Authors
1 Department of Health Management, Faculty of Health Sciences, Sabahattin Zaim University, Istanbul, Turkey
2 Department of Health Management, Faculty of Health Sciences, Medipol University, Istanbul, Turkey
3 Department of Medical Services and Techniques, Tunceli Vocatıonal School, Munzur University, Tunceli, Turkey
4 Department of Health Management, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey
Abstract
BACKGROUND/AIM: The COVID‑19 pandemic has created a long period of stress for people
worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors
that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which
affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are
associated with negative consequences on mental health. This study aims to investigate online that
how this situation affected university students.
MATERIALS AND METHODS: This research, with a descriptive study design, was conducted in
Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted
voluntary participation, chosen by the random selection method. In the study, sociodemographic
information form, Pittsburgh sleep quality index (PSQI), morningness–eveningness questionnaire
scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as
data collection tools. Pearson correlation analysis was utilized to examine the relationship between
the scales. Multiple regression analysis was performed to investigate the role of morningness–
eveningness, anxiety, depression, and insomnia severity on sleep quality.
RESULTS: Sleep quality was negatively correlated with morningness–eveningness scores (r = –0.32,
P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40,
P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while
anxiety (ꞵ = 0.041, P < 0.001) and insomnia severity scores (ꞵ = 0.226, P < 0.001) positively predicted
sleep quality, depression did not predict it significantly (ꞵ = 0.009, P > 0.05). A significant difference was
found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).
CONCLUSION: Events related to the COVID‑19 pandemic are associated with reduced sleep quality
in connection with increasing negative moods. Considering the importance of sleep for a healthy
life, efforts should be made to raise awareness about this issue and to provide psychological help
to affected individuals.
Keywords
- Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, et al. The psychological impact of quarantine
and how to reduce it: Rapid review of the evidence. Lancet
2020;395:912‑20.
2. De Giorgio A. Global psychological implications of Severe
Acute respiratory syndrome Coronavirus 2 (SARS‑CoV‑2) and Coronavirus disease‑2019 (COVİD‑19). What can be learned
from Italy. Reflections, perspectives, opportunities. Front Psychol
2020;11:1836.
3. Rubin GJ, Wessely S. The psychological effects of quarantining a
city. BMJ 2020;368:m313.
4. Altena E, Baglioni C, Espie CA, Ellis J, Gavriloff D, Holzinger B,
et al. Dealing with sleep problems during home confinement due
to the COVID‐19 outbreak: Practical recommendations from a task
force of the European CBT‐I Academy. J Sleep Res 2020;29:e13052.
5. Martire VL, Caruso D, Palagini L, Zoccoli G, Bastianini S. Stress
& sleep: A relationship lasting a lifetime. Neurosci Biobehav Rev
2020;117:65‑77.
6. Kalmbach DA, Cuamatzi Castelan AS, Tonnu CV, Tran KM,
Anderson JR, Roth T, et al. Hyperarousal and sleep reactivity in
insomnia: Current insights. Nat Sci Sleep 2018;10:193‑201.
7. Borbély AA, Daan S, Wirz Justice A, Deboer T. The two
process model of sleep regulation: A reappraisal. J Sleep Res
2016;25:131‑43.
8. Vadnie CA, McClung CA. Circadian rhythm disturbances in mood
disorders: Insights into the role of the suprachiasmatic nucleus.
Neural Plast 2017;2017:1504507.
9. McClung CA. How might circadian rhythms control mood? Let
me count the ways. Biol Psychiatry 2013;74:242‑9.
10. Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K,
Johann A, et al. Insomnia as a predictor of mental disorders:
A systematic review and meta‑analysis. Sleep Med Rev
2019;43:96‑105.
11. Silva FRD, Guerreiro RDC, Andrade HDA, Stieler E, Silva A,
de Mello MT. Does the compromised sleep and circadian
disruption of night and shiftworkers make them highly vulnerable
to 2019 coronavirus disease (COVİD‑19)? Chronobiol Int
2020;37:607‑17.
