Abstract
Background
Jordan, a Middle Eastern country, declared a state of national
emergency due to COVID-19 and a strict nationwide lockdown on 17 March
2020, banning all travel and movement around the country, potentially
impacting mental health. This study sought to investigate the
association between mental health (eg, anxiety and depressive symptoms)
and sleep health among a sample of Jordanians living through a state of
COVID-19-induced nationwide lockdown.
Methods
Using Facebook, participants (n=1240) in Jordan in March 2020 were
recruited and direct to a web-based survey measuring anxiety (items from
General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive
symptoms (items from Center for Epidemiologic Studies Depression Scale),
sleep health (items from the Pittsburgh Sleep Quality Index) and
sociodemographic. A modified Poisson regression model with robust error
variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated
to examine how anxiety and depressive symptoms may affect different
dimensions of sleep health: (1) poor sleep quality, (2) short sleep
duration, (3) encountering sleep problems.
Results
The majority of participants reported having experienced mild
(33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during
lockdown, and nearly half of respondents reported depressive symptoms
during lockdown. Similarly, over 60% of participants reported having
experienced at least one sleep problem in the last week, and nearly half
reported having had short sleep duration. Importantly, anxiety was
associated with poor sleep health outcomes. For example, corresponding
to the dose–response relationship between anxiety and sleep health
outcomes, those reporting severe anxiety were the most likely to
experience poor sleep quality (aPR =8.95; 95% CI=6.12 to 13.08), short
sleep duration (aPR =2.23; 95% CI=1.91 to 2.61) and at least one problem
sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive
symptoms were also associated with poor sleep health outcomes. As
compared with scoring in the first quartile, scoring fourth quartile was
associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04),
short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing
at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18).
Conclusions
Increased levels of anxiety and depressive symptoms can negatively
influence sleep health among a sample of Jordanian adults living in a
state of COVID-19-induced nationwide lockdown.