Received: 22 July 2020

DOI: 10.1002/smi.3016

RESEARCH ARTICLE
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Revised: 8 December 2020 Accepted: 9 December 2020

Stress and sleep in college students prior to and during the

COVID‐19 pandemic

Grant Benham

Department of Psychological Science, The

University of Texas Rio Grande Valley,
Edinburg, Texas, USA
Correspondence
Grant Benham, Department of Psychological
Science, The University of Texas Rio Grande
Valley, 1201 W. University Drive, Edinburg,
TX 78539, USA.
Email: grant.benham@utrgv.edu
Abstract
Within the short timeframe of the COVID‐19 pandemic, there has been increasing
interest in its potential impact on psychological stress and sleep. Using standardized
self‐report measures, we examined differences in stress and sleep by comparing
responses from three independent samples of undergraduates in the United States.
Samples were obtained prior to COVID‐19 (Spring 2019) and at two periods during
the pandemic (Spring 2020 and Summer 2020) which corresponded to an increasing
impact of COVID‐19 at the local level. Within the combined sample of 1222 stu-
dents, 94% identified as Hispanic. Contrary to our hypotheses, stress, sleep quality
and insomnia were not significantly higher in the samples collected during the
COVID‐19 pandemic. However, in support of our hypotheses, bedtime and wake-
time were significantly later during the pandemic, and sleep duration was signifi-
cantly longer. Although scores on the global measure of sleep quality did not differ
across semesters, supplemental exploratory analyses demonstrated a more complex
picture of differences in sleep variables. Among the findings, there was evidence of
greater sleep latency, greater sleep medication use and poorer sleep efficiency
during the pandemic. Our results suggest that, within the US college student pop-
ulation, COVID‐19's impact on stress and sleep may not be entirely negative.

KEYWORDS
college students, COVID‐19, coronavirus, Hispanic, insomnia, stress, sleep quality

1 | INTRODUCTION
Research on the psychological and behavioural impact of the COVID‐
19 pandemic is complicated by its rapid expansion, the shifting
landscape of associated policies (such as lockdowns) and the nature
of the specific populations studied. It has been suggested that
changes in stress and sleep are common psychological reactions to
the pandemic (Alkhawaja, Alrawili, & Ahmed, 2020; Morin & Car-
rier, 2020; Rajkumar, 2020), and expert recommendations have been
provided for reducing stress and managing sleep during this chal-
lenging time (Altena et al., 2020; Hagger, Keech, & Hamilton, 2020;
healthcare workers (e.g., Pappa et al., 2020), college students (e.g.,
Odriozola‐Gonzalez, Planchuelo‐Gomez, Irurtia, & de Luis‐Gar-
cia, 2020) and the general population (e.g., Alkhawaja et al., 2020).
Additionally, the impact of the pandemic on sleep has been examined
in diverse populations (Blume, Schmidt, & Cajochen, 2020; Casa-
grande, Favieri, Tambelli, & Forte, 2020; Gao & Scullin, 2020; Y. Li,
Cao, Leung, & Mak, 2020b; Lin et al., 2020; Wright et al., 2020).
However, data from non‐healthcare populations are still relatively
sparse. Of the data that exists, some findings are presented in rela-
tion to pre‐existing population norms, and many other findings are
based on retrospective recollection of pre‐COVID‐19 behaviour.

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Morin et al., 2020). Within a short timeframe, a number of studies Very few studies have been based on comparisons of similar samples
have reported the impact of COVID‐19 on anxiety, fear and stress in obtained pre‐ and during‐COVID‐19, and fewer still have conducted

