key: cord-1052422-ffyfstl6
authors: Köktürk Dalcalı, Berna; Durgun, Hanife; Taş, Ayşe Sinem
title: Anxiety levels and sleep quality in nursing students during the COVID‐19 pandemic
date: 2021-05-07
journal: Perspect Psychiatr Care
DOI: 10.1111/ppc.12839
sha: 0f19ce3188cdca255f0bb7770bf5099ec7384063
doc_id: 1052422
cord_uid: ffyfstl6

PURPOSE: This study was carried out with the aim of determining the correlation between the levels of anxiety experienced by students and their sleep quality during the coronavirus disease 2019 (COVID‐19) pandemic. DESIGN AND METHODS: This descriptive and correlational type study' sample population was 283 students. The personal information form, state‐trait anxiety inventory, Verran and Snyder–Halpern sleep scale were used in data collection. FINDINGS: Study findings indicate that students' state‐trait anxiety levels and sleep quality are average, 28.26% of them sleep interrupted and there is a correlation between their anxiety and sleep quality. PRACTICE IMPLICATION: İt is recommended that teaching students how to deal with COVID−19 and interventional studies aimed at improving sleep quality by reducing anxiety levels should be conducted to further investigate the topic.

In order for any preventive advice to be useful, a comprehensive approach is required to ensure proper health education of the public.

It is often emphasized that taking measures to prevent the spread of the virus alone is not enough and the necessary precautions, the quarantine process, and the social distancing rule should also be implemented. 2, 3 Quarantine is one of the public health measures to prevent the spread of a transferrable disease and it carries negative psychological effects. [4] [5] [6] Social distancing, cancellation of meetings, and closing schools are some of the quarantine practices.

Quarantine and transferrable diseases are an important source of stress that can lead to negative effects on the overall psychological health of students. 7 At the same time, videos, news, and articles about COVID-19 shared on the Internet create a high level of stress, anxiety, and fear in people which also cause difficulty falling asleep, changes in sleep schedule and obsessive thoughts. [8] [9] [10] It has been reported that conditions such as depression, stress, anxiety, and fatigue can lead to sleep disorders. A stressed individual has difficulty in falling asleep and mental rest cannot be achieved. 8 This situation negatively affects the quality of life and educational processes of students. 11 Some researchers found that students experiencing stress tend to develop health issues, depression, sleep disorders and their academic abilities decrease. [12] [13] [14] [15] Therefore, the study was carried out to determine the correlation between the levels of anxiety and sleep quality of the students during the COVID-19 pandemic. The main research questions are as follows: 

The study is a descriptive and correlational study to determine the correlation between anxiety levels and sleep quality of nursing students in the period of COVID-19 pandemic.

The population of the study consists of a total of 432 students studying in the 2019-2020 academic year at a Nursing Department of a Faculty of Health Sciences in Turkey and the sample of the study includes 283 students who agreed to participate in the study without sample calculation. Sixty-six percent of the total population was included.

Data collection forms that were used are the "Personal information form," "State-trait anxiety inventory" and "Verran and Snyder-Halpern sleep scale."

In the personal information form created by researchers using the literature, there are questions about students' gender, school year, the kinds of measures taken for the COVID-19 pandemic, and the news sources used to get information. 16 19 The state-trait anxiety inventory is a self-assessment questionnaire consisting of short expressions. Originally developed for the purpose of investigating anxiety in normal adults, this scale was also found to be suitable for high school students and individuals with psychiatric and physical disorders in subsequent trials. The state-trait anxiety inventory consists of two parts including the state anxiety nventory and trait anxiety inventory. 

The data were collected in May 2020 via an online survey. The participants were invited to the study electronically. Participants filled out the questionnaires through the online survey platform.

Before the initiation of the study, the necessary permission to conduct the study was granted by the Ministry of Health's Commission for Scientific Research on COVID-19, followed by the ethical committee approval (dated 2020, numbered 108) from a university's clinical study ethics committee. The first page of the prepared on-line data collection form included an informed consent section for the students, and the data collection form only filled out by the students who agreed to participate in the study. were used for descriptive statistics. The Cronbach's alpha coefficient was used to determine the internal consistency of the scales of this study. Out of the descriptive tests, the frequency and average value tests were used. Since the distribution of data was found to be normal, the correlation between two independent variables of the parametric tests was calculated using the Student t test and the correlation between multiple independent variables was calculated using the analysis of variance test. The χ 2 test was used to compare the students' sleeping conditions before and after the COVID-19 period. The Pearson correlation analysis was used to interpret the correlation between quantitative variables. Table 1 shows that the mean age of students was 20.39 ± 2.05 years and 82% (n = 232) were female, and 33.6% (n = 95) were first-year students. It was found that 48.8% (n = 138) of the students followed (Table 4) . Table 5 shows a high-level positive significant correlation between students' sleep quality and state anxiety (r: 0.305, p: 0.000**) and trait anxiety (r: 0.288; p: 0.000).

The findings were discussed under three categories in this study which aims to determine the correlation between the anxiety levels and sleep quality of students during the COVID-19 pandemic.

In the study, 48.7% of the students follow the news related to COVID-19 pandemic via social media. Roy et al. 21 25 In light of this information, students participating in this study were already in their homes and with their families on the dates when the study data was collected. It was thought that the students' feelings of safety due to being with their families could have positively affected their levels of anxiety. Similarly, in their study with university students, Cao et al. 18 reported that 75.1% of the students showed no signs of anxiety. They found that students with low levels of anxiety lived with their parents.

The study determined that the sleep quality of the students was moderate. The stress and fear instilled by the COVID-19 pandemic in students as well as in all individuals caused a negative impact on sleep quality Xiao et al. 9 In a study that examined the sleep quality of individuals during the quarantine process in Italy due to COVID-19, Casagrande et al. 10 reported that 57.1% of the 2291 individuals involved in the study had poor sleep quality. In a study to examine the sleep quality of individuals before and during the quarantine in Italy due to the COVID-19 pandemic, Cellini et al.

(2020) reported that their sleep quality was good before the quarantine, but it was negatively affected during the quarantine and the proportion of individuals experiencing sleep problems increased from 40.5% to 52.4%. In a study examining sleep quality in T A B L E 2 Levels of state anxiety, trait anxiety, and sleep quality of students 

The study determined that the students' levels of state-trait anxiety and sleep quality were moderate and there was a correlation between anxiety levels and sleep quality. The number of studies related to the correlation between anxiety and sleep quality during the COVID-19 pandemic is very limited.

The COVID-19 pandemic has had effects in the negative direction on university students' academic performance, eating and sleeping patterns, economic status and especially their coping with the process they have been in. As shown by the results of the study, it was observed that the anxiety levels of the students were high, and this affected sleep quality negatively. In the scope of these results, various activities should be planned towards protecting and improving the physical, mental and social health of university students, reducing their anxiety levels and increasing their coping levels. In this context, it may be recommended to inform and support students by organizing online and nursing students will be key players in ending the pandemic with appropriate support. The COVID-19 pandemic is a period where nurses have been using their counseling and educational roles to the greatest extent. This is why academician nurses should provide support for students by practices that will increase their motivation, reduce their anxieties and provide them with healthy lifestyles. In light of these results, it is recommended that studies with a larger sample aimed at identifying the correlation between anxiety levels and sleep quality during the COVID-19 pandemic.

T A B L E 5 Correlation between students' levels of state anxiety, trait anxiety, and sleep quality 

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The authors declare that there are no conflict of interests.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

https://orcid.org/0000-0002-2123-3386Hanife Durgun https://orcid.org/0000-0003-1622-8184