COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak

Abstract

Background The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status. Methods A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status. Results The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506, p < 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (β = 0.015, 95%C.I. = 0.009–0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (β = 0.009, 95%C.I. = − 0.002–0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (β = 0.043, p < 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress. Conclusions These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.

Healthcare Workers’ SARS-CoV-2 Omicron Variant Uncertainty-Related Stress, Resilience, and Coping Strategies during the First Week of the World Health Organization’s Alert

“…This work also supports the association between intolerance of uncertainty and negative mental health outcomes, including perceived stress, as shown in numerous studies studying both HCWs and the general public during the pandemic [ 24 , 25 , 28 , 30 , 31 , 32 ]. Intolerance of uncertainty has been mostly associated with anxiety disorders, especially Generalized Anxiety Disorder (GAD) [ 55 , 56 ], but is likely a trans-diagnostic construct predisposing to many psychiatric disorders [ 23 , 57 , 58 , 59 ].…”

“…Indeed, the construct of Intolerance of Uncertainty was developed to capture this tendency [ 22 ], which also contributes to the development of anxiety disorders [ 23 ]. In the context of the COVID-19 pandemic, higher intolerance of uncertainty has been found to correlate with stress and anxiety in various countries during the pandemic [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. A similar correlation was also observed in HCWs, whose intolerance of uncertainty was correlated with their utilized coping strategies in the face of the pandemic [ 33 ].…”

Healthcare workers’ COVID-19 Omicron variant uncertainty-related stress, resilience, and coping strategies during the first week of World Health Organization alert

“…A similar relationship was reported in previous studies on HCWs during the COVID-19 pandemic [34,35]. To the best of our knowledge, this report is the first to demonstrate this relationship during the first days of the emergence of a new variant, highlighting the need for stress management and psychological support for HCWs as the pandemic evolves This work also supports the association between intolerance of uncertainty and negative mental health outcomes, including perceived stress, as has been shown in numerous studies studying both HCWs and the general public during the pandemic[22,23,26,28-30]. Intolerance of uncertainty has been mostly associated with anxiety disorders, especially Generalized Anxiety Disorder (GAD)[56,57], but is likely a trans-diagnostic construct predisposing to many psychiatric disorders [21,58-60].…”

Effects of Coronavirus-19 Induced Loneliness on Mental Health: Sleep Quality and Intolerance for Uncertainty as Mediators

“…At the end of 2020, the World Sleep Association and Zepp, a professional digital health management brand, jointly released the "Sleep Observation in the Post-epidemic Era, " indicating that although the social isolation policy caused an increase in individual sleep time during the epidemic, the individual sleep quality was generally not optimistic with the increase of the uncertainty and loneliness brought by the epidemic. Studies have found that the social uncertainty caused by the epidemic has disturbed people's normal sleep time, resulting in longer time to prepare for sleep and poor sleep quality, half of the people suffer from daytime dysfunction (19). Sleep quality is an important indicator for individual physical and mental health.…”

“…A study on sleep quality of adolescents in China shows that IU is related to sleep problems (21); some studies believe that uncertainty intolerance (IU) is a precursor to sleep problems (22). A study in the early stage of the COVID-19 outbreak found that intolerance of uncertainty is critical factor in the relationship between COVID-19 uncertainty and sleep outcomes (19). Based on these assumptions, this study further speculates that uncertainty intolerance can positively predict sleep quality, and play a chain-like mediating role between loneliness and mental health.…”