The COVID-19 Lockdown and Changes in Routine-Oriented Lifestyle Behaviors and Symptoms of Depression, Anxiety, and Insomnia in South Africa

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $119.00

1 year online subscription

USD  $159.00

Student 2 year online subscription

USD  $227.00

2 year online subscription

USD  $302.00

Background: The authors assessed the impact of lockdown in response to the COVID-19 pandemic on routine-oriented lifestyle behaviors and symptoms of depression, anxiety, and insomnia in South Africans. Methods: In this observational study, 1048 adults (median age = 27 y; n = 767 females; n = 473 students) responded to an online survey on work, exercise, screen, alcohol, caffeine and sleep behaviors, depression, anxiety, and insomnia before and during lockdown. Comparisons were made between males and females, and students and nonstudents. Results: During lockdown, males reported larger reductions in higher intensity exercise and alcohol use than females, while depressive symptoms increased more among females, more of whom also reported poorer sleep quality. Students demonstrated larger delays in work and sleep timing, greater increases in sitting, screen, sleep duration, napping, depression and insomnia and larger decreases in work hours, exercise time, and sleep regularity compared with nonstudents. Conclusions: Students experienced more changes in their routine-oriented behaviors than nonstudents, coupled with larger increases in depression and insomnia. The dramatic change in their work and sleep timing suggests habitual routines that are at odds with their chronotype, with their sleep changes during lockdown likely reflecting “catch-up” sleep in response to accumulated sleep debt under usual routines.

Davy, Christie, Todd, and Zschernack are with the Department of Human Kinetics and Ergonomics, Rhodes University, Grahamstown, Eastern Cape, South Africa. Scheuermaier, Iacovides, and Roche are with the Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa. Roden is with the Faculty Research Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom. Roden and Rae are with the Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Province, South Africa. Bentley is with the Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa. Gomez-Olive is with the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa. Lewis and Lipinska are with the UCT Sleep Sciences and Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, Western Province, South Africa.

Rae (Dale.Rae@uct.ac.za) is corresponding author.

Supplementary Materials

    • Supplementary Table S1 (PDF 263 KB)
    • Supplementary Table S2 (PDF 279 KB)
    • Supplementary Table S3 (PDF 199 KB)
  • 1.

    Hale T, Webster S, Petherick A, Phillips T, Kira B. Oxford COVID-19 Government Response Tracker. Blavatnik School of Government; 2020.

  • 2.

    Wright KP Jr, Linton SK, Withrow D, et al. . Sleep in university students prior to and during COVID-19 Stay-at-Home orders. Curr Biol. 2020;30(14):R797R798. PubMed ID: 32693068 doi:10.1016/j.cub.2020.06.022

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020;29(4):e13074. PubMed ID: 32410272 doi:10.1111/jsr.13074

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Salehinejad MA, Majidinezhad M, Ghanavati E, et al. . Negative impact of COVID-19 pandemic on sleep quantitative parameters, quality, and circadian alignment: implications for health and psychological well-being. EXCLI J. 2020;19:12971308. PubMed ID: 33192213 doi:10.17179/excli2020-2831

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Wang X, Lei SM, Le S, et al. . Bidirectional influence of the COVID-19 pandemic lockdowns on health behaviors and quality of life among Chinese adults. Int J Environ Res Public Health. 2020;17(15):5575. doi:10.3390/ijerph17155575

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Sinha M, Pande B, Sinha R. Impact of COVID-19 lockdown on sleep-wake schedule and associated lifestyle related behavior: a national survey. J Public Health Res. 2020;9(3):1826. PubMed ID: 32874967 doi:10.4081/jphr.2020.1826

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Ingram J, Maciejewski G, Hand CJ. Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Front Psychol. 2020;11:588604. PubMed ID: 32982903 doi:10.3389/fpsyg.2020.588604

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Blume C, Schmidt MH, Cajochen C. Effects of the COVID-19 lockdown on human sleep and rest-activity rhythms. Curr Biol. 2020;30(14):R795R797. doi:10.1016/j.cub.2020.06.021

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Romero-Blanco C, Rodriguez-Almagro J, Onieva-Zafra MD, Parra-Fernandez ML, Prado-Laguna MDC, Hernandez-Martinez A. Physical activity and sedentary lifestyle in university students: changes during confinement due to the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17(18):6567. doi:10.3390/ijerph17186567

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Castaneda-Babarro A, Arbillaga-Etxarri A, Gutierrez-Santamaria B, Coca A. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health. 2020;17(18):6878. doi:10.3390/ijerph17186878

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Brooks SK, Webster RK, Smith LE, et al. . The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912920. PubMed ID: 32112714 doi:10.1016/S0140-6736(20)30460-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Baker FC, Waner JI, Vieira EF, Taylor SR, Driver HS, Mitchell D. Sleep and 24 hour body temperatures: a comparison in young men, naturally cycling women and women taking hormonal contraceptives. J Physiol. 2001;530(3):565574. doi:10.1111/j.1469-7793.2001.0565k.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Cain SW, Dennison CF, Zeitzer JM, et al. . Sex differences in phase angle of entrainment and melatonin amplitude in humans. J Biol Rhythms. 2010;25(4):288296. PubMed ID: 20679498 doi:10.1177/0748730410374943

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Korman M, Tkachev V, Reis C et al. . COVID-19-mandated social restrictions unveil the impact of social time pressure on sleep and body clock. Sci Rep. 2020;10,:22225. doi:10.1038/s41598-020-79299-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Rossi R, Socci V, Talevi D, et al. . COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Front Psychiatry. 2020;11:790. PubMed ID: 32848952 doi:10.3389/fpsyt.2020.00790

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Craig CL, Marshall AL, Sjostrom M, et al. . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):13811395. PubMed ID: 12900694 doi:10.1249/01.MSS.0000078924.61453.FB

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):12841292. PubMed ID: 14583691 doi:10.1097/01.MLR.0000093487.78664.3C

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):10921097. PubMed ID: 16717171 doi:10.1001/archinte.166.10.1092

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Morin CM. Insomnia: Psychological Assessment and Management. Guildford Press; 1993:1.

