Deterioration of sleep and mental health in individuals with insomnia during South Africa’s COVID-19 lockdown

Abstract

Sleep and mental health difficulties have been observed in response to COVID-19 pandemic-induced lockdowns, but few studies have described the impact of lockdown on individuals with self-reported insomnia. The purpose of this study was to compare the impact of lockdown on changes in symptoms of insomnia, depression and anxiety between persons with and without self-identified insomnia. In total, 1048 adult participants from the general South African population took part in this retrospective observational study during Alert Levels 4 and 3 in May and June 2020. They completed an online survey assessing current and past self-reported sleep disorders. Symptom profiles of insomnia (Insomnia Severity Index), depression (Patient Health Questionnaire-2) and anxiety (Generalised Anxiety Disorder 7-item scale) were assessed immediately before and during a 5-week lockdown (March–April 2020). Comparative analyses were conducted between participants who identified a current or previous diagnosis of insomnia (n = 135, Insomnia group, irrespective of whether they had current symptoms or not) and those reporting no sleep disorders (n = 700, No-Insomnia group). Participants who reported multiple sleep disorders were excluded from the analyses (n = 213). Symptoms of insomnia (p < 0.001), depression (p = 0.001) and anxiety (p = 0.001) worsened in all participants during lockdown compared to pre-lockdown measures. Time-by-group interaction effects were observed for all measures (p < 0.001) such that the Insomnia group reported larger increases in insomnia (p < 0.001), depression (p < 0.001) and anxiety (p < 0.001) scores compared to the No-Insomnia group during lockdown. Participants with self-reported insomnia, even if currently asymptomatic, were more vulnerable to worsening insomnia and depressive and anxiety-related symptoms during lockdown compared to those with no insomnia. This highlights vulnerability to mental-health-altering situations in individuals with self-identified insomnia, and thus the necessity to provide mental health support for this patient population.

Significance:

Individuals who self-identified as insomniacs, even if they had minimal clinical symptoms of insomnia before the COVID-19-associated lockdown, experienced worsening of sleep initiation and maintenance, as well as symptoms of depression and anxiety during lockdown. These findings suggest that these individuals either identify with an insomnia identity or are vulnerable to sleep and mental health difficulties in stressful contexts.