Short Sleep, Insomnia During Pandemic Associated With Increased Psychological Distress

A survey of health care workers in New York City during the COVID-19 pandemic’s peak identified associations between poor sleep and anxiety, acute stress, and depressive symptoms.

Health care workers (HCWs) have been under immense strain throughout the COVID-19 pandemic, often working long and stressful shifts and reporting anxiety and depressive symptoms. A recent study found that insomnia and short sleep were associated with psychological distress in HCWs in New York City and that sleep could be a potential target for interventions to reduce their psychological distress.

These findings were recently published in Journal of Affective Disorders.

Studies conducted during the COVID-19 pandemic have shown that HCWs are especially prone to pandemic-related psychological distress, according to investigators. Previous research has also shown that acute distress related to the severe acute respiratory syndrome outbreak in 2003 put HCWs at increased long-term risk of burnout, depression, and posttraumatic stress disorder.

Given that short sleep duration and poor sleep have been linked to psychological symptoms and disorders, the present researchers aimed to identify associations between insomnia and short sleep duration in HCWs in New York City when it was the epicenter of the COVID-19 pandemic in spring of 2020.

Their study used data from the COVID-19 Healthcare Provider Study, a cross-sectional survey of physicians, residents or fellows, advanced practice providers (nurse practitioners or physician assistants), and registered nurses at a large medical center in New York City. The survey included questions about the providers and their roles, COVID-19–related stressors, and available wellness resources. Also included were questions on sleep duration, insomnia symptoms, and psychological symptoms.

A total of 813 participants were eligible for the final analysis, which assessed the prevalence of reported acute stress, depressive and anxiety symptoms, and their associations with insomnia and short sleep duration. Fifty-six percent of participants were nurses, and the overall cohort was 80.6% female and 59.0% White. More than one-third of the study participants were redirected form their typical duties to work in COVID-19–related settings.

On average, the HCWs worked 4.1 shifts per week, and 38.8% reported sleeping for less than 6 hours per night. Mean sleep duration was 5.8 hours, and 72.8% of participants reported experiencing insomnia symptoms. In the overall cohort, 57.9% experienced an increase in acute stress, 33.8% experienced elevated depressive symptoms, and 48.2% had increased anxiety symptoms.

Participants with insomnia symptoms were significantly more likely to have elevated depressive symptoms (41.9% vs 12.2%), anxiety symptoms (57.8% vs 22.6%), and acute stress symptoms (67.4% vs 32.6%) than those without insomnia symptoms.

Those sleeping for less than 6 hours per night also had elevated depressive symptoms (46.4% vs 25.9%), anxiety symptoms (61.6% vs 39.8%), and acute stress symptoms (67.3% vs 52.0%) than those who slept more than 6 hours per night.

These a data suggest that sleep is an important aspect of mental health for HCWs in the pandemic.

“While we have previously reported the prevalence of disturbed sleep and psychological distress, the current study is novel and different than our previous study as it provides one of the initial investigations of the magnitude of the association of insomnia symptoms and, separately, short sleep duration with the mental health of US HCWs during the COVID-19 pandemic,” the authors wrote.

Although the study involved a large sample of HCWs and adds to a growing knowledge base on the association between disturbed sleep and psychological distress, one of its limitations is its cross-sectional nature, which limits the ability to make causal claims. The prevalence of disturbed sleep and its associated psychological symptoms in the study cohort before the pandemic is also unknown, despite data from other studies showing the rates of disturbed sleep before the pandemic were significantly lower, according to the authors.

“Future research should explore the longitudinal associations between sleep quality and psychological distress during the COVID-19 pandemic,” they conclude, “in order to develop interventions to help stem the burden of psychological distress in HCWs.”


Diaz F, Cornelius T, Bramley S, et al. The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic. J Affect Disord. 2022;298(Pt A):618-624. doi:10.1016/j.jad.2021.10.033