504 Stress and Health. 2021;37:504–515. wileyonlinelibrary.com/journal/smi © 2020 John Wiley & Sons Ltd.
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such studies in the US populations. The current study adds to the
existing literature by examining stress and sleep in college students
using independent samples obtained during Spring 2019, Spring 2020
and Summer 2020, from an area of the United States that saw dra-
matic increases in COVID‐19 related deaths during that period.
2 | STRESS
During quarantine in Wuhan, China, Du et al. (2020) found that 59% of
frontline healthcare workers reported moderate to severe levels of
perceived stress, based on scores from the well‐established Perceived
Stress Scale (PSS). Expanding beyond frontline workers, Wang
et al. (2020a) reported that 8% of their sample, obtained in the early
weeks of China's COVID‐19 outbreak, reported experiencing moder-
ate to extreme stress based on scores from the Depression Anxiety
Stress Scale (DASS‐21). Using this same measure, Odriozola
et al. (2020) found that 28% of their sample of Spanish university
students and employees met this threshold during lockdown. In Italy,
also during a lockdown period, an even higher percentage (50%) of
young adults reported moderate to extreme stress based on DASS‐21
criteria (Cellini, Canale, Mioni, & Costa, 2020). However, none of the
aforementioned studies collected data prior to the pandemic and were
thus unable to directly assess whether these scores were unusually
high for the particular populations studied. Related to the concept of
stress, several researchers have chosen to examine COVID‐19 using
measures of anxiety and depression. For example, both Huckins
et al. (2020) and H. Y. Li, Cao, et al. (2020a) conducted longitudinal
studies using the 4‐item Patient Health Questionnaire (PHQ‐4)
administered prior to and during the pandemic. Interestingly, while
Huckins et al. found increased anxiety, H. Y Li et al. found decreased
anxiety. Although the PHQ‐4 measure is significantly correlated with
the PSS (Mills et al., 2015), it was not developed to assess stress, per se.
As research on the pandemic has continued, some investigators have
focused more narrowly on COVID‐19 stress responses, relying
exclusively on COVID‐19‐specific questions during the pandemic such
as participants' self‐reports of how the virus has affected their stress
(Alkhawaja et al., 2020; Son, Hegde, Smith, Wang, & Sasangohar, 2020).
Studies of this nature provide useful data to help paint a more complex
picture of psychological stress experienced during the pandemic, but
are lacking in the use of well‐established psychometrically validated
measures of stress. To summarize, a number of studies have proposed
that the COVID‐19 pandemic is associated with increased stress, but
these findings are limited by the lack of comparison groups and/or the
nature of the stress measures employed.
3 | SLEEP
Differences in sleep prior to and during COVID‐19 have been
assessed a variety of ways, including sleep duration, sleep timing
(changes in bedtime/waketime), sleep quality and insomnia. Findings
regarding sleep timing are rather consistent, suggesting both delayed
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bedtime and delayed waketime during COVID‐19 (Cellini et al., 2020;
Gao & Scullin, 2020; Y. Li et al., 2020b; Wright et al., 2020). Findings
regarding sleep duration are more mixed, however. Some studies
relying on retrospective ratings of sleep prior to lockdown have re-
ported slight increases in sleep duration (Blume et al., 2020; Y. Li
et al., 2020b), whereas others using mixed methods found no change
(Gao & Scullin, 2020).
Studies examining differences in sleep quality have tended to
show poorer sleep quality during COVID‐19. In Italy, Casagrande
et al. (2020) found that 57% of their sample reported poor sleep
quality during lockdown, a percentage considerably higher than re-
ported for Italians in separate pre‐pandemic studies. Similarly, in two
additional Italian samples (Cellini et al., 2020; Marelli et al., 2020),
and in samples from Germany, Switzerland and Austria (Blume
et al., 2020), sleep quality was shown to be poorer during lockdown
relative to pre‐lockdown. While these suggest a fairly consistent ef-
fect, it is important to note that many (Blume et al., 2020; Cellini
et al., 2020; Marelli et al., 2020) relied on participants' retrospective
recollection of their pre‐pandemic sleep quality. A mixed‐methods
study by Gao and Scullin (2020) found that when their participants
were asked to retrospectively report their pre‐lockdown sleep
quality, they rated it as significantly better than during lockdown.
However, participants who actually completed the survey at two time
points (pre‐ and during‐lockdown) showed no change in sleep quality.
Thus, while each study contributes valuable information, it seems
that inconsistencies in findings may be partially explained by such
methodological differences.
With regard to insomnia, there is reasonably consistent evidence
that it increased in frontline healthcare workers during the pandemic
and that healthcare workers have experienced greater insomnia than
members of the general public (Lin et al., 2020). However, data for
non‐healthcare workers are currently more limited. Shortly, after the
introduction of lockdown in Greece, the prevalence of insomnia in
their general population was found to be higher than worldwide es-
timates reported pre‐COVID‐19 (Voitsidis et al., 2020). Using a
different approach, Y. Li et al. (2020b) asked participants in mainland
China to complete a standardized insomnia measure twice, based on
both the prior 2‐weeks and on their thinking back to the pre‐COVID‐
19 period some months earlier. A significantly higher percentage of
people met the threshold score for insomnia when completing the
measure in relation to their experiences during the COVID‐19
outbreak. Similarly, in Italy, university students and administrative
staff who completed an online survey during a 7‐week lockdown
period reported experiencing significantly worse insomnia during
lockdown than what they recalled experiencing during the 4 week
period prior to COVID‐19 (Marelli et al., 2020). There is also indirect
evidence for greater insomnia during the pandemic based on analysis
of Google searches. In the United States, searches for ‘insomnia’
increased by 58% in the first 5 months of 2020 relative to the same
5‐month period during the prior 3 years (Zitting et al., 2020).
In summary, within the short timeline of the COVID‐19
pandemic, there have been a variety of studies attempting to assess
its potential impact on both psychological stress and sleep, but
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further replication and extension of findings are warranted. There
have been limited studies conducted within the US populations, for
example, particularly those of Hispanic/Latinx ethnicity. Additionally,
many prior studies have relied on individuals' retrospective recall of
their experiences prior to the pandemic or prior to imposed COVID‐
19‐related lockdowns, which may be affected by recall bias or ex-
pectancy effects (Gao & Scullin, 2020). The current study examined
differences in stress and sleep using three independent undergrad-
uate samples at a Hispanic‐serving institution in the United States
one surveyed prior to the pandemic (Spring 2019) and two surveyed
during the pandemic (Spring and Summer 2020). Based on previous
findings, we hypothesized that stress and insomnia would be greater,
and that bedtime and waketime would be later, in samples collected
during the pandemic versus the pre‐pandemic period. Although prior
