Page 83 - IJPS-9-1

International Journal of
Population Studies COVID-19, economic crisis, insomnia, and stress

poverty and having more dependent children in this treatment or not having enough money to afford medications
study. Employed people also displayed higher PTSS levels and disease management (Kumar Kar et al., 2020).
compared to those who never worked (mainly retired, Finally, PTSS and insomnia levels were higher
housewives, and non-working students). Indeed, these in individuals with lower family support (lower
persons were highly preoccupied with the wilting economy APGAR scores), consistent with the previous studies
and the consequences of the COVID-19 pandemic and showing that loneliness was positively correlated with
subsequent lockdown on their work. They were unable to mental health issues during the COVID-19 pandemic
resume their regular professional activities; they also faced (Kokou-Kpolou et al., 2020; Voitsidis et al., 2020) and that
unexpected expenses and could not anticipate the long- family support promoted positive mental health status
term detrimental impacts of the pandemic on the economy. (Zhang & Ma, 2020).
Therefore, people who feared poverty and worried about
not being able to secure their children’s needs experienced 4.4. PTSS, fear of COVID-19, and insomnia
uncontrollable cognitive arousal, which is known to affect
the quality of sleep (Brooks et al., 2020). Regarding the correlation between PTSS and insomnia,
our results showed that each of these disorders could be a
Finally, those who feared not being able to access predictive factor of the other after adjustment for potential
treatment had higher levels of PTSS, which is directly related confounders. This outcome was expected since previous
to the fear of contracting the virus and not being able to afford studies widely explored their relationships (Casagrande
treatment and isolation measures. Even if human rights call et al., 2020; Sun et al., 2020), revealing that poor quality
for the “right to health,” especially during this pandemic, of sleep is linked to both onset and maintenance of PTSS
granting access to health-care services and social security (Brooks et al., 2020), regardless of FOC. Interestingly,
are hard to manage in economically crippled countries such when including PTSS as an independent variable in the
as Lebanon (Armocida et al., 2020; WHO, 2020). model with insomnia as a dependent variable, FOC was no
longer associated with insomnia; this was not the case for
4.3. Sociodemographic factors, PTSS, and insomnia
economy-related variables that would be independently
PTSS was associated with some sociodemographic factors, associated with insomnia. To the best of our knowledge,
such as gender, age, and waterpipe/cigarette smoking these results have never been described previously.
status; it was higher among women and current smokers
but inversely correlated with older age. Our results are A recent review evidenced overlapping clinical
consistent with existing literature showing that gender and characteristics between sleep disturbance and anxiety-
age were predictors of PTSD during previous infectious related disorders, including PTSS, with a bidirectional
disease outbreaks (Xu et al., 2011) or the current pandemic relationship between both disorders (Richards et al., 2020).
(Casagrande et al., 2020; Liu et al., 2020). Indeed, women The authors discussed that sleep disorders and nightmares
usually exhibit higher stress, anxiety, and helplessness occurred at a high frequency following trauma and/or in
than men, which could be related to the higher reactivity PTSS (Mysliwiec et al., 2018; Mysliwiec et al., 2014). One
of fear-associated neural networks in women’s brains possible explanation is that FOC could lead to panicked
(Felmingham et al., 2010). awakenings, increased physical movement during sleep,
and nightmares. These symptoms are typically observed
Regarding smoking status, a recent review of the following trauma, which explains the association of PTSS
literature revealed that smokers were approximately twice with insomnia (Richards et al., 2020). Some authors call it
more likely to have PTSD than non-smokers in the general “trauma-associated sleep disorder” (Mysliwiec et al., 2018;
population and that individuals with PTSD were about Mysliwiec et al., 2014). Additional studies are needed to
twice as likely to be current smokers. These outcomes elucidate the underlying mechanisms between FOC, PTSS,
could be partly explained by the expectation that smoking and insomnia.
would reduce the detrimental consequences of PTSD
symptoms, which, in turn, would increase the smoking 4.5. Limitations and strengths
rate and nicotine dependence (Kearns et al., 2018). Our study presents some limitations, mainly due to the

As for insomnia, patients suffering from violence study design and online data collection that consists of a
(physical) were more prone to insomnia, in agreement with a small cross-sectional non-randomized analysis without
recent review that identified an overall relationship between baseline evaluation. Furthermore, most participants
interpersonal violence and poor quality of sleep (Gallegos were university graduates, had appropriate computer
et al., 2019). Moreover, higher levels of insomnia were literacy, and access to the Internet, and we used a snowball
perceived by patients who feared not being able to access technique for data; thus, selection bias might have

Volume 9 Issue 1 (2023) 77 https://doi.org/10.36922/ijps.440