Abstract
Background
A global rise of a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2) with high transmissibility and a concerning mortality rate took over the world in 2020. This thesis explores the differing mental distress and sleep quality outcomes of New Zealanders during and after the COVID-19 nationwide lockdown in 2020. It focuses on the changes in sleep quality and mental health outcomes during this time.
Aims
This thesis aims to answer three questions:
1. How did the pandemic including lockdown and post-lockdown affect sleep and well-being parameters?
2. How did mental health and well-being (including sleep) outcomes relate to other sociodemographic factors (including essential employment role and living circumstances)?
3. Did people with and without a prior mental health diagnosis have different changes in sleep and other mental health/well-being measures during the COVID-19 lockdown and post-lockdown? (Adjusted for confounders)
Methods
This thesis draws upon data from an existing cross-sectional survey data set collected during the peak stages of COVID-19 in New Zealand in 2020. Qualtrics, an online survey platform was used to field the survey in lockdown between 17 April 2020 to 27 April 2020. The same survey was fielded again post-lockdown between 28 April 2020 and 2 October 2020. The final achieved sample comprised 1,477 participants for the lockdown period and 3,779 participants for post-lockdown, giving a total of 5,256 participants.
Participants were asked to self-report gender, age group and ethnicity. Sleep quality in the lockdown survey was measured by two 10-point scales which asked, ‘before the lockdown, how would you rate your sleep quality overall?’ and ‘during the lockdown, how would you rate your sleep quality overall?’. Similar questions were asked in post-lockdown which measured the same outcome during post-lockdown.
The survey included three different standardised measures of self-reported psychological distress, anxiety and well-being outcomes; the Kessler Psychological Distress Scale (K10), Generalised Anxiety Disorder Assessment Scale (GAD-7), and World Health Organisation Well-Being Index 5 (WHO-5). Participants were asked to record if they had previously received a mental health diagnosis by a doctor or psychologist.
Results
From a sleep quality scale of 1–10, with 1 being terrible and 10 being excellent, during lockdown over half the survey respondents (55.9%) rated their sleep quality as moderate (4–7). Close to one in ten respondents (8.9%,) claimed their sleep quality was poor while 35.1% had good sleep quality (8–10). Higher ratings of sleep quality categorised as good (8–10) were overall more frequently observed during post-lockdown, however those with a previous diagnosis of mental illness experienced declining levels of sleep quality post-lockdown, once restrictions lifted.
In terms of mental health, females experienced greater psychological distress than males during both lockdown (16.9) and post-lockdown (18.9%,). In lockdown, essential workers (9.6%) reported higher levels of anxiety than non-essential workers (adjusted odds ratio [aOR] = 2.03, 95% CI 1.07, 3.85). This was also evident among those with health vulnerabilities (9.9%,), who reported anxiety levels 4.1% higher than those without compromised health during the lockdown (aOR = 2.04, 95% CI 1.16, 3.52). Having a previous diagnosis of mental illness was associated with participants reporting depressive symptoms, anxiety and poor well-being. This was evident during both lockdown and post-lockdown. The trends demonstrated that mental health decreased over time for those with a history of mental illness.
Conclusions
This thesis revealed an increase in depression and anxiety during post-lockdown among the NZ adult population. Those with a previous mental health diagnosis had an overall increase in scores across all three mental health measures including depression, anxiety, and low well-being. Decreasing quality of sleep was observed throughout lockdown and post-lockdown among participants with a history of mental illness. Those with no previous history of mental illness, consistently experienced higher levels of sleep quality throughout the pandemic period.