findings for sleep duration and quality are inconsistent, we also
tentatively hypothesized that sleep duration in samples collected
during the pandemic would be longer than that of the pre‐COVID‐19
sample and that sleep quality would be poorer. Given that the course
of the pandemic was uncertain at the time the study was initiated,
and we made no a priori specific predictions about differences be-
tween the Spring 2020 and Summer 2020 semesters, but tested
these data for differences as part of our post‐hoc pairwise
comparisons.
4 | METHODS
4.1 | Participants
A total of 1222 undergraduates from a large university in the
southwestern United States participated in the study. Based on the
combined sample periods, participants ranged in age from 18 to 52
(M = 21.3, SD = 4.86), 69% were female and 94% identified as His-
panic. Participants in the Spring 2019 sample ranged in age from 18–
50 (M = 20.4, SD = 3.9), 61% were female and 94% identified as
Hispanic. Participants in the Spring 2020 sample ranged in age from
18–48 (M = 21.1, SD = 4.4), 74% were female and 94% identified as
Hispanic. Participants in the Summer 2020 sample ranged in age from
18–52 (M = 22.7, SD = 6.0), 72% were female and 95% identified as
Hispanic.
4.2 | Procedure
The study was approved by the University's Institutional Review
Board. Participants were recruited on a voluntary basis from an
introductory psychology course in return for course credit. All par-
ticipants completed an online survey hosted through Qualtrics (www.
qualtrics.com). The survey included an informed consent statement,
demographic questions including ethnicity/race, age and sex, and the
measures of stress and sleep indicated below. Data were collected
during the months of March through May in the Spring semesters of
2019 and 2020 (N = 427 and 450, respectively), and during the
months of June through August in the Summer of 2020 (N = 345). A
timeline of data collection, relevant events and total COVID‐19‐
related deaths in the surrounding counties is provided in Figure 1.
4.3 | Measures
PSS (S. Cohen, Spacapan, & Oskamp, 1988). The PSS contains 10
items asking respondents how frequently they have had stress‐
related feelings/thoughts during the past month. Sample items are “…
felt nervous and stressed?“, “…felt that you were unable to control
the important things in your life?“, with response choices ranging
from (0) “Never” to (4) “Very Often”. The 10‐item version of the scale
is a revision of the originally published 14‐item version, has been
shown to provide a slight gain in psychometric quality over the longer
version, and is recommended over the 14‐item version by the scale's
authors (S. Cohen et al., 1988). The PSS has been reported as a better
predictor of psychological symptoms, physical symptoms and health
service utilization than life‐event scales (S. Cohen, Kamarck, &
Mermelstein, 1983). Possible scores on the PSS range from 0 to 40,
with higher scores indicating greater stress. McDonald's ω was 0.80
for the current study.
Pittsburgh Sleep Quality Index (PSQI; Buysse, Reynolds, Monk,
Berman, & Kupfer, 1989). The 19‐item PSQI is the most widely used
measure of sleep quality (Mollayeva et al., 2016), providing a global
score based on seven components: subjective sleep quality, sleep la-
tency, sleep duration, habitual sleep efficiency, sleep disturbances, use
of sleeping medication and daytime dysfunction over the last month.
Each of these components is weighted equally on a 0–3 scale, with
resultant global scores ranging from 0 to 21 (higher scores indicate
poorer sleep quality). In the current study, sleep duration was assessed
using a single question from the PSQI: ‘During the past month, how many
hours of actual sleep did you get at night? (This may be different than the
number of hours you spent in bed)’. Based on the seven PSQI component
scores, McDonald's ω was 0.67 for the current study.
Insomnia Severity Index (ISI; Bastien, Vallieres, & Morin, 2001).
The ISI is a self‐report measure that assesses participants' percep-
tions of their insomnia. It includes seven items related to the extent
of difficulties with sleep onset and sleep maintenance during the
previous 2 weeks. The paper‐and‐pencil ISI scores have previously
been validated against sleep diary and polysomnography data (Bas-
tien et al., 2001), and the measure has been shown to be psycho-
metrically sound when delivered online (Thorndike et al., 2011). Total
scores range from 0 to 28, with higher scores representing greater
insomnia. McDonald's ω was 0.88 for the current study.
4.4 | Data analysis
Statistical analyses were performed using SPSS 26 (IBM Corp, 2019).
Missing data analysis was conducted to examine if data were missing
completely at random. Across all the variables, 0%–1.2% of data were
missing. Values were missing completely at random, X2 (23) = 17.83,
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F I G U R E 1 Timeline of data collection, relevant events and total COVID‐related deaths in the four main counties served by the university
at which study data was collected
p = 0.77. Participants were excluded from analyses if they reported
generally going to bed outside of the hours of 6 PM–6 AM or re-
ported getting up outside of the hours of 4 AM–5PM, reducing the
total N from 1222 to 1151. Skewness and kurtosis were below 1 for
all variables except for the ordinal PSQI component scores for sleep
medication use and sleep efficiency. To improve the analysis and
interpretability of sleep efficiency, efficiency percentages were used
as opposed to the subsequently derived PSQI component scores (0–
3). An outlier cut‐off value of 3 standard deviations was set for sleep
efficiency and outliers were replaced with the cut‐off score. Skew-
ness and kurtosis for the resultant transformed scores were below 1.
ANCOVAs using 1000 bootstrapped samples were conducted to
examine differences between the three data collection periods for
each of the measures, followed by pairwise post‐hoc contrasts with
Sidak correction for multiple comparisons. Because both mean age
and the distribution of men to women differed significantly between
semesters, age and gender were included as covariates if they were
significantly correlated with a given stress/sleep measure. Covariates
for each analysis are indicated in Table 2. Comparisons of frequency
distributions for selected variables were analysed using Chi‐square
tests with 1000 bootstrapped samples.
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5 | RESULTS
Descriptive statistics of, and correlations between, stress and sleep
variables are shown in Table 1, based on the combined sample of
1151 participants. As can be seen, higher stress was significantly
associated with poorer sleep quality and greater insomnia, along with
later bedtime and shorter sleep duration. Results of the ANOVA/
ANCOVA analyses, including post‐hoc pairwise comparisons and
corresponding effect sizes (d), are shown in Table 2. Figures 2 and 3
present 95% confidence interval error bar graphs of estimated
marginal means for the various measures for each of the three
sampled semesters.
5.1 | Stress
Self‐perceived stress differed significantly across semesters. Post‐
hoc pairwise comparisons indicated that students sampled in the
summer semester had significantly lower stress than students
sampled in the pre‐COVID‐19 Spring 2019 semester. There were no
other significant differences between semesters.
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T A B L E 1 Descriptive statistics of, and correlations between, stress and sleep measures, based on the combined sample of 1151
participants

