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COVID-19 Worries and Insomnia: A Follow-Up Study.

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Brown, Lily A 
Zhu, Yiqin 
Hamlett, Gabriella E  ORCID logo
Moore, Tyler M 
DiDomenico, Grace E 


The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elevations in either worry or insomnia should be considered for evidence-based treatments for these symptoms to prevent secondary symptoms in the future. Future research should evaluate the extent to which dissemination of evidence-based practices for chronic worry (a core feature of generalized anxiety disorder or illness anxiety disorder) or insomnia reduces the development of co-occurring symptoms during a global disaster.


Peer reviewed: True

Funder: Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania


COVID-19 pandemic, anxiety, insomnia, worry, Humans, COVID-19, Sleep Initiation and Maintenance Disorders, Follow-Up Studies, Pandemics, Cross-Sectional Studies, Anxiety, Depression

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Int J Environ Res Public Health

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National Institute of Mental Health (K23MH120437)