Prospective Associations of COVID‐19 Pandemic‐Related Stressful Events With Mental and Sleep Health in a Population‐Based Cohort Study of Adults With SARS‐CoV‐2 Infection

COVID-19 pandemic-related stressful events are associated with adverse mental health outcomes; however, prior evidence is limited due to cross-sectional designs or convenience sampling, with little focus on sleep health. We examined prospective associations of COVID-19 pandemic-related stressful events at baseline with mental health and sleep health at follow-up using a population-based cohort of Michigan adults with PCR-confirmed COVID-19. We measured COVID-19-related stressful events using the 6-item Epidemic-Pandemic Impacts Inventory (EPII), designed to assess pandemic impacts across personal and social life domains. We conducted (1) modified Poisson regression with robust standard errors for depressive symptoms, anxiety symptoms, COVID-19-related post-traumatic stress disorder (PTSD) symptoms, and poor-to-very poor sleep quality and (2) multinomial logistic regression for sleep duration (< 6, 6-9, > 9 h). We adjusted for sociodemographic, clinical, and survey factors. Our analytic samples were n = 3523 for mental health and n = 3191 for sleep health. Each additional COVID-19-related stressful event reported was associated with a higher risk of reporting depressive symptoms (adjusted risk ratio [aRR]: 1.22, 95% confidence interval [CI]:1.14-1.30), anxiety symptoms (aRR: 1.20, 95% CI: 1.14-1.27) and COVID-19-related PTSD symptoms (aRR: 1.31, 95% CI: 1.22-1.42). Each additional COVID-19-related stressful event reported was also associated with a 1.13 times higher risk of reporting poor-to-very poor sleep quality (95% CI: 1.07-1.20). In the multinomial logistic regression models, stressful events were associated with a 1.21 (95% CI: 1.06-1.37) higher risk of sleeping < 6 h relative to sleeping 6-9 h. We need social support services and programs to improve psychological and behavioural responses to COVID-19-related stressful events.