Insomnia of students after the lifting of COVID-19 restrictions in China: prevalence, influencing factors and associations with depression, anxiety and PTSD

Hang Zhang^1,2Li Yin¹Cong Wang^1,3Yihao Liu^1,3Yiyue Yang^1,3Lie Zhou^1,3Hui Jin^1,3Yun Xiao^1,3Yang Wen^1,3Jawad Ahmad^1,3Jia Cai¹Yu Wang³Lu Tan^1,2Tao-Mei Li^1,2Xuehua Huang¹Jin Chen⁴Xiangdong Tang^1,2*Mao-Sheng Ran^1,3*

• ¹Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
• ²Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
• ³Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, China
• ⁴Department of Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, Chengdu, China

Introduction: Insomnia has emerged as a major concern among youth following the lifting of COVID-19 restrictions in China. This study aimed to explore the prevalence, influencing factors of insomnia and its associations with mental health in young students during this specific period. Methods: A cross-sectional survey was conducted among 82873 students in Sichuan Province, China using a self-designed questionnaire and standardized assessment tools. Chi-square test, the ANOVA with post-hoc test and logistic regression analysis were employed to identify the prevalence and influencing factors of insomnia and its association with mental health. Results: A total of 28,178 (34.0%) students reported insomnia. Self-reported history of mental disorders, neglectful parenting and started drinking during the pandemic were found with higher odds of insomnia, while satisfied with academy, totally recovered from daily life routine, greatly improved family relationship, keep no change in friendship, and higher education level of mother were associated with lower odds of insomnia (p<0.001). Severe insomnia was strongly associated with depression, anxiety and PTSD (ORs of 17.55, 3.35 and 17.45). There were interaction effects between mild to moderate insomnia and COVID-19 infection on depression, anxiety and PTSD. Conclusion: Following the lifting of COVID-19 restriction, insomnia remained prevalent in Chinese young students. Pre-existing self-reported mental disorders, neglectful parenting, and pandemic-related maladaptive behaviors increase the risk of insomnia while positive lifestyle adjustments, stable relationships, and higher maternal education appear protective. A significant association was observed between insomnia severity and depression, anxiety, and PTSD. These findings identify the persistent associations among social, behavioral, and demographic factors, sleep, and mental health, emphasizing the importance of focusing sleep disturbance after the public health crisis.