Culver Najwa C, Song Yeonsu, Kate McGowan Sarah, Fung Constance H, Mitchell Michael N, Rodriguez Juan Carlos, Dzierzewski Joseph M, Josephson Karen R, Jouldjian Stella, Washington Donna L, Yano Elizabeth M, Schweizer C Amanda, Alessi Cathy A, Martin Jennifer L
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California.
Clin Ther. 2016 Nov;38(11):2373-2385. doi: 10.1016/j.clinthera.2016.09.019. Epub 2016 Oct 27.
Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches.
A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know").
In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep.
Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.
女性退伍军人存在睡眠问题的高风险，因此需要为患有失眠症的这一人群提供有效的治疗。本研究的主要目标是比较女性退伍军人中药物治疗与非药物治疗对失眠的可接受性。此外，我们考察了患者年龄、睡眠障碍严重程度和精神症状对每种治疗方法可接受性以及这些方法之间可接受性差异的影响。
对4000名在过去6个月（2012年5月29日至2012年11月28日）在退伍军人管理局（VA）设施接受过医疗保健的女性退伍军人进行随机抽样，开展一项大规模的全国性邮寄调查。共收到1559份完成的调查问卷。用于当前分析的调查项目包括：人口统计学特征、睡眠质量、精神症状、军事服役经历以及药物和非药物治疗失眠的可接受性。在分析中，仅使用“非常可接受”的评分来表明对治疗方法的兴趣（与“完全不可接受”“有点可接受”“ somewhat可接受”以及 “无意见/不知道”的评分相对）。
在1538名拥有完整数据的女性最终样本中，57.7% 的人将非药物治疗评为非常可接受，而只有33.5% 的人将药物治疗评为非常可接受。对于整个群体以及根据年龄、睡眠质量、精神症状和军事经历对患者亚组进行考察时，这种差异具有统计学意义。年龄较小、睡眠障碍更严重、精神症状更多、未经历过战斗暴露以及经历过军事性创伤的女性中，将药物治疗评为非常可接受的受访者比例更高。相比之下，将非药物治疗评为非常可接受的受访者比例仅在年龄方面存在差异（年轻女性更有可能认为非药物治疗可接受）以及入睡困难方面存在差异。
与药物治疗相比，女性退伍军人更有可能认为非药物失眠治疗是可接受的。因此，将这些患者与有效的行为干预措施（如失眠认知行为疗法）相匹配非常重要。努力让医疗服务提供者了解这些偏好以及失眠认知行为疗法的疗效，可能有助于将患有失眠症的女性退伍军人与她们喜欢的治疗方法联系起来。这些发现还表明，年龄较大的女性退伍军人可能比年轻女性更不太可能认为这两种方法都可接受。
