and Utah. Portions of the population in Colorado (49%), Minnesota (55%), New Mexico (61%), and Utah (35%) and the whole population of Maryland are included as part of the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). https://www.cdc.gov/coronavirus/2019-ncov/covid-data/ covid-net/purpose-methods.html † A COVID-19 case (confirmed or probable) was defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person aged ≥18 years per the Council of State and Territorial Epidemiologists' update to the standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19) (21-ID-01

What is already known on this topic? One-third of US adults report that they sleep less than the recommended amount, and approximately 20% have received a diagnosis of a mental illness. The link between inadequate sleep and mental distress has been viewed historically as a symptom-disease association with sleep inadequacies deriving from preexisting mental distress. What is added by this report?We examined the association between inadequate sleep and frequent mental distress in a diverse, population-based sample of adults aged 18 to 65.What are the implications for public health practice? By identifying the correlation between inadequate sleep and frequent mental distress we can better understand this relationship as a risk factor instead of a symptom-disease relationship.

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