The Relationship Between Insomnia and Anxiety Among COVID-19 Patients in China: the Chain Mediating Effect of Psychological Capital and Self-esteem

Abstract

Abstract Background：The outbreak of Corona Virus Disease (COVID-19) in 2019 has continued until now, posing a huge threat to the public’s physical and mental health, resulting in different degrees of mental health problems. As a vulnerable segment of the public, anxiety is one of the most common mental health problems among COVID-19 patients. Excessive anxiety aggravates the physical and psychological symptoms of COVID-19 patients, which is detrimental to their treatment and recovery, increases financial expenditure, affects family relations, and adds to the medical burden. Objective: This study aimed to explore the role of psychological capital and self-esteem in the relationship between insomnia and anxiety, thereby shedding light on the mechanism of the effect of insomnia on anxiety in COVID-19 patients. Methods: A cross-sectional study was conducted from April to May 2022 in Fangcang hospital in Shanghai, China. The self-administered questionnaires were distributed to 718 COVID-19 patients via cell phone using the Internet platform "Questionnaire Star", which included Athens Insomnia Scale, Psychological Capital Questionnaire, Self-esteem Scale, Self-Rating Anxiety Scale, gender, age, marital status, education. Data analysis was performed using descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analysis, ordinary least-squares regression, and bootstrap method. Results: Education background had significant impact on anxiety in COVID-19 patients (F =7.701, P < 0.001). Insomnia, psychological capital, self-esteem and anxiety were significantly correlated, respectively (P < 0.001). And Regression analysis showed that insomnia had a direct negative predictive effect on psychological capital (β = -0.699, P < 0.001) and self-esteem (β = -0.129, P < 0.001). Psychological capital had a direct positive predictive effect on self-esteem (β = 0.116, P < 0.001). Insomnia had a direct positive predictive effect on anxiety (β = 0.611, P < 0.001). Both psychological capital and self-esteem had significant negative predictive effects on anxiety (β = -0.060, P < 0.001; β = -0.722, P < 0.001). Conclusions: Insomnia had a significant positive predictive effect on anxiety. Insomnia was first associated with a decrease in psychological capital, followed by a sequential decrease in self-esteem, which in turn was associated with increased anxiety symptoms in COVID-19 patients.