Sleep and Mood Disturbances during the COVID-19 Outbreak in an Urban Chinese Population in Hong Kong: A Longitudinal Study of the Second and Third Waves of the Outbreak

Int J Environ Res Public Health. 2021 Aug 10;18(16):8444. doi: 10.3390/ijerph18168444.


In response to the worsening situation of the COVID pandemic, this follow-up study aimed to assess the impact of the "third wave" of the outbreak on sleep and mood disturbances among Hong Kong citizens. A total of 339 respondents included in our last study during the second wave (4-11 August 2020) joined this survey (response rate = 51.1%). The questionnaire collected data on sleep conditions, mood, stress, and risk perception. The sleep quality and mood status were assessed using the Insomnia Severity Index (ISI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9. The weighted prevalence of insomnia, anxiety, and depression was 33.6%, 15.3%, and 22.0%, respectively. Compared with the last survey, five out of six sleep parameters significantly worsened despite the lack of difference in the ISI score. The GAD-7 score was significantly lower. Old-aged adults were less likely to maintain good sleep quality compared with middle-aged adults (adjusted OR = 4.03, 95% CI: 1.04-15.73). Respondents without psychiatric disorder were more likely to be anxiety-free across the two time points (adjusted OR = 7.12, 95% CI: 1.33-38.03). One-third of Hong Kong people reported poor sleeping quality in the third wave of the COVID-19 outbreak. Policy-makers need to propose a contingent plan to allocate mental health resources to vulnerable subpopulations.

Keywords: cohort; insomnia; mental health; pandemic; web-based.

MeSH terms

  • Adult
  • Anxiety
  • COVID-19*
  • China / epidemiology
  • Cross-Sectional Studies
  • Depression
  • Disease Outbreaks
  • Follow-Up Studies
  • Hong Kong / epidemiology
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • SARS-CoV-2
  • Sleep
  • Surveys and Questionnaires