Department of Psychiatry, Westmead Hospital, Sydney, Australia.
US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, Vermont.
J Clin Sleep Med. 2021 Jun 1;17(6):1267-1277. doi: 10.5664/jcsm.9182.
Veterans experience high levels of trauma, psychiatric, and medical conditions that may increase their risk for insomnia. To date, however, no known study has examined the prevalence, risk correlates, and comorbidities of insomnia in a nationally representative sample of veterans.
A nationally representative sample of 4,069 US military veterans completed a survey assessing insomnia severity; military, trauma, medical, and psychiatric histories; and health and psychosocial functioning. Multivariable analyses examined the association between insomnia severity, psychiatric and medical comorbidities, suicidality, and functioning.
A total of 11.4% of veterans screened positive for clinical insomnia and 26.0% for subthreshold insomnia. Greater age and retirement were associated with a lower likelihood of insomnia. Adverse childhood experiences, traumatic life events, lower education and income were associated with greater risk for insomnia. A "dose-response" association was observed for health comorbidities, with increasing levels of insomnia associated with elevated odds of psychiatric and medical conditions (clinical vs no insomnia odds ratio = 1.8-13.4) and greater reductions in health and psychosocial functioning (clinical vs no insomnia Cohen's d = 0.2-0.4). The prevalence of current suicidal ideation was 3-5 times higher in veterans with clinical and subthreshold insomnia relative to those without insomnia (23.9% and 13.6% vs 4.5%, respectively).
Nearly 2 in 5 US veterans experience clinical or subthreshold insomnia, which is associated with substantial health burden and independent risk for suicidal ideation. Results underscore the importance of assessment, monitoring, and treatment of insomnia in veterans as they transition from the military.
退伍军人经历着高水平的创伤、精神和医疗状况，这可能会增加他们失眠的风险。然而，迄今为止，尚无已知研究在一个具有代表性的退伍军人样本中调查失眠的患病率、风险相关性和合并症。
一个由 4069 名美国退伍军人组成的全国代表性样本完成了一项调查，评估失眠严重程度、军事、创伤、医疗和精神病史以及健康和心理社会功能。多变量分析检查了失眠严重程度、精神和医疗合并症、自杀意念和功能之间的关联。
共有 11.4%的退伍军人筛查出临床失眠，26.0%的退伍军人筛查出亚临床失眠。年龄较大和退休与失眠的可能性较低有关。不良的童年经历、创伤性生活事件、较低的教育和收入与更高的失眠风险相关。健康合并症存在“剂量反应”关联，随着失眠程度的增加，与精神和医疗状况的几率增加（临床失眠与无失眠的比值比= 1.8-13.4）和健康和心理社会功能的降低更大（临床失眠与无失眠的 Cohen's d = 0.2-0.4）。与无失眠的退伍军人相比，有临床和亚临床失眠的退伍军人当前自杀意念的发生率高出 3-5 倍（分别为 23.9%和 13.6%与 4.5%）。
近五分之二的美国退伍军人经历临床或亚临床失眠，这与大量的健康负担和独立的自杀意念风险相关。结果强调了在退伍军人从军队过渡期间评估、监测和治疗失眠的重要性。
