Published: 2020-10
Volume: 74
Pages: 39-47
ISSN: 1389-9457 (ISSN-L)
DOI: 10.1016/j.sleep.2020.06.001
PMC: PMC7274988
OpenAlex: W3033214140
Cited by: 316
References: 61
Citations by year: 2026: 7 · 2025: 31 · 2024: 36 · 2023: 61 · 2022: 97 · 2021: 71 · 2020: 13
FWCI: 58.49
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Sleep Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Beijing Municipal Administration of Hospitals
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: insomnia, sleep disorders, COVID-19 pandemic, adolescents, young adults, depression, anxiety, social support, sex differences, urban residence, sleep quality
MeSH terms: Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Child, China, Cross-Sectional Studies, Depression, Female, Humans, Male, Pneumonia, Viral, Surveys and Questionnaires, Sleep Wake Disorders, Social Support, Coronavirus Infections, Young Adult, Pandemics

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Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic

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