High risk of infection caused posttraumatic stress symptoms in individuals with poor sleep quality: A study on influence of coronavirus disease (COVID-19) in China

Fan Zhang; Zhilei Shang; Haiying Ma; Yanpu Jia; Luna Sun; Xin Guo; Lili Wu; Zhuoer Sun; Yaoguang Zhou; Yan Wang; Nianqi Liu; Weizhi Liu

According to the Diagnostic and Statistical Manual of Mental Disorders-5th edition (APA, 2013), Posttraumatic Stress Disorder (PTSD) is characterized by four symptom groups: (a) involuntary memories of the trauma such as intrusions or nightmares; (b) persistent avoidance of stimuli associated with the traumatic event; (c) negative alterations in cognitions and mood that are associated with the trauma; and (d) alterations in arousal and reactivity that are associated with the trauma. Also in DSM-5, exposure to traumatic events is the immediate causes of PTSD and an essential condition of diagnosis. Being infected with a life-threatening physical illness is a traumatic event and can lead to posttraumatic stress symptoms. For example, 12%-15% survivors of SARS showed one type of PTSD symptom (PTSS) at one month after discharge (Wu et al, 2005) ; the morbidity of PTSD in patients with traumatic injury reached 9.6% at months (Bryant et al., 2017) . In addition, not only being attacked by traumatic illness could cause PTSD symptoms, being contacts and carers of a deadly virus could also lead to symptoms like alternations in mood and arousal (Tine et al., 2016) . Living in the endemic area, every Chinese is a carer and a ( Previous studies have proved that massive outbreaks of epidemics like SARS and Ebola virus disease (EVD) could cause sleep problems in relevant individuals. For example, Yu et al. (2005) reported that midlife women felt "sleep was restless" during SARS and this problem was closely associated with their overall negative emotions. Another study showed that chronic post-SARS symptoms were characterized by sleep-related problems (Moldofsky and Patcai, 2011) . Survivors of EVD also reported various sleep quality problems (Keita et al., 2017) . More importantly, Sleep and PTSS are closely related, and sleep disturbances are core features of PTSD. According to the model raised by Richard et al. (2020) , sleep disturbances (short sleep duration, frequent arousals, and et al.) could lead to maladaptive sleep-related compensatory behaviors and cause hyperarousal and anxiety-related disorders like PTSD. Sleep disruption also promoted anxious emotions by disrupt emotion regulation and adaptive memory functions. Thus, it was reasonable to hypothesize that wide-spread transmission of COVID-19 could causes sleep problems in Chinese and result in PTSS.