Predictiveness of Covid-19 Anxiety and Emotion Regulation on Sleep Quality: The Moderator Effect of Gender

Abstract

Prior research indicates that anxiety and emotion regulation are related to sleep quality. This study extends the body of research by investigating how people in different gender groups are affected by the coronavirus disease 2019 (Covid-19) anxiety and emotion regulation in terms of sleep quality. The present study examined gender as a potential moderating variable on the associations of Covid-19 anxiety and emotion regulation with sleep quality. University students were recruited via e-mail to participate in a brief online survey. Data were collected using the Pittsburgh Sleep Quality Index, Fear of COVID-19, and Emotion Management Skills Scale. The current study used SPSS PROCESS, an SPSS macro developed by Hayes. Results indicated that Covid-19 anxiety was related to poor sleep quality and emotion regulation was related to good sleep quality. Gender was a significant moderator for the relationship between Covid-19 anxiety and sleep quality, but not emotion regulation and sleep quality. The female gender presented a positive association between Covid-19 anxiety and poor sleep quality in comparison to the male gender. The relationship between emotion regulation and good sleep quality was found to be significant and positive for both genders. In the pandemic, Covid-19 anxiety should be reduced and people should have skills to manage their emotions. Otherwise, they will experience serious sleep problems.

Keywords

• Sleep quality
• Covid-19 anxiety
• emotion regulation.

References

1. Adams, S. K., & Kisler, T. S. (2013). Sleep quality as a mediator between technology-related sleep quality, depression, and anxiety. Cyberpsychology, Behavior, and Social Networking, 16(1), 25–30. https://doi.org/10.1089/cyber.2012.0157
2. Ağargün, M. Y., Kara, H., & Anlar, Ö. (1996). Pittsburgh uyku kalite indeksi’nin geçerliği ve güvenirliği. Turk Psikiyatri Dergisi 7(2), 107-15.
3. Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020) The Fear of COVID-19 Scale: development and initial validation. International Journal of Mental Health and Addiction, 1. https://doi.org/10.1007/s11469-020-00270-8
4. Al-Qaisy, L. M. (2011). The relation of depression and anxiety in academic achievement among group of university students. International Journal of Psychology and Counselling, 3(5), 96-100.
5. Baum, K. T., Desai, A., Field, J., Miller, L. E., Rausch, J., & Beebe, D. W. (2014). Sleep restriction worsens mood and emotion regulation in adolescents. Journal of Child Psychology and Psychiatry, 55(2), 180-190.
6. Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43(8), 667-672.
7. Bigalke, J. A., Greenlund, I. M., & Carter, J. R. (2020). Sex differences in self-report anxiety and sleep quality during COVID-19 stay-at-home orders. Biology of Sex Differences, 11(1), 1-11.
8. Buysse, D. J., Reynolds, C. R., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res, 28, 193-213.

