Psychosocial Correlates of Insomnia Severity in Primary Care

The Journal of the American Board of Family Medicine

Amanda C. Healey²  Carolyn M. Rutledge³  Daniel Bluestein¹ 

[1] Department of Family and Community Medicine, Geriatrics Division, Eastern Virginia Medical School, Norfolk, VA (DB);Department of Educational Leadership and Counseling (ACH), Old Dominion University, Norfolk, VA;Center for Research and Scholarship, School of Nursing (CMR), Old Dominion University, Norfolk, VA

关键词: Insomnia;    Self-efficacy;    Depressive Disorder;    Behavior and Behavior Mechanisms;    Primary Health Care;    Cross-Sectional;   

DOI  :  10.3122/jabfm.2010.02.090179

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Insomnia is a substantive primary care issue that leads to adverse outcomes. These can be improved by addressing factors that accentuate insomnia severity. Accordingly, this study identifies correlates of insomnia severity and determines whether these relationships vary with sociodemographic attributes.

Methods: This correlational cross-sectional study was conducted in a hospital-sponsored primary care clinic and 2 urban, academic family practice centers. Participants consisted of 236 patients 18 years old or older with clinically significant insomnia (Insomnia Severity Index scores of 7 or more). Surveys instruments included the Insomnia Severity Index, SF-8 (Medical Outcomes Study SF-8 global health status measure), CES-D (Center for Epidemiologic Studies-Depression Scale), DBAS (Dysfunctional Beliefs about Sleep scale), SE-S (Self-Efficacy for Sleep Scale), and a researcher-designed demographic survey. Analytic techniques included descriptive statistics to characterize the study sample, Pearson or Spearman Correlation Coefficients to examine individual associations with insomnia severity, and step-wise linear regression to identify net predictors.

Results: Insomnia severity was significantly correlated with health status, depression, self-efficacy, and dysfunctional beliefs (P < .001) but not with sociodemographic attributes. Linear regression demonstrated insomnia severity was best predicted by low self-efficacy and high depression scores.

Discussion: These findings indicate that clinicians treating insomnia should not only manage comorbid depression but also facilitate self-efficacy for sleep-inducing behavioral change.

• Insomnia
• Self-efficacy
• Depressive Disorder
• Behavior and Behavior Mechanisms
• Primary Health Care
• Cross-Sectional

Chronic insomnia is defined as difficulty initiating or maintaining sleep or nonrestorative sleep that impairs daytime functioning.¹ An estimated 40 to 70 million Americans are affected with insomnia intermittently and 10% to 20% are affected chronically.² Placed in perspective, this figure is double the prevalence of major depression (6.6% per year).³ Consequences of insomnia are substantive and include mood disturbances, medication habituation, memory impairment, daytime fatigue, vocational and interpersonal difficulties, increased health care utilization, impaired health status,^4–6 and accidents.⁷ Insomnia costs exceed $42 billion each year.⁸ Thus, in view of its prevalence, consequences, and costs, insomnia is a primary care concern.

Insomnia severity often leads to distress and resultant help-seeking in primary care.^9,10 Therapeutic responses typically address the sleep disturbance itself.¹¹ As an adjunctive approach, addressing psychosocial factors that accentuate insomnia severity and help-seeking can also reduce distress and enhance well-being.¹² In the recent literature several psychosocial factors—poor health status,¹³ depression,¹⁴ perceptions of low self-efficacy,¹⁵ and dysfunctional beliefs about sleep¹⁶—have been associated with insomnia severity. However, none of these studies nor other major reviews of insomnia in primary care^9–11,17 indicate which of these factors best predict insomnia severity.

Addressing potential predictors of insomnia severity has important clinical management implications. Specifically, if poor health status is most salient, then addressing contributory comorbidities such as arthritis, heart failure, and other chronic medical illnesses should be prioritized. Alternatively, time and resources should be directed to the management of depressive symptoms should these best predict insomnia severity. A net relationship with low self-efficacy would indicate a role for self-efficacy enhancement techniques that facilitate personalized, achievable goal setting and self-care.¹⁸ Preeminence of dysfunctional beliefs would warrant greater emphasis on the integration of cognitive-behavioral approaches in medical settings.¹⁹ Knowing how relationships vary across sociodemographic subgroups can also inform management. Accordingly, this study was conducted to identify individual and net psychosocial correlates of insomnia severity and to determine whether these relationships vary with sociodemographic attributes.

【 授权许可】

Unknown   

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