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Coping, symptoms, and insomnia among people with heart failure during the COVID-19 pandemic
Meghan O'Connell1, Sangchoon Jeon1, Samantha Conley1
1Yale School of Nursing, 300 Heffernan Drive, West Haven, CT 06516, USA.
Insights
Poor sleep and mood disturbances in heart failure patients during COVID-19 predicted coping strategies. Improving sleep may enhance coping and offer protective effects.
Area of Science:
- Cardiology
- Sleep Medicine
- Psychiatry
Background:
- The COVID-19 pandemic exacerbated stress, anxiety, depression, and sleep issues, particularly impacting individuals with chronic conditions like heart failure (HF).
- People with HF are a vulnerable population susceptible to heightened psychological distress and sleep disturbances during public health crises.
Purpose of the Study:
- To investigate how sleep characteristics, cognitions, anxiety, depression, and stress predict coping mechanisms in HF patients during the COVID-19 pandemic.
- To analyze changes in these factors over time and their relationship with coping strategies within the HeartSleep study cohort.
Main Methods:
- Participants (n=112) with HF completed validated questionnaires assessing sleep, mood, stress, and coping during the pandemic (June-August 2020).
- Data were collected at baseline, 6 months post-intervention, and during the pandemic, including measures of insomnia severity, anxiety, depression, perceived stress, and sleep-related cognitions.
- Coping strategies were assessed, focusing on secondary control coping, involuntary engagement, and involuntary disengagement.
Main Results:
- 43% of participants reported pandemic-related stressors, with secondary control coping being the most frequently employed strategy.
- Insomnia severity, anxiety, depression, perceived stress, and sleep-related cognitions significantly predicted various coping responses, including positive thinking, cognitive restructuring, acceptance, distraction, rumination, and emotional numbing.
- Specific sleep and mood disturbances were linked to different coping styles, highlighting the complex interplay between psychological state and stress management.
Conclusions:
- Insomnia and mood disturbances are critical determinants of how individuals with HF cope with and respond to stress.
- Interventions aimed at improving sleep and alleviating mood symptoms in HF patients may enhance their ability to cope with stressful events.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) may offer protective benefits for coping during stressful periods, warranting further investigation.
Aims:
Increases in stress, symptoms of anxiety and depression, and sleep problems have been reported during the Covid-19 pandemic, and people with chronic medical conditions such as heart failure (HF) are especially vulnerable. The purpose of this study was to examine the extent to which sleep characteristics, sleep-related cognitions, anxiety, depression, perceived stress, and changes in these phenomena over time predict ways of coping with pandemic-related stress among participants in the HeartSleep study, a randomized controlled trial of the effects of cognitive behavioural therapy for insomnia (CBT-I) in people with HF.
Methods And Results:
Participants completed questionnaires to elicit sleep characteristics, daytime symptoms, mood and stress at baseline, 6 months after the intervention and during the Covid-19 pandemic. We added measures of coping during the pandemic (June-August 2020). The sample included 112 participants (M age = 63 ± 12.9 years; 47% women; 13% Black; 68% NY Heart Class II or III). Participants (43%) reported pandemic-related stressors and most often used secondary control coping. Insomnia severity, anxiety, depression, perceived stress, and sleep-related cognitions predicted secondary control coping (positive thinking, cognitive restructuring, acceptance, distraction), involuntary engagement (physiological arousal, rumination), and involuntary disengagement (emotional numbing).
Conclusions:
Insomnia and mood disturbance are important determinants of coping and responses to stress. Improving sleep and symptoms among people with HF may improve coping during stressful events, and CBT-I may have protective effects.
Registration:
ClinicalTrials.gov: NCT02660385.
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