Study Finds More Than One-Third of Healthcare Workers Suffered From Insomnia During COVID-19 Epidemic in China

More than a third of healthcare workers responding to the coronavirus disease 2019 (COVID-19) pandemic in China during its peak suffered from insomnia, with those reporting sleeplessness also more likely to feel depressed, anxious, and have stress-based trauma, according to study findings published Tuesday in Frontiers in Psychiatry.

Physicians are one of the highest at-risk populations for burnout, which can affect healthcare workers both physically and mentally. Insufficient sleep has been noted as a chief factor in causing burnout, which may be precipitated by the increased need of medical assistance due to COVID-19. By examining physicians who had worked during the peak of the COVID-19 crisis in China, researchers sought to examine the prevalence of insomnia and psychological factors.

The study included 1563 medical staff members in China who completed a questionnaire via the WeChat program between January 29 and February 3. The questionnaire obtained demographic data and asked self-design questions related to the COVID-19 outbreak, insomnia/depressive/anxiety symptoms, and stress-related symptoms. A logistic regression analysis was conducted to examine the associations between sociodemographic factors (occupation, education) and insomnia symptoms.

Of the study cohort, 36.1% (n = 564) reported experiencing insomnia symptoms, a statistic that the study authors indicated was similar to that found in nurses who treated patients with SARS (37%). In those reporting insomnia, significantly higher levels of depression were found compared with those not experiencing symptoms (87.1% vs 31%), with notably higher rates of moderate (22.9% vs 2.8%) and severe cases (16.7% vs 1.8%).

When stratified for sociodemographic factors, medical staff with a high school education or below were found to be at a 2.69 times higher risk of developing insomnia than those with a doctoral degree (odds ratio [OR] = 2.69, P = .042, 95% CI, 1.0—7.0). Insomnia was additionally linked with a myriad of other factors, such as working in an isolation unit (OR = 1.71, P = .038, 95% CI, 1.0—2.8), worry about being infected (OR = 2.30, P < .001, 95% CI, 1.6—3.4), perceived lack of helpfulness in terms of psychological support from news or social media with regard to COVID-19 (OR = 2.10, P = .001, 95% CI, 1.3—3.3), and having very strong uncertainty regarding effective disease control (OR = 3.30, P = .013, 95% CI, 1.3—8.5).

Researchers note that healthcare workers were under incredible stress in general, which may have been intensified by the psychological factors examined in the study. "Under these dangerous conditions, medical staff become mentally and physically exhausted, and therefore experience an increased risk of insomnia due to high stress," said the study authors.

Recently, the American Academy of Sleep Medicine issued a position statement noting the significance of sleep among physicians, with proposed interventions such as rest breaks, designated nap areas, and counseling. As these preventive strategies seek to curb burnout, adherence may prove vital for US healthcare workers as stress-related insomnia can become chronic if physicians are exposed to poor conditions for extended periods of time, noted study author Bin Zhang, MD, a professor at Southern Medical University in Guangzhou, China.

Zhang highlighted that future research tracking the changes of insomnia symptoms is warranted among medical staff, especially in hospital settings where medical staff die due to COVID-19.

Reference

Zhang C, Yang L, Liu S, et al. Survey of insomnia and related social psychological factors among medical staff involved with the 2019 novel coronavirus disease outbreak [published online April 14, 2020]. Front Psychiatry. doi: 10.3389/fpsyt.2020.00306.