COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak
Open accessAbstract
BACKGROUND: The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. METHODS: A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. RESULTS: The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (β = 0.015, 95%C.I. = 0.009-0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (β = 0.009, 95%C.I. = - 0.002-0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (β = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. CONCLUSIONS: These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.
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Greater stress suggests greater intolerance to unpredictability, risk, anxiety, and fear.
“Greater stress, therefore, suggests greater intolerance to unpredictability, risk, anxiety, and fear [64].”
From Impact of Stress during COVID-19 Pandemic in Italy: A Study on Dispositional and Behavioral Dimensions for Supporting Evidence-Based Targeted Strategies (2024) · cites this paper as [64]
The Discussion reports a positive correlation between perceived stress and intolerance of uncertainty, supporting the link between greater stress and difficulty tolerating unpredictability. It also discusses anxiety and fear in relation to uncertainty, but does not establish that greater stress indicates greater intolerance of risk, anxiety, and fear as separate outcomes. The indexed passages provide section labels but no page numbers. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOnly limited studies have investigated the role of intolerance of uncertainty in sleep disturbances.
“Only limited studies have investigated the role of intolerance of uncertainty in sleep disturbances [15, 38, 67, 68].”
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- Authors
- Wu, D., Yang, T., Hall, D. L., Jiao, G., Huang, L., & Jiao, C.
- Affiliations
- Shenzhen University (CN)
- Women's Hospital, School of Medicine, Zhejiang University (CN)
- Harvard University (US)
- Guangdong Medical College (CN)
- Corresponding author
- Jiao, Can
- Venue
- BMC Psychiatry
- Published
- 2021-06-14
- Volume
- 21
- Issue
- 1
- Pages
- 306-306
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC8200549
- OpenAlex
- W3129244595
- Cited by
- 57
- References
- 51
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 18 · 2023: 14 · 2022: 13 · 2021: 2
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Natural Science Foundation of Guangdong Province (2018A030307002)
- National Center for Complementary and Integrative Health (K23AT010157)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Communication › Communication and COVID-19 Impact
- Keywords
- COVID-19 pandemic, intolerance of uncertainty, perceived stress, sleep status, poor sleep quality, mediation, Chinese residents, lockdown, quarantine, sleep onset delay, sleep duration
- MeSH terms
- COVID-19, SARS-CoV-2, China, Communicable Disease Control, Cross-Sectional Studies, Disease Outbreaks, Humans, Sleep, Stress, Psychological, Uncertainty, Pandemics
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