  • 20.

    Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297307. PubMed ID: 11438246 doi:10.1016/S1389-9457(00)00065-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Sjostrom M, Ainsworth, B., Bauman, A., Bull, F., Hamilton-Craig, C., Sallis, J. Guidelines for Data Processing Analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms. 2005. https://sites.google.com/site/theipaq/scoring-protocol. Accessed October 21, 2020.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kokou-Kpolou CK, Megalakaki O, Laimou D, Kousouri M. Insomnia during COVID-19 pandemic and lockdown: prevalence, severity, and associated risk factors in French population. Psychiatry Res. 2020;290:113128. PubMed ID: 32563951 doi:10.1016/j.psychres.2020.113128

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Voitsidis P, Gliatas I, Bairachtari V, et al. . Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020;289:113076. PubMed ID: 33242799 doi:10.1016/j.psychres.2020.113076

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Lin LY, Wang J, Ou-Yang XY, et al. . The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status. Sleep Med. 2020;77:348354. PubMed ID: 32593614 doi:10.1016/j.sleep.2020.05.018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954. PubMed ID: 32325383 doi:10.1016/j.psychres.2020.112954

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep. 2006;29(1):8593. PubMed ID: 16453985 doi:10.1093/sleep/29.1.85

  • 27.

    Attal JH, Lurie I, Neumark Y. A rapid assessment of migrant careworkers’ psychosocial status during Israel’s COVID-19 lockdown. Isr J Health Policy Res. 2020;9(1):61. PubMed ID: 33138855 doi:10.1186/s13584-020-00422-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Salameh P, Hajj A, Badro DA, Abou Selwan C, Aoun R, Sacre H. Mental health outcomes of the COVID-19 pandemic and a collapsing economy: perspectives from a developing country. Psychiatry Res. 2020;294:113520. PubMed ID: 33142145 doi:10.1016/j.psychres.2020.113520

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Gu YQ, Zhu Y, Xu FZ, Xi JZ, Xu GX. Factors associated with mental health outcomes among patients with COVID-19 treated in the Fangcang shelter hospital in China. Asia-Pac Psychiat. 2020;13(2):e12443. doi:10.1111/appy.12443

    • Search Google Scholar
    • Export Citation
  • 30.

    Salfi F, Lauriola M, Amicucci G, et al. . Gender-related time course of sleep disturbances and psychological symptoms during the COVID-19 lockdown: a longitudinal study on the Italian population. Neurobiol Stress. 2020;13:100259. PubMed ID: 33102641 doi:10.1016/j.ynstr.2020.100259

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Kantermann T. Behavior: how a global social lockdown unlocks time for sleep. Current Biology. 2020;30(14):R822R823. doi:10.1016/j.cub.2020.06.037

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Bei B, Wiley JF, Trinder J, Manber R. Beyond the mean: a systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. Sleep Med Rev. 2016;28:108124. PubMed ID: 26588182 doi:10.1016/j.smrv.2015.06.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Lyall LM, Wyse CA, Graham N, et al. . Association of disrupted circadian rhythmicity with mood disorders, subjective wellbeing, and cognitive function: a cross-sectional study of 91 105 participants from the UK Biobank. Lancet Psychiatry. 2018;5(6):507514. PubMed ID: 29776774 doi:10.1016/S2215-0366(18)30139-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Murray JM, Phillips AJK, Magee M, et al. . Sleep regularity is associated with sleep-wake and circadian timing, and mediates daytime function in delayed sleep-wake phase disorder. Sleep Med. 2019;58:93101. PubMed ID: 31132578 doi:10.1016/j.sleep.2019.03.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Kroonenberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag and obesity. Curr Biol. 2012;22(10):939943. PubMed ID: 22578422 doi:10.1016/j.cub.2012.03.038

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Wheaton AG, Chapman DP, Croft JB. School start times, sleep, behavioral, health, and academic outcomes: a review of the literature. J Sch Health. 2016;86(5):363381. PubMed ID: 27040474 doi:10.1111/josh.12388

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Marx R, Tanner-Smith EE, Davison CM, et al. . Later school start times for supporting the education, health, and well-being of high school students. Cochrane Database Syst Rev. 2017;7:CD009467. doi:10.1002/14651858.cd009467.pub2

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Zerbini G, van der Vinne V, Otto LKM, et al. . Lower school performance in late chronotypes: underlying factors and mechanisms. Sci Rep. 2017;7(1):4385. PubMed ID: 28663569 doi:10.1038/s41598-017-04076-y

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Aulsebrook AE, Jones TM, Mulder RA, Lesku JA. Impacts of artificial light at night on sleep: a review and prospectus. J Exp Zool A Ecol Integr Physiol. 2018;329(8-9):409418. PubMed ID: 29869374 doi:10.1002/jez.2189

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 3 3 3
Full Text Views 165 165 165
PDF Downloads 126 126 126