Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective

Pan Chen; Ling Zhang; Sha Sha; Mei Ieng Lam; Ka-In Lok; Ines Hang Iao Chow; Tong Leong Si; Zhaohui Su; Teris Cheung; Yuan Feng; Todd Jackson; Yu-Tao Xiang

doi:10.3389/fpsyt.2023.1113122

Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective

Front Psychiatry. 2023 Feb 16:14:1113122. doi: 10.3389/fpsyt.2023.1113122. eCollection 2023.

Authors

Pan Chen^{1

2}, Ling Zhang³, Sha Sha³, Mei Ieng Lam^{1

4}, Ka-In Lok⁴, Ines Hang Iao Chow¹, Tong Leong Si¹, Zhaohui Su⁵, Teris Cheung⁶, Yuan Feng³, Todd Jackson⁷, Yu-Tao Xiang^{1

2}

Affiliations

¹ Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.
² Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.
³ Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
⁴ Kiang Wu Nursing College of Macau, Macao, Macao SAR, China.
⁵ School of Public Health, Southeast University, Nanjing, China.
⁶ School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.
⁷ Department of Psychology, University of Macau, Macao, Macao SAR, China.

Abstract

Background: The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective.

Methods: A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure.

Results: A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F_(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL.

Conclusion: The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.

Keywords: COVID-19 outbreak; insomnia; network analysis; prevalence; quality of life.

Grants and funding

This study was supported by the University of Macau (MYRG2019-00066-FHS and MYRG2022-00187-FHS), Sci-Tech Innovation 2030 – Major Project of Brain Science and Brain-Inspired Intelligence Technology (2021ZD0200600), Beijing Scholar 2021 (No. 063), and Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX202128).