Measure M SD 1 2 3 4 5 6 7 8 9 10 11

1. Stress (PSS) 20.84 (6.29) ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

2. Bedtime 1.10 AM (113 min) 0.20** ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

3. Waketime 9.06 AM (146 min) 0.05 0.61** ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

4. Sleep duration 6 h, 46 min (100 min) −0.16** −0.12** 0.37** ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

5. Sleep quality (PSQI) 7.21 (3.55) 0.38** 0.25** 0.06* −0.58** ‐ ‐ ‐ ‐ ‐ ‐ ‐

6. Insomnia (ISI) 10.86 (6.25) 0.46** 0.34** 0.10** −0.33** 0.72** ‐ ‐ ‐ ‐ ‐ ‐

PSQI components

7. Latency 1.49 (1.04) 0.21** 0.26** 0.14** −0.20** 0.65** 0.53** ‐ ‐ ‐ ‐ ‐

8. Sleep medication 0.38 (0.83) 0.10** 0.04 0.05 −0.03 0.42** 0.25** 0.21** ‐ ‐ ‐ ‐

9. Sleep efficiency 0.70 (1.02) 0.08* 0.00 0.30** −0.40** 0.52** 0.19** 0.15** 0.05 ‐ ‐ ‐

10. Sleep disturbances 1.28 (0.60) 0.31** 0.07* 0.00 −0.16** 0.52** 0.42** 0.29** 0.16** 0.10** ‐ ‐

11. Sleep quality 1.38 (0.74) 0.34** 0.30** 0.03 −0.42** 0.73** 0.70** 0.48** 0.19** 0.21** 0.31** ‐

12 daytime dysfunction 1.24 (0.90) 0.40** 0.14** −0.04 −0.22** 0.57** 0.50** 0.23** 0.15** 0.06 0.31** 0.37**

Abbreviations: ISI, Insomnia Severity Index; PSQI, Pittsburgh Sleep Quality Inventory; PSS, Perceived Stress Scale.
*p < 0.05; **p < 0.01.

TABLE 2 ANOVA/ANCOVA analyses and post‐hoc contrasts for differences between semesters in stress and sleep

ANOVA/ANCOVA Estimated marginal means Post‐hoc contrast effect sizes (d)

2
Measure F p‐value η SP19 SP20 Su20 SP19‐SP20 SP19‐Su20 SP20‐Su20
A,G b b
Stress (PSS) 3.33 0.036 0.006 21.35 20.91 20.15 0.07 0.19 0.12
A a,b a b
Bedtime 30.82 <0.001 0.051 7.61 8.58 8.28 0.54 0.38 0.17
A a,b a b
Waketime 110.38 <0.001 0.161 4.77 6.87 6.72 0.96 0.89 0.07
A a,b a b
Sleep duration 30.80 <0.001 0.051 6.25 7.02 7.07 0.48 0.51 0.03
A,G
Sleep quality (PSQI) 0.02 0.978 0.000 7.18 7.23 7.20 0.01 0.00 0.01
G
Insomnia (ISI) 0.75 0.471 0.001 10.66 11.16 10.74 0.08 0.01 0.07

