Insomnia symptoms among female veterans: Prevalence, risk factors, and the impact on psychosocial functioning and health care utilization

Abstract

Study Objectives: To examine the prevalence of self-reported insomnia symptoms, identify subgroups of female veterans with clinically significant insomnia symptoms, and examine the effect on psychosocial functioning and health care utilization. Methods: Cross-sectional analysis of insomnia symptoms and associated characteristics among a stratified random sample of female veterans using Department of Veterans Affairs primary care facilities between October 1, 2010 and September 30, 2011 (n = 6,261) throughout the United States. The primary outcome was reported presence of insomnia symptoms. Other variables included psychological disorders, chronic conditions, chronic pain, and demographic variables. Results: Overall, 47.39% of female veterans screened positively for insomnia symptoms. They differed demographically from those without insomnia symptoms and reported more substance use, chronic physical conditions, and psychological conditions. Receiver operating characteristic analysis indicated the primary factor that differentiated those with versus those without insomnia symptoms was depression. Individuals were further differentiated based on presence of pain and posttraumatic stress disorder. Results yielded eight homogenous subgroups of women at low and high risk of experiencing insomnia symptoms. Conclusions: Sleep problems are common among female veterans (47.39%) despite limited diagnosis of sleep disorders (0.90%). Eight unique subgroups of female veterans with both low and high insomnia symptoms were observed. These subgroups differed in terms of psychosocial functioning and health care utilization, with those with depression, posttraumatic stress disorder, and pain having the poorest outcomes. These results shed light on the prevalence of insomnia symptoms experienced among female veterans and the effect on psychosocial functioning and health care utilization. Results can inform targeted detection and customized treatment among female veterans.