{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:06:45Z","timestamp":1771258005183,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,3,4]],"date-time":"2023-03-04T00:00:00Z","timestamp":1677888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Mental Health","award":["K23MH120437"],"award-info":[{"award-number":["K23MH120437"]}]},{"name":"Lifespan Brain Institute of Children\u2019s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania","award":["K23MH120437"],"award-info":[{"award-number":["K23MH120437"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elevations in either worry or insomnia should be considered for evidence-based treatments for these symptoms to prevent secondary symptoms in the future. Future research should evaluate the extent to which dissemination of evidence-based practices for chronic worry (a core feature of generalized anxiety disorder or illness anxiety disorder) or insomnia reduces the development of co-occurring symptoms during a global disaster.<\/jats:p>","DOI":"10.3390\/ijerph20054568","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T03:22:05Z","timestamp":1678072925000},"page":"4568","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["COVID-19 Worries and Insomnia: A Follow-Up Study"],"prefix":"10.3390","volume":"20","author":[{"given":"Lily A.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiqin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3764-2966","authenticated-orcid":false,"given":"Gabriella E.","family":"Hamlett","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler M.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"},{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace E.","family":"DiDomenico","sequence":"additional","affiliation":[{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elina","family":"Visoki","sequence":"additional","affiliation":[{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Music, Bar Ilan University, Ramat Gan 5290002, Israel"},{"name":"Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel"},{"name":"Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben C.","family":"Gur","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"},{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raquel E.","family":"Gur","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"},{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Barzilay","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA"},{"name":"Lifespan Brain Institute of the Children\u2019s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA"},{"name":"Department of Child Adolescent Psychiatry and Behavioral Sciences, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10608-021-10241-5","article-title":"College mental health before and during the COVID-19 pandemic: Results from a nationwide survey","volume":"46","author":"Kim","year":"2022","journal-title":"Cogn. 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