9. Chaplin, T. M., Hong, K., Bergquist, K., & Sinha, R. (2008). Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Alcoholism: Clinical and Experimental Research, 32(7), 1242-1250.
10. Creswell, J. W. (2012). Educational research: Planning, conducting, and evaluating quantitative and qualitative research. Pearson.
11. Çeçen, A. R. (2006). Duyguları yönetme becerileri ölçeği’nin geliştirilmesi: Geçerlik ve güvenirlik çalışmaları. Türk Psikolojik Danışma ve Rehberlik Dergisi, 3(26), 101-113.
12. Debrot, A., Cook, W. L., Perrez, M., & Horn, A. B. (2012). Deeds matter: Daily enacted responsiveness and intimacy in couples’ daily lives. Journal of Family Psychology, 26, 617–627
13. Derdikman‐Eiron, R., Indredavik, M. S., Bratberg, G. H., Taraldsen, G., Bakken, I. J. & Colton, M. (2011). Gender differences in subjective well‐being, self‐esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord‐Trøndelag health study. Scandinavian Journal of Psychology, 52, 261–267.
14. Gaeta, M. L., Gaeta, L., & Rodriguez, M. D. S. (2021). The impact of COVID-19 home confinement on mexican university students: Emotions, coping strategies, and self-regulated learning. Frontiers in Psychology, 12, 1323.
15. Galland, B. C., Gray, A. R., Penno, J., Smith, C., Lobb, C., & Taylor, R. W. (2017). Gender differences in sleep hygiene practices and sleep quality in New Zealand adolescents aged 15 to 17 years. Sleep Health, 3(2), 77-83.
16. Garnefski, N., Teerds, J., Kraaij, V., Legerstee, J., & van den Kommer, T. (2004). Cognitive emotion regulation strategies and depressive symptoms: Differences between males and females. Personality and Individual Differences, 36, 267–276.
17. Goubet, K. E., & Chrysikou, E. G. (2019). Emotion Regulation Flexibility: Gender Differences in Context Sensitivity and Repertoire. Frontiers in Psychology, 10, 935.
18. Gregory, A. M., Buysse, D. J., Willis, T. A., Rijsdijk, F. V., Maughan, B., Rowe R, et al. (2011). Associations between sleep quality and anxiety and depression symptoms in a sample of young adult twins and siblings. J Psychosom Res. 71(4), 250–5.
19. Gross, J. J. (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology, 2(3), 271.
20. Haberturk, (April, 2020). https://www.haberturk.com/koronavirus-oldugunu-ogrenince-intihar-etti-2636634-spor
21. Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Research, 112954.
22. IMC, (2014). Assessment of mental health and psychosocial support (MHPSS) needs and resources in the context of Ebola.
23. Iqbal, S., Gupta, S., & Venkatarao, E. (2015). Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates. The Indian Journal of Medical Research, 141(3), 354.
24. Kamara, S., Walder, A., Duncan, J., Kabbedijk, A., Hughes, P. & Muana. A. (2017). Mental health care during the Ebola virus disease outbreak in Sierra Leone. Bull. World Health Organ., 95, 842-847.
25. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617-627.
26. Kirwan, M., Svenson, D. W., Pickett, S. M., & Parkhill, M. R. (2019). Emotion regulation as a mediator between sleep quality and interpersonal aggression. Personality and Individual Differences, 148, 32-37.
27. Kyle, S. D., Miller, C. B., Rogers, Z., Siriwardena, A. N.,MacMahon, K. M., & Espie, C. A. (2014). Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: Implications for the clinical management of insomnia disorder. Sleep, 37(2), 229–237. https://doi.org/10.5665/sleep.3386
28. Lafrance-Robinson, A., Kosmerly, S., Mansfield-Green, S., & Lafrance, G. (2014). Disordered eating behaviours in an undergraduate sample: associations among gender, body mass index, and difficulties in emotion regulation. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement, 46, 320-326, doi: 10.1037/a0031123
29. Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Tan, H. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3).
30. Latif, I., Hughes, A. T., & Bendall, R. C. (2019). Positive and negative affect mediate the influences of a maladaptive emotion regulation strategy on sleep quality. Frontiers in Psychiatry, 10, 628.
31. Lee, D. K. (2016). Alternatives to P value: confidence interval and effect size. Korean Journal of Anesthesiology, 69(6), 555.
32. Lee, S. M., Kang, W. S., Cho, A. R., Kim, T., & Park, J. K. (2018). Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry, 87, 123-127.
33. Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., ... & Liu, W. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research, 112921.
34. Liu, Y., Zhang, N., Bao, G., Huang, Y., Ji, B., Wu, Y., ... & Li, G. (2019). Predictors of depressive symptoms in college students: A systematic review and meta-analysis of cohort studies. Journal of Affective Disorders, 244, 196-208.
35. Madrid-Valero, J. J., Martínez-Selva, J. M., Couto, B. R. D., Sánchez-Romera, J. F., & Ordoñana, J. R. (2017). Age and gender effects on the prevalence of poor sleep quality in the adult population. Gaceta Sanitaria, 31, 18-22.
36. Mahmoud, J. S. R., Staten, R. T., Hall, L. A., & Lennie, T. A. (2012). The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing, 33(3), 149-156.
37. Majedi, S., & Majedi, S. (2020). Existing drugs as treatment options for COVID-19: A brief survey of some recent results. Journal of Chemistry Letters, 1(1), 2-8.
38. Mann, R. E., Ialomiteanu, A. R., Chan, V., Cheung, J. T. W., Stoduto, G., Ala-Leppilampi, K., … Rehm, J. (2012). Relationships of alcohol use and alcohol problems to probable anxiety and mood disorder. Contemporary Drug Problems, 39(2), 247–263. https://doi.org/10.1177/009145091203900204
