(PS7-B31) Impact of Insomnia as COVID-19 Restrictions Decrease: Effect on Mental Health, Particularly Among Sexual Minorities

The COVID-19 pandemic has been linked to worsened sleep health and higher rates of mental health concerns. Poor sleep can negatively impact the ability to cope with stress, and has been linked with increased risk of major depressive episodes and suicidal ideation. Although few studies have investigated sleep health in sexual minorities (SM), results show sleep disparities compared to heterosexuals and subsequent links to depression.

College students may be at particular risk for worsened sleep health due to less regulated sleep-wake patterns related to diminished structure in school during the pandemic. Although studies have investigated sleep health and mental health impacts in college students, many of these findings focused on the early months of the pandemic. The current study examined the association between insomnia severity and mental health concerns across Spring 2021, Fall 2021, and Spring 2022 semesters, and differences among these outcomes for SM. We hypothesized that 1) students with more severe insomnia symptoms would report greater mental health concerns, 2) these relations would be worse among SM, and 3) insomnia severity and mental health concerns would improve across semesters for all students given decreased COVID-19 constraints and more regulated sleep-wake patterns.

Participants included 618 undergraduate students (110 of whom were SM) recruited across three semesters. The Insomnia Severity Index (ISI) was used as a measure of insomnia severity. Total scores were coded ordinally: absence of insomnia (0–7); sub-threshold insomnia (8–14); moderate insomnia (15–21); and severe insomnia (22–28). Participants also completed the Depression Anxiety Stress Scales (DASS) and Suicide Behaviors Questionnaire-Revised (SBQ-R) as a measure of mental health concerns.

In support of hypothesis 1, mental health concerns were significantly worse for those reporting greater insomnia severity. Hypothesis 2 was partially supported: SM status was associated with higher depressive symptoms, stress, and higher likelihood of future suicidal behavior (LFSB), although there was no association with insomnia severity. Hypothesis 3 was partially supported: depressive symptoms improved across semesters for participants reporting severe and subthreshold insomnia levels. Conversely, LFSB worsened across semesters for those reporting severe clinical and no clinically significant insomnia. Among SM, depressive symptoms decreased from 2021 to 2022 across all insomnia levels, except for no clinically significant insomnia. Additionally, LFSB decreased from 2021 to 2022 for SM who reported subthreshold to moderate clinical insomnia. Conversely, LFSB increased from 2021 to 2022 for SM who reported severe clinical and no clinically significant insomnia.

These findings are consistent with the current literature but extend it by evidencing improvements in some mental health concerns during later phases of the pandemic. Additionally, findings supported that some levels of insomnia were associated with improvement in depressive symptoms and LFSB as pandemic restrictions decreased, especially among SM. The varying impact of insomnia severity implies that certain levels of insomnia lead to more distress and clinical effects.