Abstract
During lockdowns associated with the COVID-19 pandemic, individuals have experienced poor sleep quality and sleep regularity, changes in lifestyle behaviours, and heightened depression and anxiety. However, the inter-relationship and relative strength of those behaviours on mental health outcomes is still unknown. We collected data between 12 May and 15 June 2020 from 1048 South African adults (age: 32.76 ± 14.43 years; n = 767 female; n = 473 students) using an online questionnaire. Using structural equation modelling, we investigated how insomnia symptoms, sleep regularity, exercise intensity/frequency and sitting/screen-use (sedentary screen-use) interacted to predict depressive and anxiety-related symptoms before and during lockdown. We also controlled for the effects of sex and student status. Irrespective of lockdown, (a) more severe symptoms of insomnia and greater sedentary screen-use predicted greater symptoms of depression and anxiety and (b) the effects of sedentary screen-use on mental health outcomes were mediated by insomnia. The effects of physical activity on mental health outcomes, however, were only significant during lockdown. Low physical activity predicted greater insomnia symptom severity, which in turn predicted increased depressive and anxiety-related symptoms. Overall, relationships between the study variables and mental health outcomes were amplified during lockdown. The findings highlight the importance of maintaining physical activity and reducing sedentary screen-use to promote better sleep and mental health.
Highlights
Insomnia and an irregular sleep pattern are intimately associated with symptoms of depression and a nxiety[1,2]
When assessed using the Before Lockdown dataset, goodness-of-fit indices of the hypothesised measurement model were within acceptable range
Many studies report on lifestyle, sleep and mental health outcomes during the COVID-19 pandemic
Summary
Insomnia and an irregular sleep pattern are intimately associated with symptoms of depression and a nxiety[1,2] Lifestyle behaviours such as exercise and sedentary behaviour, influence these mental health outcomes independently of sleep quality[3,4,5,6,7]. During the COVID-19 pandemic, many sleep-related and lifestyle behaviours changed due to ‘lockdowns’ of populations which were introduced as one of the non-pharmaceutical interventions to manage the transmission of the SARS-CoV-2 virus[8,9,10,11] During this period, increases in depressive and anxiety-related symptoms were widely reported[12,13]. Another study found that individuals who were active before lockdown but became inactive during lockdown, had increased depressive symptoms, feelings of loneliness and stress and decreased positive mental h ealth[32]
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