PSQI components

LatencyG 8.85 <0.001 0.015 4.34a,b 4.91a 5.16b 0.21 0.30 0.09

Sleep medicationA,G 5.55 0.004 0.010 0.29b 0.39 0.49b 0.12 0.25 0.13

Sleep efficiencyG 5.82 0.003 0.010 89.60a,b 86.14a 85.43b 0.19 0.23 0.04

Sleep disturbancesA,G 0.66 0.518 0.001 1.26 1.31 1.28 0.08 0.03 0.05

Sleep qualityA,G 2.00 0.135 0.003 1.41 1.40 1.31 0.02 0.14 0.12

Daytime dysfunction 3.72 0.025 0.006 1.34a 1.18a 1.21 0.18 0.15 0.04

Notes: Bolded measure names indicate statistically significant ANOVA/ANCOVA at the 0.05 level. Superscript letters next to measure indicate
covariates included for ANCOVA (A = age; G = gender). Matching superscript letters next to estimated marginal means denote semesters that differ
significantly from each other at the 0.05 level after Sidak adjustment for multiple comparisons. Post‐hoc contrast effect sizes (d) are formatted to
indicate those that are ‘small’ (underlined) or ‘medium’/‘high’ (bolded). Estimated marginal means for bedtime and waketime represent coded scores, not
actual time of day. Latency based on single PSQI question on minutes usually taken to fall asleep (categorized in 5‐min increments rather than the PSQI
component score categorization 0–3). Sleep efficiency is based on the calculated efficiency percentage from PSQI questions (sleep duration relative to
time in bed) after transformation of outliers, rather than the PSQI component score categorization of those values.
Abbreviations: PSS, Perceived Stress Scale; PSQI, Pittsburgh Sleep Quality Inventory; ISI, Insomnia Severity Index.
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F I G U R E 2 95% confidence intervals of each semester's estimated marginal means for (a) stress, (b) bedtime, (c) waketime, (d) sleep
duration, (e) sleep quality and (f) = insomnia. Matching symbols on graph indicate statistically significant differences between samples based
on pairwise post‐hoc comparisons of estimated marginal means.

5.2 | Sleep timing and duration
Bedtime, waketime and sleep duration differed significantly across
semesters. Post‐hoc pairwise comparisons indicated that, relative
to students from the pre‐COVID‐19 Spring 2019 semester,
bedtime was significantly later during both the Spring and Summer
2020 semesters, supporting our hypotheses about sleep timing.
Specifically, bedtimes shifted from an average of 12:37 AM
(SD = 89 min) during Spring 2019 to an average bedtime of 1:35
AM (SD = 122 min) during Spring 2020 (58 min later) and 1:17
AM (SD = 116 min) during Summer 2020 (40 min later). Delayed
waketimes were more pronounced, shifting from an average of
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F I G U R E 3 95% confidence intervals of each semester's estimated marginal means for (a) sleep latency, (b) sleep medication use, (c) sleep
efficiency, (d) sleep disturbances, (e) sleep quality, and (f) = daytime dysfunction. Matching symbols on graph indicate statistically significant
differences between samples based on pairwise post‐hoc comparisons of estimated marginal means.

