Children and Adolescents’ Sleep Patterns and Their Associations with Mental Health During the COVID-19 Pandemic in Shanghai, China

Abstract

Background: School closures and home confinement due to the ongoing COVID-19 pandemic may lead to disrupted sleep patterns. Consequently, it could increase the risk of children and adolescents’ mental health disorders. We examined sleep patterns before and during the COVID-19 pandemic, and their associations with mental health in children and adolescents during the pandemic in Shanghai, China.Methods: In this natural experiment study, a total of 7,544 children and adolescents aged 6-17 years were randomly selected from ten schools in Shanghai, China in the first wave of the survey between January 3 and 21, 2020. Approximately two months after the COVID-19 outbreak declared, a second wave of the survey was conducted among 4,391 children and adolescents from six schools. In total, 2,250 individuals were surveyed in both waves. Participants’ mental health status (depression, anxiety and stress), sleep patterns and other demographic information were measured in both waves. Multivariate regression analysis was used to examine the associations between sleep patterns and mental health status. Multiple imputation was used to reduce the risk of bias from missing data.Findings: During the COVID-19 pandemic, a total of 873 participants (19.9%), 1,100 participants (25.1%), and 670 participants (15.3%) reported depression, anxiety and stress symptoms, respectively. Significant changes of both sleep duration and sleep-wake cycle patterns were observed before and during the COVID-19 pandemic. Moreover, shorter sleep duration and late to rise patterns (including early to bed late to rise and late to bed late to rise) were found to be associated with higher odds of having mental illnesses during the pandemic.Interpretation: These results suggest there is pressing need to monitor children and adolescents’ health behaviour and mental health and develop timely evidence‐based strategies and interventions to mitigate adverse behavioural and psychological impacts caused by these unprecedented challenges.Funding Statement: This research was funded by the National Natural Science Foundation of China (grant number 71804110) for Mi Xiang and supported by Global Public Health strand of the Elizabeth Blackwell Institute for Health Research, funded under the University of Bristol’s QR GCRF strategy. Declaration of Interests: None.Ethics Approval Statement: Ethics approval was obtained from the Ethics Committee of Shanghai Jiaotong University School of Medicine (SJUPN-201813). Written, informed consent was obtained from caregivers of all participants.