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Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study
Open accessAbstract
Importance and study objective The COVID-19 pandemic has produced unprecedented changes in social, work, and leisure activities, which all have had major impact on sleep and psychological well-being. This study documented the prevalence of clinical cases of insomnia, anxiety, and depression and selected risk factors (COVID-19, confinement, financial burden, social isolation) during the first wave of the pandemic in 13 countries throughout the world.Design and participants International, multi-center, harmonized survey of 22 330 adults (mean age = 41.9 years old, range 18-95; 65.6% women) from the general population in 13 countries and four continents. Participants were invited to complete a standardized web-based survey about sleep and psychological symptoms during the first wave of the COVID-19 pandemic from May to August 2020.Results Clinical insomnia symptoms were reported by 36.7% (95% CI, 36.0-37.4) of respondents and 17.4% (95% CI, 16.9-17.9) met criteria for a probable insomnia disorder. There were 25.6% (95% CI, 25.0-26.2) with probable anxiety and 23.1% (95% CI, 22.5-23.6) with probable depression. Rates of insomnia symptoms (>40%) and insomnia disorder (>25%) were significantly higher in women, younger age groups, and in residents of Brazil, Canada, Norway, Poland, USA, and United Kingdom compared to residents from Asian countries (China and Japan, 8% for disorder and 22%-25% for symptoms) (all Ps < 0.01). Proportions of insomnia cases were significantly higher among participants who completed the survey earlier in the first wave of the pandemic relative to those who completed it later. Risks of insomnia were higher among participants who reported having had COVID-19, who reported greater financial burden, were in confinement for a period of four to five weeks, and living alone or with more than five people in same household. These associations remained significant after controlling for age, sex, and psychological symptoms.Conclusion and relevance Insomnia, anxiety, and depression were very prevalent during the first wave of the COVID-19 pandemic. Public health prevention programs are needed to prevent chronicity and reduce long-term adverse outcomes associated with chronic insomnia and mental health problems.
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Metadata
- Authors
- Morin, C. M., Bjorvatn, B., Chung, F., Holzinger, B., Partinen, M., Penzel, T., Ivers, H., Wing, Y. K., Chan, N. Y., Merikanto, I., Mota-Rolim, S., Macêdo, T., De Gennaro, L., Léger, D., Dauvilliers, Y., Plazzi, G., Nadorff, M. R., Bolstad, C. J., Sieminski, M., Benedict, C., Cedernaes, J., Inoue, Y., Han, F., & Espie, C. A.
- Affiliations
- Université Laval (CA)
- Haukeland University Hospital (NO)
- University Health Network (CA)
- Medical University of Vienna (AT)
- University of Helsinki (FI)
- Charité – Universitätsmedizin Berlin (DE)
- Chinese University of Hong Kong (HK)
- Universidade Federal do Rio Grande do Norte (BR)
- Université Paris Cité (FR)
- Inserm (FR)
- University of Modena and Reggio Emilia (IT)
- Baylor College of Medicine (US)
- Uppsala University (SE)
- Tokyo Medical University (JP)
- University of Oxford (GB)
- Corresponding author
- Morin, Charles M.
- ORCID
- Morin, Charles M.
- Bjorvatn, Bjørn
- Chung, Frances
- Holzinger, Brigitte
- Partinen, Markku
- Penzel, Thomas
- Ivers, Hans
- Wing, Yun Kwok
- Chan, Ngan Yin
- Merikanto, Ilona
- Mota-Rolim, Sergio
- Macêdo, Tainá
- De Gennaro, Luigi
- Léger, Damien
- Dauvilliers, Yves
- Plazzi, Giuseppe
- Nadorff, Michael R.
- Bolstad, Courtney J.
- Sieminski, Mariusz
- Benedict, Christian
- Cedernaes, Jonathan
- Inoue, Yuchi
- Han, Fang
- Espie, Colin A.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 87
- Pages
- 38-45
- ISSN
- 1389-9457 (ISSN-L)
- PMC
- PMC8425785
- OpenAlex
- W3189350764
- Cited by
- 312
- References
- 33
- Citations by year
- 2026: 26 · 2025: 36 · 2024: 66 · 2023: 90 · 2022: 85 · 2021: 9
- FWCI
- 42.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
- HAL (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- Novo Nordisk Fonden (NNF19OC0056777)
- Japan Society for the Promotion of Science (18K07581)
- 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 › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- insomnia, anxiety, depression, COVID-19 pandemic, sleep, psychological well-being, quarantine, lockdown, financial burden, social isolation, living alone, household size, sex differences, prevalence, risk factors, mental health prevention, cross-national comparison, chronic insomnia, COVID-19 risk
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Young Adult, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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