Wang Dongfang, Zhou Liang, Wang Jiali, Sun Meng
Department of Social Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China.
School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, People's Republic of China.
Nat Sci Sleep. 2021 Nov 9;13:2029-2037. doi: 10.2147/NSS.S335508. eCollection 2021.
Previous literature supports that insomnia is predictive of subsequent psychotic-like experiences (PLEs) in the general population. However, there is a lack of empirical data on the reverse causality between the two variables and on the correlation between the symptom severity of insomnia and PLEs. This study aimed to explore the bidirectional associations between insomnia and PLEs before and during the COVID-19 pandemic.
A total of 938 students aged 14-25 years completed both waves of the survey before and during the pandemic (the first wave: October 2019 to November 2019; the second wave: April 2020 to May 2020). PLEs were assessed using the 15-item positive subscale of the community assessment of psychic experiences (CAPE-P15), and insomnia was assessed using three questions on difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening.
Students with baseline insomnia were more likely to exhibit new-onset PLEs during the pandemic (OR: 5.13, 95% CI: 2.54-10.38), while no significant predictive effect of insomnia was found for the persistence and severity of PLEs. Meanwhile, baseline PLEs not only predicted the presence of insomnia during the pandemic (OR: 2.14, 95% CI: 1.25-3.65) but also correlated with its severity (B: 0.89, 95% CI: 0.47-1.31).
The study provides the first piece of evidence for the bidirectional association between insomnia and PLEs in the general population. However, although insomnia has an important predictive role in the occurrence of PLEs, it does not predict the persistence and development of PLEs, suggesting that there is a more complex mechanism underlying the process.
既往文献支持失眠可预测普通人群随后出现的类精神病性体验（PLEs）。然而，关于这两个变量之间的反向因果关系以及失眠症状严重程度与PLEs之间的相关性，缺乏实证数据。本研究旨在探讨新冠疫情之前及期间失眠与PLEs之间的双向关联。
共有938名年龄在14至25岁之间的学生完成了疫情之前及期间的两轮调查（第一轮：2019年10月至2019年11月；第二轮：2020年4月至2020年5月）。使用精神体验社区评估（CAPE-P15）的15项阳性子量表评估PLEs，使用关于入睡困难、维持睡眠困难和早醒的三个问题评估失眠。
基线时有失眠的学生在疫情期间更有可能出现新发PLEs（比值比：5.13，95%置信区间：2.54 - 10.38），而未发现失眠对PLEs的持续存在和严重程度有显著预测作用。同时，基线时的PLEs不仅预测了疫情期间失眠的存在（比值比：2.14，95%置信区间：1.25 - 3.65），还与其严重程度相关（B值：0.89，95%置信区间：0.47 - 1.31）。
该研究为普通人群中失眠与PLEs之间的双向关联提供了首个证据。然而，尽管失眠在PLEs的发生中具有重要预测作用，但它并不能预测PLEs的持续存在和发展，这表明该过程背后存在更复杂的机制。
