Longitudinal trajectories of insomnia symptoms among college students during the COVID-19 lockdown in China

Purpose: This study aimed to examine the patterns and predictors of the trajectories of college students' insomnia symptoms across different stages of the COVID-19 pandemic. Methods: A total of 35,516 college students completed three online surveys during the COVID-19 outbreak period (3-10 February 2020), initial remission period (24 March-3 April 2020), and effective control period (1-15 June 2020), respectively. These surveys measured the participants' socio-demographic and pandemic related factors, insomnia symptoms, mental health status, and psychosocial factors. Multivariate logistic regressions were used to examine predictors for trajectory membership. Results: The prevalence of insomnia symptoms increases during home quarantine. Five insomnia symptoms trajectories were observed: resistance (82.8% of the sample), recovery (5.0%), delayed-dysfunction (5.8%), chronic-dysfunction (1.8%), and relapsing/remitting (4.6%). Female gender, residence location in urban, has history of sleep problems, smoking, alcohol use, community or village has confirmed COVID-19 cases, current poor mental health, higher negative coping were related to higher risk of developing insomnia symptoms in at least one time point, whereas better family function increased the possibility of recovery relative to chronic dysfunction. Lower social support and positive coping could also cause insomnia chronicity. Conclusion: Adolescents have different trajectories of insomnia symptoms during pandemic lockdown. Although most adolescents did not experience insomnia or recovered over time, some adolescents, especially those with the risk factors noted above, exhibit delayed or chronic symptoms. These findings could inform mental health professionals regarding how to provide individualized and appropriate intervention for college students after their return to school.