A recent survey reveals several factors associated with insomnia among medical staff during the COVID-19 pandemic. The study, published in Frontiers in Psychiatry, found that working in the isolation unit, worry about infection, and a low level of education were all risk factors for insomnia.
Past research has uncovered significant psychological distress among medical staff on the frontlines of virus outbreaks. In Wuhan, China, the epicenter of the country’s COVID-19 outbreak, hospitals saw an unprecedented influx of infected patients and over 30,000 doctors were called in to assist from other regions of China.
Given that stress is the principal cause of sleep disturbance, researchers Zhang and colleagues wanted to examine insomnia among medical workers during the stress-inducing coronavirus pandemic. The researchers describe the immense pressure on medical staff to avoid contagion, revealing that workers often spend 12 hours a day wearing “double-layer protective equipment, double-face masks, double-layer gloves, isolation caps, foot covers, and protective glasses” and are discouraged from interacting with patients and colleagues.
Researchers conducted an online survey during the early phase of the pandemic, from January 29 to February 3, 2020. A total of 1,563 medical workers in China filled out the Insomnia Severity Index, the depression module of the Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Subjects also completed the Impact of Events Scale-Revised as an assessment of self-reported distress associated with the virus outbreak.
Results showed that more than one third (around 36%) of medical workers showed symptoms of insomnia. Additionally, roughly half of respondents (around 51%) showed symptoms of depression, around 45% displayed symptoms of anxiety, and about 73% showed symptoms of stress.
Statistical analysis uncovered several risk factors for insomnia. Having a lower education (high school or lower), working in the isolation unit, and worry about getting infected were all associated with higher scores on the Insomnia Severity Index. Additionally, it was found that those reporting the most uncertainty regarding proper disease control and those deeming the psychological support of news and social media to be unhelpful were more likely to show symptoms of insomnia.
Interestingly, it was found that doctors were significantly less likely than nurses to show symptoms of insomnia. As the researchers suggest, doctors typically work during the daytime and are less likely than nurses to see an increased workload, and therefore might experience less of a disruption in circadian rhythm. They also tend to have a higher education and less interaction with patients than nurses do.
The authors share how the brain’s response to stress can feed into an endless cycle of stress and insomnia in medical staff. “Stress,” they say, “involves increased psychological and physical activation in response to demand, and the activated hypothalamus-pituitary adrenal (HPA) system is incompatible with normal sleep. The resulting sleep disorders may appear to lead to further increases in the HPA system, thereby promoting a vicious cycle of stress and insomnia.”
Finally, results from the Impact of Events Scale showed that those with insomnia symptoms were most affected by the pandemic, supporting the idea that pandemic-related stress was responsible for medical staff’s reduced quality of sleep.
The authors conclude that their findings reveal several risk factors associated with insomnia in medical staff and provide guidelines for treatment. “Cognitive insomnia behavior therapy (CBTI) can effectively treat acute insomnia,” the researchers say. “The risk factors,” they continue, “such as low education level, being in an isolation unit, and staff type could help psychiatrists screen the susceptible population rapidly and offer personalized treatment.”
The study, “Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak”, was authored by Chenxi Zhang, Lulu Yang, Shuai Liu, Simeng Ma, Ying Wang, Zhongxiang Cai, Hui Du, Ruiting Li, Lijun Kang, Meilei Su, Jihui Zhang, Zhongchun Liu, and Bin Zhang.