7:46 AM (SD = 115 min) during Spring 2019 to 9:52 AM
(SD = 148 min) during Spring 2020 (2 h 6 min later) and 9:43 AM
(SD = 144 min) during Summer 2020 (1 h 58 min later). The
Spring and Summer 2020 samples did not significantly differ in
bedtime or waketime.
Correspondingly, sleep duration also significantly differed across
semesters. Post‐hoc analyses revealed that students in the Spring
and Summer 2020 semesters slept an average of 46 and 51 min
longer, respectively, than students in Spring 2019. In Spring 2019,
45.5% of students reported getting the recommended seven or more
hours of sleep per night (Hirshkowitz et al., 2015). During the Spring
and Summer 2020 semesters, that percentage had increased to
59.9% and 63.6%, respectively. This difference was statistically sig-
nificant χ2 (2) = 28.1, p < 0.001)2.
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5.3 | Sleep quality and insomnia
Based on the global score from the PSQI measure, sleep quality did
not differ significantly across semesters. In addition to the ANCOVA
analysis, we examined the distribution across the three semesters of
those who met the threshold for ‘poor quality’ sleep, based on a PSQI
score criterion of 5 or greater. Pre‐COVID‐19 (Spring 2019), almost
two‐thirds of students (64%) were classified as having poor quality
sleep. Spring 2020 and Summer 2020 samples showed similar per-
centages (65% and 66.5%, respectively). The distribution of good/
poor quality sleepers did not differ significantly between semesters,
χ2 (2) = 4.9, p > 0.05).
Similarly, insomnia severity did not differ significantly across
semesters, based on the ISI measure. To supplement the ANCOVA
analysis, we examined the distribution across the three semesters of
those who met the threshold for insomnia, based on an ISI score
criterion of 10 or greater3. Pre‐COVID‐19, almost half of the stu-
dents (48%) met the threshold for insomnia. These percentages were
slightly higher for Spring 2020 and Summer 2020 samples (54% and
51.2%, respectively), but the differences across semesters were not
statistically significant, χ2 (2) = 3.0, p > 0.05).
5.4 | Supplemental exploratory analysis
The global sleep quality score provided by the PSQI score is calcu-
lated by summing scores from a variety of components (e.g., sleep
disturbances and daytime dysfunction). Although we found no sig-
nificant differences between semesters based on the global PSQI
score, we performed a supplemental exploratory analysis of PSQI
components to examine potential differences in these specific sleep‐
related variables across our three samples. Results of these analyses
are shown in Table 2 and Figure 3.
5.4.1 | Sleep latency
Sleep latency (the time it takes to fall asleep) was significantly longer
in both 2020 samples relative to the pre‐pandemic semester. Values
for sleep latency within Table 2 represent scores that were assigned
to 5‐min categories (e.g., 0–5, 6–10, etc.). Figure 3a provides a more
interpretable visual summary of the observed differences.
5.5 | Sleep medication use
The PSQI includes a sleep medication score, based on a single
question about frequency of prescription or over‐the‐counter sleep
medicine use. ANCOVA results indicated a significant difference in
the use of sleep medications across semesters, with pairwise com-
parisons demonstrating significantly greater use during the Summer
2020 semester relative to the pre‐COVID‐19 Spring 2019 semester
(Figure 3b). Although Spring 2020 sleep medication use was greater
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than Spring 2019, this difference was not statistically different. We
also explored this issue by examining the percentage of students who
used sleep medication at least three times a week. In the 2019
sample (pre‐COVID‐19), only 2% of students used medication at this
frequency. In Spring and Summer 2020, that percentage had tripled
or quadrupled (6.4% and 8.7%, respectively). A chi‐squared test with
subsequent Bonferroni‐corrected Z‐tests indicated that both 2020
sample percentages were significantly greater than those of Spring
2019, χ2 (2) = 16.6, p < 0.001.
5.5.1 | Sleep efficiency
Sleep efficiency represents the percentage of time one spends asleep
relative to the time spent in bed, with higher efficiency representing
better sleep. As seen in Table 2 and Figure 3c, sleep efficiency was
significantly lower for both samples obtained during the pandemic
relative to pre‐pandemic.
5.5.2 | Sleep disturbances
Across the data collection periods, there was no evidence for dif-
ferences in sleep disturbances (e.g., having bad dreams, cannot
breathe comfortably, etc.).
5.5.3 | Sleep quality
Across the data collection periods, there was no evidence for dif-
ferences in sleep quality (specific component score of the PSQI based
on a single question about self‐perceived quality of sleep).
5.5.4 | Daytime dysfunction
Daytime dysfunction reflects the impact of inadequate sleep on
daytime functioning (‘During the past month, how much of a problem
has it been for you to keep up enough enthusiasm to get things done?’)
and was significantly less in the Spring 2020 sample relative to the
pre‐pandemic Spring 2019 sample. Although it was also somewhat
lower in Summer 2020 relative to pre‐pandemic levels, this differ-
ence was not statistically significant.
6 | DISCUSSION
It has been proposed that the impact on sleep health resulting from
‘substantial changes in lifestyle, responsibilities and stressors’ during the
COVID‐19 pandemic could be negative (stress view), minimal (resil-
ience view) or positive (reduced work/schedule burden view; Gao &
Scullin, 2020). In the current study, our findings suggested a mixture
of the three, depending on the specific outcome measure being
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assessed. Contrary to our hypothesis, students' stress ratings during
the COVID‐19 pandemic either did not differ from those provided by
students during the pre‐pandemic period or were significantly lower
(Spring and Summer 2020, respectively). This is not to suggest that
the pandemic had no impact on students' psychological state, but
does demonstrate that one of the most widely used and psycho-
metrically validated measure of self‐perceived stress was insensitive
to any changes that may have occurred. We are not aware of any
previous COVID‐19 pandemic studies that have used this particular
stress measure. Several studies have assessed stress during the
pandemic using the Depression and Anxiety Stress Scale, with the
percentage of participants reporting moderate to extreme stress
ranging between 8% and 50% depending on the sample. Recently,
