Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: A cross-sectional analysis of adults in Jordan

Al-Ajlouni Y.A.,
Park S.H.,
Alawa J.,
Shamaileh G.,
Bawab A.,
El-Sadr W.M.,
Duncan D.T.
Document Type
Source Title
BMJ Open
BMJ Publishing Group


Background Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19-induced nationwide lockdown. Methods Using Facebook, participants (n=1240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive symptoms (items from Center for Epidemiologic Studies Depression Scale), sleep health (items from the Pittsburgh Sleep Quality Index) and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated to examine how anxiety and depressive symptoms may affect different dimensions of sleep health: (1) poor sleep quality, (2) short sleep duration, (3) encountering sleep problems. Results The majority of participants reported having experienced mild (33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during lockdown, and nearly half of respondents reported depressive symptoms during lockdown. Similarly, over 60% of participants reported having experienced at least one sleep problem in the last week, and nearly half reported having had short sleep duration. Importantly, anxiety was associated with poor sleep health outcomes. For example, corresponding to the dose-response relationship between anxiety and sleep health outcomes, those reporting severe anxiety were the most likely to experience poor sleep quality (aPR €¯=8.95; 95% CI=6.12 to 13.08), short sleep duration (aPR €¯=2.23; 95% CI=1.91 to 2.61) and at least one problem sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared with scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04), short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18). Conclusions Increased levels of anxiety and depressive symptoms can negatively influence sleep health among a sample of Jordanian adults living in a state of COVID-19-induced nationwide lockdown. ©

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Index Keywords

adult; anxiety; communicable disease control; complication; depression; female; human; insomnia; Jordan; male; mental health; prevalence; prevention and control; procedures; psychological and psychiatric procedures; psychology; questionnaire; sleep hygiene; social isolation; Adult; Anxiety; Communicable Disease Control; COVID-19; Depression; Female; Humans; Jordan; Male; Mental Health; Online Social Networking; Prevalence; Psychological Techniques; SARS-CoV-2; Sleep Hygiene; Sleep Initiation and Maintenance Disorders; Social Isolation; Surveys and Questionnaires