Most but not all epidemiologic evidence suggests a female predisposition of insomnia. We applied meta-analytic methods to investigate sex differences in the risk of insomnia among the published epidemiologic studies. Meta-analysis with Comprehensive Meta-Analysis (Englewood, NJ); 9 different analyses were performed to investigate the sex difference of insomnia among different conditions. A comprehensive search of the medical literature databases was performed to identify epidemiologic studies of insomnia. A rolling snowball method was also used. General population. N/A. Thirty-one related papers were found, but 2 studies only reported the subtype prevalence of insomnia. All other studies (1,265,015 participants, female/male: 718,828/546,187) were included in the overall analysis of insomnia. A risk ratio of 1.41 [95% confidence interval: 1.28–1.55] for female versus male was found. The female excess in the risk of insomnia in large and quality studies was much higher than that of small and nonquality studies. The trend of female predisposition was consistent and progressive across age, with more significance in the elderly. The use of various criteria and frequency and duration of insomnia did not influence the predisposition of female in the risk of developing insomnia. Although obvious female excess in the risk of insomnia exists among different regions, there was a relatively lower female excess in East Asia. This meta-analysis confirmed a female predisposition of insomnia. Further studies will be needed to examine the roles of different factors in leading to the sex difference of insomnia.

The world was struck by a severe acute respiratory syndrome (SARS) pandemic in 2003, resulting in considerable morbidities and mortalities. A substantial proportion of SARS survivors experienced SARS-related physical complications, including avascular necrosis (AVN),¹ pulmonary fibrosis,² and hypocortisolism.³ The physical conditions of most of the patients continuously improved in the first year of follow-up, but their mental conditions showed limited signs of improvement.⁴ The 1-year follow-up study after the outbreak found that some SARS survivors had persistent mental problems.^4,5 Many studies found that the status of being a health care worker at the time of SARS infection,^5-10 the severity of the infection, and the dosage of steroid usage were related to the short-term mental outcomes. However, these studies were limited by the relatively modest sample sizes and the reliance on self-reported questionnaires. In addition, prominent fatigue was commonly reported among SARS survivors, but its magnitude was seldom investigated. In this regard, there was a dearth of long-term follow-up data regarding the mental sequelae and the impact of fatigue among these patients. We investigated the long-term aftermath of SARS survivors, focusing on psychiatric morbidities, chronic fatigue, and associated factors.

SARS-related Perceptions in Hong Kong