715 Insomnia as a Risk for PTSD During the COVID-19 Pandemic

Abstract

IntroductionThe COVID-19 pandemic and associated attempts to curb its spread have led to a significant increase in mental health issues. Evidence suggests that sleep provides a protective resilience against the adverse effects of stress. Moreover, sleep disruption is often considered the “hallmark symptom” of posttraumatic stress disorder (PTSD). Here we hypothesized that insomnia would increase during the first six months of the pandemic, and that higher insomnia would be associated with elevated rates of PTSD.MethodsA total of 6,190 adults ranging in age from 18 to 84 years (53.6% female), completed an online cross-sectional survey at one of six time points between April and September 2020 (~1,000 per administration). Instruments included the Insomnia Severity Index (ISI), Primary Care PTSD Checklist (PC-PTSD), and the PTSD Checklist-5 (PCL-5). Standard clinical cutoffs were used for ISI (≥10) and PCL-5 (≥38). Data were analyzed with analysis of variance, chi-square contingency tables, and bivariate correlations.ResultsOver the first six-months of the pandemic, PTSD increased with each passing month on both the PC-PTSD (p=.001) and PCL-5 (p<.0001). Similarly, ISI scores increased month-by-month (p<.0002). Insomnia scores were highly correlated with PCL-5 PTSD scores (r=.62, p<.0001), even when sleep items on the scale were excluded (r=.60, p<.0001). Finally, the rate of PTSD remained below 5% across all months for those without insomnia, but among those with insomnia, the prevalence of PTSD increased between May (26% positive) and September (40% positive), representing an increase of 56% over the data collection period (interaction p=.0004).ConclusionBoth insomnia and PTSD have increased dramatically over the first six months of the COVID-19 pandemic. Moreover, insomnia appears to be highly linked with the emergence of PTSD during this time. While it is not possible to make causal attributions from these cross-sectional findings, the steadily increasing rates of PTSD over time only among those with insomnia, raise the possibility that sleep disruption could act as a diathesis for the development of PTSD symptoms in response to the pandemic. Addressing insomnia during the pandemic may be an important aspect of maintaining psychological resilience in the populace.Support (if any):