Wang et al. (2020b) examined whether participants' stress scores on
this measure had increased from the time of the initial outbreak to its
peak a month later and found no change. Importantly, unlike the
current research, none of these studies included comparable samples
assessed by the researchers pre‐pandemic. The use of the PSS in our
study, and the ability to compare scores obtained during the
pandemic to scores obtained prior to the pandemic from similar
samples, adds meaningfully to this area of enquiry.
In keeping with several previous studies and our hypothesis, we
found that students went to bed significantly later during the
pandemic, with differences of almost one hour between the bedtime
of Spring 2019 and Spring 2020 semesters. Delayed waketimes were
even more pronounced, with 2019/2020 Spring semester waketimes
differing by 2 h. An important context to these changes in sleep
timing is that our 2020 samples were collected after students had
transitioned to fully online classes as a part of the university's social
distancing initiatives, a move that created greater flexibility for many
students in their sleep‐wake schedule as a consequence of most
classes shifting to an asynchronous format. Additionally, although not
directly assessed by our survey, institutional data indicates that only
3% of undergraduates live in campus housing. The elimination of
commute time for most participants during the pandemic is likely to
have further reduced the need for early waketimes.
Although prior findings have been somewhat inconsistent
regarding changes in sleep duration, our results showed significantly
greater sleep quantity during the pandemic relative to pre‐pandemic
values, thereby supporting our tentative directional hypothesis.
Importantly, prior to the pandemic, the average sleep duration was
below the recommended 7 or more hours of sleep per night (Hirsh-
kowitz et al., 2015), but the average duration within both of the 2020
samples satisfied this recommendation. Prior research suggests that
individuals with delayed sleep schedules (those with habitually late
bedtimes/waketimes) tend to have shorter sleep duration when they
have obligations in the morning, but that their duration normalizes
when those obligations are not present (Moderie, Van der Maren,
Paquet, & Dumont, 2020). In our college student population, a pop-
ulation whose sleep schedule tends to be delayed at the best of times
(Lund, Reider, Whiting, & Prichard, 2010), the shift to predominantly
asynchronous online courses may have lessened morning obligations
and thereby allowed for an extension of sleep duration.
Our hypotheses that sleep quality would be poorer, and insomnia
greater, during the pandemic was not supported. Our findings are in
accordance with those Gao and Scullin (2020), but contrast with
studies that made use of general population means as a pre‐pandemic
comparison or that relied on retrospective recollection of pre‐
COVID‐19 sleep behaviour. Our results were based on two widely
used sleep measures, the PSQI and ISI. However, it is worth noting
that both measures are multi‐faceted. For example, the Pittsburgh
Sleep Quality Index includes questions about daytime enthusiasm
and trouble staying awake, and the Insomnia Severity Index includes
questions on daytime functioning and satisfaction with sleep. Indeed,
the global PSQI score is purposefully based on the summation of
seven component scores of related indices. As such, it provides
measurement of a broader construct of ‘sleep quality’ at the expense
of greater composite score reliability (Peters, 2014). By conducting a
supplemental exploratory analysis of various PSQI components, we
were able to uncover a number of subtler distinctions. Although sleep
disturbances and self‐rated sleep quality (based on a single question)
did not differ between samples, sleep latency, sleep medication use,
sleep efficiency and daytime dysfunction did. Despite already delayed
bedtimes, students in both 2020 samples reported taking signifi-
cantly longer to fall asleep (latency) than students in the 2019 pre‐
COVID‐19 samples. Similarly, the calculated sleep efficiency was
significantly lower for both 2020 samples relative to pre‐pandemic
values.
Findings related to sleep medication use and daytime dysfunc-
tion were less straightforward. Differences in sleep medication use
varied depending on the nature of the analysis. Based on the mean
component score, only students in the Summer semester of 2020
scored significantly higher than the pre‐pandemic sample. However,
when examining frequent use of sleep medication (three or more
times per week), a significantly larger proportion of students re-
ported such use during both semesters of the pandemic period,
reaching almost 9% of the sample by Summer 2020. It is therefore
possible that sleep latency would have been further elevated in the
2020 samples if these individuals had not been making regular use of
sleep medication. Due to the wording of the PSQI sleep medication
question, we were unable to determine whether students were using
prescription or over‐the‐counter sleep medications. Although some
have raised concerns about the association between chronic pre-
scription zolpidem use and suicide risk (Cho et al., 2020), the findings
on long‐term efficacy and safety are generally positive (Krystal
et al., 2008). Lastly, relative to pre‐pandemic values, daytime
dysfunction was lower in the Spring 2020 semester but this finding
did not extend to the Summer 2020 sample. However, given the
nature of the question4 used to assess this construct, it is unclear
whether this was a direct result of inadequate sleep or whether it
was due to a broader effect of the pandemic on ‘enthusiasm.’ Our
supplemental exploratory analysis therefore provides a more
nuanced understanding of sleep‐related behaviour and experiences
across the sampled semesters.
It is surprising that self‐perceived stress was not greater during
the pandemic, and even more so that it was significantly lower during a
BENHAM
time where the pandemic was exerting its greatest toll within the local
community. It would be reasonable to speculate that psychological and
behavioural reactions to the pandemic would, at least to a certain
degree, be tied to the severity of the disease in the local environment.
Data collection for Spring 2020 began on 17th March, 2 days before
the first case of COVID‐19 was confirmed within the four main
counties that the University serves, and almost 3 weeks before the
first confirmed death in the area. However, as shown in Figure 1, a
number of disruptions to normal life occurred during that early period.
