Short sleep, insomnia throughout a pandemic related to elevated psychological stress

Healthcare workers (HCWs) have been under tremendous stress during the COVID-19 pandemic, often working long and stressful shifts and reporting anxiety and depressive symptoms. A recent study found that insomnia and sleep were associated with psychological distress among health workers in New York City and that sleep could be a potential target for interventions to reduce their psychological distress.

These findings were recently published in the Journal of Affective Disorders.

Studies conducted during the COVID-19 pandemic have shown that medical workers are particularly vulnerable to pandemic-related mental stress, investigators said. Previous research has also shown that acute stress associated with the severe onset of acute respiratory syndrome in 2003 put healthcare workers at an increased long-term risk of burnout, depression and post-traumatic stress disorder.

Given that sleep duration and poor quality sleep have been associated with mental health symptoms and disorders, the present researchers sought to identify associations between insomnia and sleep duration among healthcare workers in New York City, when it was the epicenter of the COVID-19 pandemic in the spring was 2020.

Their study used data from the COVID-19 Healthcare Provider Study, a cross-sectional survey of physicians, residents or grantees, advanced practice providers (nurses or physician assistants), and registered nurses at a large medical center in New York City. The survey included questions about the providers and their roles, COVID-19-related stressors, and available wellness resources. Also included were questions about sleep duration, insomnia symptoms, and mental health symptoms.

A total of 813 participants were eligible for the final analysis, which assessed the prevalence of reported acute stress, depressive, and anxiety symptoms and their associations with insomnia and short sleep duration. 56% of the participants were nurses and the overall was 80.6% female and 59.0% white. More than a third of study participants were diverted from their typical duties to work in COVID-19-related environments.

On average, HCWs worked 4.1 shifts per week and 38.8% reported sleeping less than 6 hours per night. The average sleep duration was 5.8 hours and 72.8% of the participants reported symptoms of insomnia. In the total , 57.9% experienced an increase in acute stress, 33.8% an increase in depressive symptoms, and 48.2% an increase in anxiety symptoms.

Participants with insomnia symptoms were significantly more likely to have depressive symptoms (41.9% vs. 12.2%), anxiety symptoms (57.8% vs. 22.6%), and acute stress symptoms (67.4% vs. 32.6%) than Participants without insomnia symptoms.

Those who slept less than 6 hours per night also had more depressive symptoms (46.4% vs. 25.9%), anxiety symptoms (61.6% vs. 39.8%) and acute stress symptoms (67.3% vs. 52.0%) than those who slept more than 6 hours per night.

This a-data suggests that sleep is an important aspect of mental health for medical workers in the pandemic.

“While we have previously reported on the prevalence of sleep disorders and mental distress, the current study is novel and different from our previous study in that it provides one of the first investigations into the extent of the association of insomnia symptoms, and separately short sleep duration, with mental health.” of US HCWs during the COVID-19 pandemic,” the authors wrote.

Although the study included a large sample of HCWs and contributes to a growing body of knowledge about the association between sleep disorders and psychological distress, one of its limitations is its cross-sectional nature, which limits the ability to make causal claims. The prevalence of sleep disorders and associated mental health symptoms in the pre-pandemic study cohort is also unknown, although data from other studies show that pre-pandemic sleep disorder rates were significantly lower, the authors said.

“Future research should examine the longitudinal associations between sleep quality and mental distress during the COVID-19 pandemic,” they conclude, “to develop interventions that help curb the burden of mental distress among health workers.”


Diaz F, Cornelius T, Bramley S, et al. The link between sleep and psychological distress among healthcare workers in New York City during the COVID-19 pandemic. J Affect Disord. 2022;298(Pt.A):618-624. doi:10.1016/j.jad.2021.10.033

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