Associations Between Poor Sleep Quality, Anxiety Symptoms, and Depressive Symptoms Among Chinese Adolescents Before and During COVID-19: A Longitudinal Study

Abstract

Since the novel coronavirus disease 2019 (COVID-19) outbreak, adolescents' emerging mental health and behavior issues have been an international public health concern. This longitudinal study aimed to examine the situation of poor sleep quality, anxiety, and depressive symptoms among Chinese adolescents and to explore the associations between them before and during COVID-19. A total of 1,952 middle and high school students as eligible participants at baseline (pre-COVID-19, Wave 1; response rate: 98.79%), 1,831 eligible students were followed up at Wave 2 (October 2019 to December 2019, pre-COVID-19; retention rate: 93.80%), and 1,790 completed the follow-up at Wave 3 (during the COVID-19; retention rate: 97.80%). The mean age of the baseline students was 13.56 (SD: 1.46) years. The differences in anxiety and depressive symptoms between Wave 1, Wave 2, and Wave 3 were not statistically significant. The proportion of students with poor sleep quality increased over time, from Wave 1 (21.0%) to Wave 3 (26.0%, OR = 1.37, 95% CI = 1.17–1.60, P = 0.001) and from Wave 2 (21.9%) to Wave 3 (OR = 1.29, 95% CI = 1.11–1.51, P < 0.001). The cross-lagged generalized linear mixed models revealed that the concurrent and cross-lagged associations of poor sleep quality with anxiety symptoms across the three waves were significant (P < 0.05) and vice versa. Only a marginally significant positive cross-lagged association between poor sleep quality at Wave 2 and depressive symptoms at Wave 3 was found (standardized β estimate = 0.044, SE = 0.022, P = 0.045). Sleep quality was adversely affected during COVID-19, and the bidirectional associations of poor sleep quality with anxiety symptoms could not be neglected.

Association between quality of sleep and screen time during the COVID‐19 outbreak among adolescents in the United Arab Emirates

“…As noted in our study, the shift in sleep cycle (delayed sleep/wake behaviours) in adolescents during lockdown periods is associated with difficulties initiating and maintaining sleep (Helito et al, 2021 ; Illingworth et al, 2022 ; Wang et al, 2021 ; Zhai et al, 2021 ). There remains a gap in understanding sleep quality as most studies were either cross‐sectional or retrospective.…”

“…Consistent with our findings, sleep latency and sleep disturbance had the highest PSQI domain scores at 0.83 and 0.64, respectively (Zhai et al, 2021 ). In addition, another longitudinal study from China that analyzed the impact of COVID‐19 on adolescents' sleep (mean age 13.56 ± 1.46 years) during the three waves of the pandemic found a steady increase in the percentage of poor sleep (21% in wave 1, 21.9% in wave 2, and 26% in wave 3) (Wang et al, 2021 ). Such findings may further emphasize that adolescents globally suffered from poor sleep during the lockdown period associated with the COVID‐19 pandemic.…”

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents

“…Understanding this relationship could be helpful for adolescents to adopt lifestyle changes to reduce anxiety-induced sleep disturbance, which could result in improved mental health. Considering that both anxiety disorders and sleep problems at young ages increased considerably during the COVID-19 pandemic ( Wang et al, 2022 ), the relationship between the two conditions has gained increased attention and requires the expansion of the available body of scientific evidence. In addition, considering the sex differences found in both the prevalence of sleep disturbance ( Blank et al, 2015 ; Zhang et al, 2016 ) and its associated factors ( Zhang et al, 2016 ), it seems of relevance to know the specific lifestyle factors differences between sexes, in order to promote more appropriate prevention and intervention programs.…”

Physical activity, sleep quality and life satisfaction in adolescents: A cross-sectional survey study

“…Sleep is an important component of the 24-h movement behaviors of adolescents, while poor sleep quality is prevalent among this population (1)(2)(3)(4)(5)(6). There has been a significant decline in sleep quality among adolescents (7), while this decline has been exacerbated by the COVID-19 outbreak (8)(9)(10)(11)(12). Not only the pandemic, but also physiological, psychological, demographic, geographical, and socioeconomic factors influence the prevalence of sleep quality in adolescents (13)(14)(15).…”

“…Additionally, poor sleep quality was a risk factor for recurrent aphthous ulcers and primary nocturnal enuresis ( 32 , 33 ). In terms of mental health, poor sleep quality has been demonstrated as a risk factor for poor mental health conditions, such as depression, anxiety and lower subjective well-being ( 8 , 34 – 37 ). Furthermore, several cross-sectional studies reported that high school students with lower sleep quality were more likely to have suicidal ideation and carried out non-suicidal self-injury ( 34 , 38 , 39 ).…”