All classes were moved online, a curfew was issued 23rd March, and a
shelter‐at‐home order was issued on 26th March. The shelves of large
local grocery stores lay empty as people engaged in panic buying of
basic provisions. Additionally, by extending our data collection beyond
the Spring semester, we were also able to investigate the impact of
dramatically worsening conditions as infections took hold in the local
community. By the end of April (Spring 2020 sample), 20 people had
died in the four surrounding counties. By 12th August (Summer 2020
sample), that number was more than 60 times higher, at 1270.
One plausible explanation for this finding is that the observed
changes in sleep duration and timing might have exerted a positive
effect on self‐perceived stress. Our data showed significant associ-
ations between these sleep variables and stress and, although these
were purely correlational, a recent longitudinal study found shorter
sleep duration to be associated with greater stress the following day
(Hisler, Krizan, & DeHart, 2019). Additionally, there is evidence that
social jetlag in college students has lessened during COVID‐19
(Wright et al., 2020) and it is possible that a combination of greater
duration and higher consistency in sleep timing may have resulted in
less stress. While not tied to social jetlag specifically, sleep consis-
tency during the weekdays, when combined with sleep duration of at
least 7 h per night, has been shown to predict lower self‐perceived
stress, as indexed by the PSS (Barber, Munz, Bagsby, & Powell, 2010;
Barber & Munz, 2011). Additionally, given that most of our sample
were young adults, it is possible that the salience of the pandemic
may have been minimized by the low risk of COVID‐19‐related
morbidity/mortality for that age group. Partial support for this idea
comes from a study by Hu, He, and Zhou (2020) who found that
participants' state anxiety was associated with subjective measures
of COVID‐19 mortality salience rather than the actual number of
daily COVID‐19 related deaths. However, it should also be noted
that while college students may not be particularly anxious about
their own health risks during the pandemic, they tend to be worried
about the health of their family (A. K. Cohen, Hoyt, & Dull, 2020; Son
et al., 2020), a concern that might be amplified by the strong convivial
collectivism and familism in Hispanic culture (Campos & Kim, 2017).
Our study adds to the emerging literature on this topic. It benefits
from the use of widely used and psychometrically validated measures
and is not reliant on retrospective recall of pre‐pandemic behaviour
and experiences. In addition, we provide data on a Hispanic population,
an ethnicity underrepresented in studies of sleep (Loredo et al., 2010)
and disproportionately affected by the COVID‐19 pandemic in terms
of both incidence of cases (Moore et al., 2020) and COVID‐19‐asso-
ciated deaths (Gold et al., 2020). It is important to recognize some
- 513
limitations to our study, however. Because of shifting policy changes
throughout the 2020 timeline of our study, our study does not spe-
cifically address the psychological consequences of lockdown (e.g.,
Blume et al., 2020) or quarantine (e.g., Brooks et al., 2020) which may
have different effects than the broader impact of the pandemic. Our
findings are limited in generalizability, particularly given the increased
scheduling flexibility provided to our college student sample, and in no
way challenges prior findings regarding the strain experienced by those
on the frontline of the pandemic (e.g., healthcare workers). Addition-
ally, the use of separate samples during the three time periods does not
allow us to directly examine changes within individuals as would have
been afforded through a longitudinal design. Lastly, we did not assess
socioeconomic status or current employment so were unable to con-
trol for the potential financial toll of the pandemic on students. As one
might anticipate, both unemployment and the inability to adequately
cover monthly expenses during the pandemic has been shown to be
associated with increased psychological distress in young adults
(Achdut & Refaeli, 2020).
Taken together, our primary analyses suggest that the COVID‐19
pandemic was not linked to greater self‐perceived stress, and that
students were largely resilient to the changes in lifestyle that resulted
from the shifting policies enacted by the University and local leaders,
even as the impact of the disease worsened at the local level. Indeed,
some positive differences were seen in that a larger proportion of
students obtained the recommended 7+ h of sleep per night during the
pandemic. However, beyond these rather encouraging findings, closer
inspection of individual sleep components revealed some differences
that were disguised by the pooled PSQI score but indicative of prob-
lematic sleep. Alongside established measures of psychological stress,
future studies on the psychological impact of the pandemic may
benefit from the integration of tailored measures, such as the newly
developed Fear of COVID‐19 Scale (Ahorsu et al., 2020). Additionally,
it seems imperative that studies examining the effect of the pandemic
on sleep employ a comprehensive but eclectic combination of
measures in order to fully capture changes in sleep‐related behaviour
and experience.
CO N F L I C T O F I N T E R E S T
There are no conflicts of interest associated with this research.
OR CI D
Grant Benham https://orcid.org/0000-0002-5664-6025
E ND N OT E S
1
Because there is no defined ‘appropriate’ bedtime/waketime, the
decision as to whom to exclude from analysis is complex. In an
attempt to identify those who might be on inverted schedules (or
who perhaps selected an AM/PM time in error) we determined sta-
tistical outliers using boxplots and standardized values greater than
2.5 SD above/below the mean. This was coupled with an assessment
of what seemed within the reasonable bounds of a normal sleep
schedule.
2
Z‐test with column proportions (Bonferroni‐corrected) indicated that
Spring and Summer 2020 semesters differed from Spring 2019, but not
from each other.
514
- BENHAM
3
This cut‐off score has been proposed as being optimal in a general
population sample (Morin, Belleville, Bélanger, & Ivers, 2011).
4
‘During the past month, how much of a problem has it been for you to keep
up enough enthusiasm to get things done?’
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How to cite this article: Benham, G. (2021). Stress and sleep
in college students prior to and during the COVID‐19
pandemic. Stress and Health, 37(3), 504–515. https://doi.org/
10.1002/smi.3016