Age, Gender, and Chronotype Affect Sleep, Mental Health During COVID-19 Pandemic

A small improvement in decreased sleep disturbances, insomnia, depressive and anxiety symptoms was observed 2 years after the pandemic.

Younger age, female gender, and evening chronotype significantly influenced mental health status and sleep variables during the COVID-19 pandemic, according to study findings published in the Journal of Sleep Research.

Researchers in Italy conducted a longitudinal study from March 25, 2020 to April 22, 2022 to analyze sleep disturbance patterns and general mental health status during the COVID-19 pandemic.

The researchers surveyed 1062 Italian citizens (80% female) at 3 different times using web-based questionnaires.  The first 2 assessments took place at the height of the contagion peaks during the first lockdown in the spring of 2020 and the second wave during the winter of 2020. The third assessment took place 2 years following the first assessment.

The validated questionnaires evaluated sleep quality/habits and insomnia as well as symptoms of depression, stress, and anxiety. These included the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Morningness-Eveningness Questionnaire-reduced version, the Beck Depression Inventory-II, the 10-item Perceived Stress Scale, and the state-anxiety subscale of the State-Trait Anxiety Inventory.

The persistence of high stress levels…between age groups, genders and chronotypes suggest that people transversely continued to feel the burden of this unprecedented and protracted historical period.

Stress levels increased between March 2020 to December 2020; however, stress levels remained unchanged between the second and third assessments regardless of age, gender, or chronotype.

Anxiety, depression, and sleep disturbances, such as insomnia, improved incrementally across the 3 time points. Sleep quality also improved during the third assessment compared with the earlier 2 assessments.

Age, gender, and chronotype affected sleep variables and psychological symptoms. Older age and female gender correlated with poorer sleep quality and more severe insomnia. Evening chronotypes (individuals who are more productive at night or dawn) correlated with lower sleep quality, more severe insomnia, and shorter total sleep time. Younger age, female gender, and eveningness all correlated with more severe depressive symptoms and higher perceived stress levels.  

Overall, the pandemic significantly impacted sleep habits and total sleep time. The researchers observed a trend in younger people (P =.008) and people with evening or late chronotypes for progressively decreasing sleep duration (P <.001; P =.028, respectively) and increasing daytime dysfunction (P <.028, all).

In general, people in Italy reported significantly earlier bedtimes and wake-up times during the second (-34.567 min, P <.001; -50.400 min, P <.001; respectively) and third (-50.400 min, P <.001; -70.567 min, P <.001; respectively) assessments compared with the first.

“The reestablishment of pre-pandemic social and working dynamics configured a negative effect on sleep duration, which was reduced among the overall sample, and more strongly in particular population groups such as younger and evening-type people,” the researchers noted. “The persistence of high stress levels…between age groups, genders and chronotypes suggest that people transversely continued to feel the burden of this unprecedented and protracted historical period.”

Study limitations included lack of generalizability outside of the Italian population, the predominance of female participants, the recruitment using a non-probabilistic sampling method, the reliance on self-reported data increasing likelihood for response biases, and lack of a baseline prepandemic comparison of data points.


Salfi F, Amicucci G, Corigliano D, et al. Two years after lockdown: longitudinal trajectories of sleep disturbances and mental health over the COVID-19 pandemic, and the effects of age, gender and chronotype. J Sleep Res. Published online November 1, 2022. doi:10.1111/jsr.13767