Study: COVID-19 Health Care Workers Face Higher Risk of Insomnia

Health care workers helping to fight coronavirus disease 2019 (COVID-19) are well aware they face a heightened risk of infection with SARS-CoV-2, as well as high levels of added stress.

Now, a new study shows another way the COVID-19 workload is affecting health care workers: insomnia.

A team of Chinese investigators found more than one-third of frontline health care workers responding to the coronavirus outbreak reported symptoms of insomnia. The findings were published in Frontiers in Psychiatry.

Corresponding author Bin Zhang, MD, PhD, of China’s Southern Medical University, and colleagues sent out questionnaires to Chinese health care workers using the platform WeChat.

The survey was conducted in late January and early February, just as the virus was hitting its peak in the region.

A total of 1563 people responded to the survey. Of those, 564 people (36.1%) had symptoms of insomnia. Those patients with insomnia also reported higher levels of other health issues. For instance, 87.1% of patients with insomnia symptoms reported depression (87.1% in the insomnia group versus 31% in the non-insomnia group).

The group with insomnia symptoms also had higher rates when depression was broken down based on severity. Seventeen percent of respondents in the insomnia group reported severe depression, versus just 1.8% in the non-insomnia group. Similar disparities were found for anxiety and trauma, Zhang and colleagues reported.

Zhang said the length of the COVID-19 pandemic should heighten concern.

“Typically, stress-related insomnia is transient and persists for only a few days," Zhang said, in a press release. “But if the COVID-19 outbreak continues, the insomnia may gradually become chronic insomnia in the clinical setting.”

Insomnia was calculated using the Insomnia Survey Index. Patients with a score of 8 or above were classified as having insomnia. Further analysis showed that workers with lower levels of education had higher rates of insomnia, as did those working in an isolation unit, those with fears about being infected, and those concerned about the effectiveness of disease control.

“The most important factor was having very strong uncertainty regarding effective disease control among medical staff,” Zhang said.

The paper notes that while health care can already be a high-stress field, the specific conditions under which health care workers are working during the pandemic can make already stressful jobs much more difficult, such as working 12-hour shifts while wearing cumbersome personal protective equipment.

“Under these dangerous conditions, medical staff become mentally and physically exhausted, and therefore experience an increased risk of insomnia due to high stress,” Zhang and colleagues said.

The authors suggest a number of options to help address the problem of insomnia, including cognitive behavioral therapy for insomnia. The authors say health care organizations should take time to screen medical staff for risk factors of insomnia in order to identify workers who might be at risk.

As the crisis continues, Zhang and colleagues said it will be important for investigators to track symptoms like insomnia over time, particularly to get a sense of the extent to which the symptoms change at key inflection points, such as when staff COVID-19 deaths or infections among staff are announced.