Associations between COVID-19 related stigma and sleep quality among COVID-19 survivors six months after hospital discharge

Leiwen Fu; Bingyi Wang; Paul Shing Fong Chan; Dan Luo; Weiran Zheng; Niu Ju; Yuqing Hu; Xin Xiao; Hui Xu; Xue Yang; Yuan Fang; Zhijie Xu; Ping Chen; Jiaoling He; Hongqiong Zhu; Huiwen Tang; Dixi Huang; Zhongsi Hong; Xiaojun Ma; Yanrong Hao; Lianying Cai; Jianrong Yang; Jianhui Yuan; Yao-Qing Chen; Fei Xiao; Zixin Wang; Shupei Ye; Huachun Zou

doi:10.1016/j.sleep.2021.10.020

Associations between COVID-19 related stigma and sleep quality among COVID-19 survivors six months after hospital discharge

Sleep Med. 2022 Mar:91:273-281. doi: 10.1016/j.sleep.2021.10.020. Epub 2021 Oct 21.

Authors

Leiwen Fu¹, Bingyi Wang¹, Paul Shing Fong Chan², Dan Luo¹, Weiran Zheng¹, Niu Ju¹, Yuqing Hu¹, Xin Xiao³, Hui Xu¹, Xue Yang², Yuan Fang⁴, Zhijie Xu⁵, Ping Chen⁵, Jiaoling He⁵, Hongqiong Zhu⁵, Huiwen Tang⁵, Dixi Huang⁵, Zhongsi Hong⁵, Xiaojun Ma⁶, Yanrong Hao⁷, Lianying Cai⁸, Jianrong Yang⁹, Jianhui Yuan¹⁰, Yao-Qing Chen¹, Fei Xiao⁵, Zixin Wang², Shupei Ye¹¹, Huachun Zou¹²

Affiliations

¹ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
² JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
³ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁴ Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong SAR, China.
⁵ The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁶ Guangdong Provincial People's Hospital, Guangzhou, China.
⁷ Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁸ Department of Education, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁹ Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
¹⁰ Shenzhen Nanshan District Center for Disease Control and Prevention, Shenzhen, China.
¹¹ Department of Emergency, SSL Central Hospital of Dongguan City, Dongguan, China.
¹² School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia; Shenzhen Center for Disease Control and Prevention, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, China. Electronic address: zouhuachun@mail.sysu.edu.cn.

Abstract

Background: Many COVID-19 survivors reported stigmatization after recovery. This study investigated the association between stigma (discrimination experiences, self-stigma and perceived affiliate stigma) and sleep quality among COVID-19 survivors six months after hospital discharge.

Methods: Participants were recovered adult COVID-19 survivors discharged between February 1 and April 30, 2020. Medical staff of five participating hospitals approached all discharged COVID-19 period during this period. A total of 199 participants completed the telephone interview during July to September, 2020. Structural equation modeling was performed to test the hypothesize that resilience and social support would mediate the associations between stigma and sleep quality.

Results: The results showed that 10.1% of the participants reported terrible/poor sleep quality, 26.1% reported worse sleep quality in the past week when comparing their current status versus the time before COVID-19. After adjusting for significant background characteristics, participants who had higher number of discrimination experience, perceived stronger self-stigma and stronger perceived affiliate stigma reported poorer sleep quality. Resilience and social support were positively and significantly associated with sleep quality. The indirect effect of self-stigma on sleep quality through social support and resilience was significant and negative. Perceived affiliate stigma also had a significant and negative indirect effect on sleep quality through social support and resilience.

Conclusions: Various types of stigma after recovery were associated with poor sleep quality among COVID-19 survivors, while social support and resilience were protective factors. Resilience and social support mediated the associations between self-stigma/perceived affiliate stigma and sleep quality.

Keywords: COVID-19 survivors; China; Resilience; Sleep quality; Social support; Stigma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19*
Hospitals
Humans
Patient Discharge
Sleep Initiation and Maintenance Disorders*
Sleep Quality
Social Support
Survivors