12. Van de Langenberg D, Vlaanderen JJ, Dollé ME, Rookus MA,
van Kerkhof LW, Vermeulen RC. Diet, physical activity, and
daylight exposure patterns in night‑shift workers and day
workers. Ann Work Expo Health 2019;63:9‑21.
13. Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern,
sense of time and digital media use during COVID-19 lockdown
in Italy. J Sleep Res 2020;29:e13074.
14. Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep
quality in individuals who self‑isolated for 14 days during the
coronavirus disease 2019 (COVİD‑19) outbreak in January 2020
in China. Med Sci Monit 2020;26:923921‑1.
15. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence
and predictors of PTSS during COVİD‑19 outbreak in China
hardest‑hit areas: Gender differences matter. Psychiatry Res
2020;287:112921.
16. Huang Y, Zhao N. Generalized anxiety disorder, depressive
symptoms and sleep quality during COVİD‑19 outbreak in
China: A web‑based cross‑sectional survey. Psychiatry Res
2020;288:112954.
17. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate
psychological responses and associated factors during the initial
stage of the 2019 coronavirus disease (COVİD‑19) epidemic
among the general population in China. Int J Environ Res Public
Health 2020;17:1729.
18. Buysse DJ. Sleep health: Can we define it? Does it matter? Sleep
2014;37:9‑17.
19. Ağargün MY, Çilli AS, Kara H, Bilici M, Telcioğlu M, Semiz ÜB,
et al. Epworth Uykululuk Ölçeği’nin geçerliği ve güvenirliği. Türk
Psikiyatri Dergisi 1999;10:261‑7.
20. Horne JA, Östberg O. A self‑assessment questionnaire to
determine morningness‑eveningness in human circadian
rhythms. Int J Chronobiol 1976;4:97‑110.
21. Punduk Z, Gür H, Ercan İ. Sabahçil‑Akşamcil Anketi Türkçe
uyarlamasinda güvenilirlik çalişmasi (A reliability study of the
Turkish version of the Morningness‑Eveningness Questionnaire).
Türk Psikiyatri Dergisi 2005;16:40‑5.
22. Beck AT, Ward C, Mendelson M, Mock J, Erbaugh JJAGP. Beck
depression inventory (BDI). Arch Gen Psychiatry 1961;4:561‑71.
23. Hisli N. Beck Depresyon Ölçeği’nin bir Türk örnekleminde
geçerlilik ve güvenilirliği. Psikoloji Dergisi 1988;6:118‑22.
24. Beck AT, Epstein N, Brown G, Steer RA. An inventory for
measuring clinical anxiety: Psychometric properties. J Consult
Clin Psychol 1988;56:893‑7.
25. Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck
Anxiety Inventory: Psychometric properties. J Cogn Psychother
1998;12:163.
26. Aybek EC, Şahin DB, Eriş HM, Şimşek AS, Köse M. Kağıt‑kalem
ve bilgisayar formunda uygulanan testlerde öğrenci başarısının
karşılaştırıldığı çalışmaların meta‑analizi. Asian J Instruct
2014;2:18.
27. WHO. COVID‑19 Weekly Epidemiological Update. Edition 65.
Available from: https://www.who.int/emergencies/diseases/
novel‑coronavirus‑2019/situation‑reports. [Last accessed on
2012 Nov 15.
28. Bilge Y, Keleş E, Beydili KN. The impact of COVID‑19 vaccination
on mental health. J Loss Trauma 2022;27:285‑8.
29. Cielo F, Ulberg R, Di Giacomo D. Psychological impact of the
COVID‑19 outbreak on mental health outcomes among youth:
A rapid narrative review. Int J Environ Res Public Health
2021;18:6067.
30. Savarese G, Curcio L, D’Elia D, Fasano O, Pecoraro N.
Online University counselling services and psychological
problems among Italian students in lockdown due to Covid‑19.
Healthcare (Basel) 2020;8:440.
31. Sintema EJ. Effect of COVID‑19 on the performance of grade 12
students: Implications for STEM education. Eurasia J Math Scie
Technol Educ 2020;16:em1851.
32. Dutta S, Smita MK. The impact of COVID‑19 pandemic on tertiary
education in Bangladesh: Students’ perspectives. Open J Soc Sci
2020;8:53.
33. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The
psychological impact of the COVID‑19 epidemic on college
students in China. Psychiatry Res 2020;287:112934.
34. De Pedraza P, Guzi M, Tijdens K. Life Dissatisfaction and
Anxiety in COVID‑19 pandemic, MUNI ECON Working Paper,
No. 2020‑03, Masaryk University, Faculty of Economics and
Administration, Brno.
35. Weingart R, Bryan C, Olson D, Gazmararian J, Rosati B, Hale L,
et al. Adolescent sleep duration and timing during early
COVID‑19 school closures. Sleep Health 2021;7:543‑7.
36. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The
prevalence of depressive symptoms, anxiety symptoms and sleep
disturbance in higher education students during the COVID‑19
pandemic: A systematic review and meta‑analysis. Psychiatry
Res 2021;301:13863.
37. Saadeh H, Saadeh M, AlmobaideenW, Al Refaei A, Shewaikani N,
Al Fayez RQ, et al. Effect of COVID‑19 quarantine on the sleep
quality and the depressive symptom levels of university students in
Jordan during the spring of 2020. Front Psychiatry 2021;12:605676.
38. Tang W, Hu T, Hu B, Jin C, Wang G, Xie C, et al. Prevalence
and correlates of PTSD and depressive symptoms one month
after the outbreak of the COVID‑19 epidemic in a sample of
home‑quarantined Chinese university students. J Affect Disord
2020;274:1‑7.
39. Alimoradi Z, Broström A, Tsang HW, Griffiths MD, Haghayegh S,
Ohayon MM, et al. Sleep problems during COVID‑19 pandemic
and its’ association to psychological distress A systematic review
and meta‑analysis. E‑ClinicalMedicine 2021;36:100916.
40. Torkian S, Akhlaghi E, Khosravi V, Etesami R, Ahmadi A,
Khanjani N, et al. Depression symptoms and sleep quality during
COVID‑19 outbreak in Iran: A national cross‑sectional study. Iran
J Psychiatry Behav Sci 2021;15:e108500. - 41. Evans S, Alkan E, Bhangoo JK, Tenenbaum H, Ng‑Knight T.
Effects of the COVID‑19 lockdown on mental health, wellbeing,
sleep, and alcohol use in a UK student sample. Psychiatry Res
2021;298:113819.
42. Xie J, LiX, Luo H, He L, BaiY, Zheng F, et al. Depressive symptoms,
sleep quality and diet during the 2019 novel coronavirus epidemic
in China: A survey of medical students. Front Public Health
2021;8:588578.
43. AhmadiZ, Omidvar S. The quality of sleep and daytime sleepiness
and their association with quality of school life and school
achievement among students. J Educ Health Promot 2022;11:159.
44. Kumar G, Dash P, Jnaneswar A, Suresan V, Jha K, Ghosal S.
Impact of internet addiction during COVID‑19 on anxiety and
sleep quality among college students of Bhubaneswar city. J Educ
Health Promot 2022;11:156.
45. Marelli S, Castelnuovo A, Somma A, Castronovo V, Mombelli S,
Bottoni D, et al. Impact of COVID‑19 lockdown on sleep quality
in university students and administration staff. J Neurol
2021;268:8‑15.
46. Lu P, Yang L, Wang C, Xia G, Xiang H, Chen G, et al. Mental
health of new undergraduate students before and after COVID‑19
in China. Sci Rep 2021;11:1‑9.
47. Ahammed B, Jahan N, Seddeque A, Hossain MT, Khan B,
Mamun MA, et al. Exploring the association between mental
health and subjective sleep quality during the COVID‑19
pandemic among Bangladeshi university students. Heliyon
2020;7:e07082.
48. Kabeloğlu V, Gül G. COVID‑19 Salgını sırasında uyku kalitesi ve
ilişkili sosyal ve psikolojik faktörlerin araştırılması. J Turk Sleep
Med 2021;2:97‑104.
49. Li Y, Zhou Y, Ru T, Niu J, He M, Zhou G. How does the COVID‑19
affect mental health and sleep among Chinese adolescents:
A longitudinal follow‑up study. Sleep Med 2021;85:246‑58.