0855 Insomnia Severity Predicts Depression, Anxiety, and PTSD in Veterans with Spinal Cord Injury or Disease

Abstract

Introduction: Sleep disturbance and mental health symptoms are common in patients with spinal cord injury or disease (SCI/D). Unfortunately, data are limited regarding the relationship between insomnia and mental health in patients with SCI/D. Our objective was to examine the impact of insomnia symptoms on mental health symptoms in patients with SCI/D. Method(s): 57 Veterans (58.53 +/- 10.69 years; 91% male) with SCI/D completed baseline assessments for a positive airway pressure adherence intervention study. Nested regression models predicted Patient Health Questionnaire (PHQ-9; 6.57 +/- 5.19) or Generalized Anxiety Disorder screener (GAD-7; 6.53 +/- 5.84) without sleep items. Logistic regression predicted probable PTSD (PC-PTSD >= 3; n=36) vs. no PTSD (PC-PTSD < 3; n=20). Block 1 included demographic covariates (age, gender, race, education, marital status, BMI), Block 2 included level of injury (cervical vs. thoracic and below), and Block 3 included Insomnia Severity Index (ISI) total score. Result(s): Block 1 explained significant variance in GAD-7 (p=.05), but not PHQ-9 (p=.17). Level of injury did not explain significant variance in GAD-7 (p=.34) or PHQ-9 (p=.94) over and above Block 1. ISI explained an additional 13% of variance in GAD-7 (p=.003) and 12% in PHQ-9 (p=.007) over and above blocks 1 and 2. All variables in Blocks 1-3 were jointly associated with GAD-7 (R2=37.06%, adjusted R2=0.26) and PHQ-9 (R2=29.80%, adjusted R2=0.18). Odds of probable PTSD were increased 1.51 fold for each 1 unit increase in ISI (p=.004). Conclusion(s): In Veterans with SCI/D, insomnia symptom severity was associated with anxiety and depression severity and higher odds of PTSD. Endorsement of difficulty falling and staying asleep in SCI/D should prompt mental health screening in addition to screening for sleep-related breathing disorders. Further research should evaluate whether insomnia interventions may benefit mental health symptoms in SCI/D.