Psychological resilience to trauma and longitudinal sleep outcomes among current and former nurses

A life-disrupting stressor (e.g. pandemic) may cause or exacerbate poor sleep health; resilience may offset impacts. We assessed relationships between pre-pandemic psychological resilience to trauma and sleep-related outcomes during the first year of the pandemic among current and former nurses.

Using data from 18,670 women in the Nurses' Health Study II, we characterized pre-pandemic resilience by cross-classifying experiences of higher versus lower lifetime trauma burden with unfavorable, adequate, and favorable psychological health (through January 2020). Sleep was measured before (2017) and during the pandemic, including: changes, quality, and duration. We modeled trajectories of sleep duration assessed at five time points (pre-pandemic in 2017, and then in four COVID-19-related surveys, 2020-2021) using latent class growth analysis.

We observed four trajectories of sleep duration, all showing stable patterns, with averages ranging from 5.5 to 6 to 8.5-9 h of sleep per 24 h. Women with higher trauma/unfavorable psychological health had the highest risk for all poor sleep outcomes (e.g., RR for being in the shortest sleep trajectory versus healthy sleep duration: 2.53; 95 % CI: 2.21, 2.91). Relative to women categorized as most resilient, only women with lower trauma/favorable psychological health showed lower risk of getting less sleep after the pandemic started compared to no change (RR: 0.76; 95 % CI: 0.70, 0.83). This same pattern was observed for poor sleep quality.

Higher pre-pandemic resilience may have protected women against poor sleep outcomes during the pandemic. Findings could have long-term health implications, particularly if they generalize to other stressors.