39. Masumoto, K., Taishi, N., & Shiozaki, M. (2016). Age and gender differences in relationships among emotion regulation, mood, and mental health. Gerontology and Geriatric Medicine, 2, 2333721416637022.
40. Mauss, I. B., Troy, A. S., & LeBourgeois, M. K. (2013). Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm. Cognition & Emotion, 27(3), 567-576.
41. McAlonan, G. M., Lee, A. M., Cheung, V., Cheung, C., Tsang, K. W., Sham, P. C., Chua, S. E., & Wong. J. G. (2007). Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry, 52, 241-247. Doi: 10.1177/070674370705200406
42. McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of psychiatric research, 45(8), 1027-1035.
43. McRae, K., Ochsner, K. N., Mauss, I. B., Gabrieli, J. J. D., & Gross, J. J. (2008). Gender differences in emotion regulation: An fMRI study of cognitive reappraisal. Group Processes & Intergroup Relations, 11(2), 145–162. doi: 10.1177/1368430207088035
44. Mendes, W. B., Reis, H. T., Seery, M. D., & Blascovich, J. (2003). Cardiovascular correlates of emotional expression and suppression: Do content and gender context matter? Journal of Personality and Social Psychology, 84, 771–792.
45. NTV, (April, 2020). https://www.ntv.com.tr/turkiye/coronadankorunmak-icin-ictigi-dezenfektan-ve-etil-alkol-sonu-oldu,jSQNHxj2xUmn0e1IczA1CA
46. Paules, C. I., Marston, H. D., & Fauci, A. S.( 2020). Coronavirus infections-more than just the common cold. JAMA, 323(8), 707-708. doi:10.1001/jama.2020.0757.
47. Pickett, S. M., Barbaro, N., & Mello, D. (2016). The relationship between subjective sleep disturbance, sleep quality, and emotion regulation difficulties in a sample of college students reporting trauma exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 25.
48. Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry, 33(2).
49. O’Leary, K., Bylsma, L. M., & Rottenberg, J. (2017). Why might poor sleep quality lead to depression? A role for emotion regulation. Cognition and Emotion, 31(8), 1698-1706.
50. Racine, C., Kalra, K., Ceide, M., Williams, N. J., Zizi, F., Mendlowicz, M. V., & Jean-Louis, G. (2013). Sleep duration, insomnia symptoms, and emotion regulation among black women. Journal of Sleep Disorders & Therapy, 2(122).
51. Rajeswari, S., & SanjeevaReddy, N. (2020). Efficacy of progressive muscle relaxation on pregnancy outcome among anxious Indian primi mothers. Iranian Journal of Nursing and Midwifery Research, 25(1), 23.
52. Rehman, A., Gumley, A., & Biello, S. (2018). Sleep quality and paranoia: the role of alexithymia, negative emotions and perceptual anomalies. Psychiatry Research, 259, 216-222.
53. Satici, B., Gocet-Tekin, E., Deniz, M. E., & Satici, S. A. (2020). Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. International Journal of Mental Health and Addiction, 1. https://doi.org/10.1007/s11469-020-00294-0
54. Smrtnik-Vitulić, H., & Prosen, S. (2016). Coping and emotion regulation strategies in adulthood: Specificities regarding age, gender and level of education. Društvena Istraživanja: Časopis Za Opća Društvena Pitanja, 25(1), 43-62.
55. Spaapen, D. L., Waters, F., Brummer, L., Stopa, L., & Bucks, R. S. (2014). The Emotion Regulation Questionnaire: Validation of the ERQ-9 in two community samples. Psychological Assessment, 26, 46-54.
56. Sutton, E. L. (2014). Psychiatric disorders and sleep issues. Medical Clinics of North America, 98(5), 1123-1143. https://doi.org/10.1016/j.mcna.2014.06.009
57. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6. Ed.). Pearson
58. Taherdoost, H. (2016). Sampling methods in research methodology; how to choose a sampling technique for research. International Journal of Advance Research in Management, 5(2), 18-27.
59. Tavernier, R., & Willoughby, T. (2015). A longitudinal examination of the bidirectional association between sleep problems and social ties at university: The mediating role of emotion regulation. Journal of youth and Adolescence, 44(2), 317-330.
60. Tung, Y. J., Lo, K. K., Ho, R. C., & Tam, W. S. W. (2018). Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Education Today, 63, 119-129.
61. van Middendorp, H., Geenen, R., Sorbi, M. J., Hox, J. J., Vingerhoets, A. J. J. M., van Doornen, L. J. P., & Bijlsma, J. W. J. (2005). Gender differences in emotion regulation and relationships with perceived health in patients with rheumatoid arthritis. Women & Health, 42(1), 75–97.
62. Vantieghem, I., Marcoen, N., Mairesse, O., & Vandekerckhove, M. (2016). Emotion regulation mediates the relationship between personality and sleep quality. Psychology & Health, 31(9), 1064-1079.
63. Vriend, J. L., Davidson, F. D., Corkum, P. V., Rusak, B., Chambers, C. T., & McLaughlin, E. N. (2013). Manipulating sleep duration alters emotional functioning and cognitive performance in children. Journal of Pediatric Psychology, 38 (10), 1058-1069.
64. Williams, L. M., & Barry, J. (2003). Do sex differences in emotionality mediate sex differences in traits of psychosis-proneness? Cognition and Emotion, 17, 747–758.
65. World Health Organization, (2020a). Coronavirus disease (COVID-19) pandemic. Accessed July 14, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
66. World Health Organization, (2020b). Current novel coronavirus (2019-nCoV) outbreak. Accessed July 14, 2020. https://www.who.int/health-topics/coronavirus
67. Zhang, B., & Wing, Y. K. (2006) Sex differences in insomnia: a meta-analysis. Sleep. 29, 85-93.