Abstract
INTRODUCTION: The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk. METHODS: N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm. RESULTS: Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps<.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps<.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p<.0001) after controlling for demographic variables. DISCUSSION: Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.