Associations Between Childhood Stressors, COVID-19-Related Anxiety, and Sleep Quality of Adults During the Third Wave of the COVID-19 Pandemic in Israel

Abstract

Purpose: Studies point to a persistent effect of the COVID-19 pandemic on sleep quality and mental health, including anxiety. Exposure to stressors during childhood increases the susceptibility to anxiety in later life. Given the negative effects of anxiety on sleep quality, the present study aimed to examine the associations between various childhood stressors and poor sleep quality of adults during the COVID-19 pandemic, and whether these associations are mediated by COVID-19-related anxiety. Participants and Methods: A total of 586 participants aged 18–40 (mean age 27.53± 6.48 years, 301 females) were recruited to take part in an online survey conducted in Israel between February 7 and 15, 2021, during the third wave of the COVID-19 pandemic. Participants completed questionnaires assessing retrospectively adverse childhood experiences (ACEs), childhood harshness (indexed separately by exposure to morbidity and mortality and low socioeconomic status, SES), and childhood unpredictability. COVID-19-related anxiety was assessed using two items. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and insomnia symptoms with the Insomnia Severity Index (ISI). Participants were asked to complete the ISI concerning two time points: (a) retrospectively, before the COVID-19 outbreak, and (b) currently, during the pandemic. Results: Path analysis indicated that poor sleep quality (PSQI) was directly and indirectly (through COVID-19-related anxiety) predicted by the number of ACEs and childhood morbidity-mortality exposure, directly predicted by childhood low SES, and indirectly predicted by childhood unpredictability. Insomnia symptoms increase (ISI) was indirectly predicted by the number of ACEs, childhood morbidity-mortality exposure, and childhood unpredictability. Conclusion: ACEs as well as harsh and unpredictable childhood environments are predictive of poorer sleep during the COVID-19 pandemic. COVID-19-related anxiety mediates the effects of childhood stressors (other than low SES) on sleep. These findings may have clinical implications relevant to stressful periods in general.