Background: Jordan, a Middle Eastern country, declared a state of national emergency due to the novel coronavirus (COVID-19) and a strict nation-wide lockdown on March 17, 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (e.g., anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19 induced nation-wide lockdown.

Methods: Using Facebook, participants (N=1,240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from GAD-7 instrument), depressive symptoms (items from DES-10), sleep health (items from the PSQI), and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (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 percent 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 =6.12–13.08), short sleep duration (aPR =2.23; 95% CI = 1.91–2.61), and at least one problem sleep problem (aPR = 1.73; 95% CI = 1.54–1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared to scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR = 11.82; 95% CI = 6.64 – 21.04), short sleep duration (aPR = 1.87; 95% CI = 1.58–2.22), and experiencing at least one sleep problem (aPR = 1.90; 95% CI = 1.66 – 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 nation-wide lockdown.