Many studies show that sleep health is critical for mental health 14, 15. The pandemic-engendered lockdowns provide a unique opportunity to draw conclusions about the relative importance of these factors, which can then be applied clinically both in ordinary times and in times of significant disruption and stress. However, the inter-relationship between sleep and lifestyle factors regarding their strength and relative contribution to mental health outcomes during lockdown, has not been sufficiently explored. During this period, increases in depressive and anxiety-related symptoms were also widely reported 12, 13. During the COVID-19 pandemic, many sleep-related and lifestyle behaviours changed due to ‘lockdowns’ of populations which were introduced as one of the non-pharmaceutical interventions to manage the transmission of the SARS-CoV-2 virus 8, 9, 10, 11. Furthermore, lifestyle behaviours such as exercise and sedentary behaviour, influence these mental health outcomes independently of sleep quality 3, 4, 5, 6, 7. Insomnia and an irregular sleep pattern are intimately associated with symptoms of depression and anxiety 1, 2. The findings highlight the importance of maintaining physical activity and reducing sedentary screen-use to promote better sleep and mental health. Overall, relationships between the study variables and mental health outcomes were amplified during lockdown. Low physical activity predicted greater insomnia symptom severity, which in turn predicted increased depressive and anxiety-related symptoms. The effects of physical activity on mental health outcomes, however, were only significant during lockdown. Irrespective of lockdown, (a) more severe symptoms of insomnia and greater sedentary screen-use predicted greater symptoms of depression and anxiety and (b) the effects of sedentary screen-use on mental health outcomes were mediated by insomnia. We also controlled for the effects of sex and student status. Using structural equation modelling, we investigated how insomnia symptoms, sleep regularity, exercise intensity/frequency and sitting/screen-use (sedentary screen-use) interacted to predict depressive and anxiety-related symptoms before and during lockdown. We collected data between 12 May and 15 June 2020 from 1048 South African adults (age: 32.76 ± 14.43 years n = 767 female n = 473 students) using an online questionnaire. ![]() However, the inter-relationship and relative strength of those behaviours on mental health outcomes is still unknown. During lockdowns associated with the COVID-19 pandemic, individuals have experienced poor sleep quality and sleep regularity, changes in lifestyle behaviours, and heightened depression and anxiety.
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