Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip

Abstract

Objectives/backgroundSleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip. Patients/methodsA population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9. ResultsThree out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality. ConclusionPoor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.