Publication year
2017
Citation Title
Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers.
Journal Name
Journal of Affective Disorders
Journal Volume
221
Page Numbers
25-30
DOI
10.1016/j.jad.2017.06.023
Summary
A common complaint of combat-exposed Service members is insomnia. Frequently, insomnia occurs along with other psychiatric disorders (e.g., depression). Since insomnia can affect vigilance, moral reasoning, and decision making, this study examined the relationship between insomnia, other psychiatric disorders, and their impact on cognition (e.g., memory and concentration) in Service members. Results suggest that the presence of other psychiatric disorders influence the relationship between cognitive ability and insomnia.
Key Findings
A large percentage of Service members who were experiencing a major depressive episode were also experiencing insomnia (85%).
Insomnia often occurred in conjunction with generalized anxiety disorder (82.6%) and posttraumatic stress disorder (69.7%).
Certain psychiatric disorders were found to influence the relationship between insomnia and cognitive problems; namely, a major depressive episode, posttraumatic stress disorder, and generalized anxiety disorder.
The presence of more than one psychiatric disorder further increased the likelihood of a Service member to experience insomnia.
Implications for Program Leaders
Educate Service members and their partners on ways to improve sleep habits
Provide support groups for Service members who are experiencing insomnia and another psychiatric disorder to reduce the risk of cognitive problems
Disseminate information to Service members and their families regarding the effects of insomnia on cognitive functioning and where they can find help for insomnia
Implications for Policy Makers
Encourage the training of professionals to better identify Service members who may be experiencing cognitive problems due to insomnia
Recommend integrating education on ways to improve sleep quality into existing delivery systems (e.g., parent education, reintegration programming) for military families
Encourage the development and continuation of programs that promote better mental health and sleep quality for Service members and their families
Methods
U.S. Army Service members were recruited quarterly between 2011 and 2013. Units with less than 30 Service members or who only included civilians were excluded from recruitment.
Surveys included measures assessing insomnia, psychiatric disorders, and cognitive problems.
Researchers analyzed associations between insomnia, psychiatric disorders, and cognitive problems.
Participants
Participants were Service members in the U.S. Army who completed the All Army Study of the Army Study to Assess Risk and Resilience in Service members (n=695,784).
The sample included both men (86.5%) and women (13.5%).
The sample was 66.3% White, 16.3% Black, 3.6% Asian American, 1.3% Native American, 4.1% Multiracial, and 8.5% other.
Limitations
There is an increased chance that mental health data included inaccurate diagnoses or estimates since all data was self-reported and not based on professional diagnoses or neurocognitive tests.
The long-term effects of insomnia on the cognitive functioning of Service members cannot be determined since a follow-up survey was not conducted.
Data were cross sectional; therefore, the directions of effects cannot be determined.
Avenues for Future Research
Use full diagnostic measures for mental health diagnoses in order to improve accuracy of classification
Conduct a longitudinal study that includes follow-up data to further assess the direction of effects, such as how insomnia and psychiatric disorders influence cognition over time
Expand the study to include other branches of the military in order to increase the relevance to all service branches
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
BACKGROUND:
There has been a great deal of research on the comorbidity of insomnia and psychiatric disorders, but much of the existing data is based on small samples and does not assess the full diagnostic criteria for each disorder. Further, the exact nature of the relationship between these conditions and their impact on cognitive problems are under-researched in military samples.
METHOD:
Data were collected from the All Army Study of the Army Study to Assess Risk and Resilience in Service members (unweighted N = 21, 449; weighted N = 674,335; 18-61 years; 13.5% female). Participants completed the Brief Insomnia Questionnaire to assess for insomnia disorder and a self-administered version of the Composite International Diagnostic Interview Screening Scales to assess for psychiatric disorders and cognitive problems.
RESULTS:
Military soldiers with current major depressive episode (MDE) had the highest prevalence of insomnia disorder (INS; 85.0%), followed by current generalized anxiety disorder (GAD; 82.6%) and current posttraumatic stress disorder (PTSD; 69.7%), respectively. Significant interactions were found between insomnia and psychiatric disorders; specifically, MDE, PTSD, and GAD status influenced the relationship between insomnia and memory/concentration problems.
LIMITATIONS:
Cross-sectional nature of the assessment and the absence of a comprehensive neurocognitive battery.
CONCLUSION:
Psychiatric disorders moderated the relationship between insomnia and memory/concentration problems, suggesting that psychiatric disorders contribute unique variance to cognitive problems even though they are associated with insomnia disorder. Results highlight the importance of considering both insomnia and psychiatric disorders in the diagnosis and treatment of cognitive deficits in military soldiers.
There has been a great deal of research on the comorbidity of insomnia and psychiatric disorders, but much of the existing data is based on small samples and does not assess the full diagnostic criteria for each disorder. Further, the exact nature of the relationship between these conditions and their impact on cognitive problems are under-researched in military samples.
METHOD:
Data were collected from the All Army Study of the Army Study to Assess Risk and Resilience in Service members (unweighted N = 21, 449; weighted N = 674,335; 18-61 years; 13.5% female). Participants completed the Brief Insomnia Questionnaire to assess for insomnia disorder and a self-administered version of the Composite International Diagnostic Interview Screening Scales to assess for psychiatric disorders and cognitive problems.
RESULTS:
Military soldiers with current major depressive episode (MDE) had the highest prevalence of insomnia disorder (INS; 85.0%), followed by current generalized anxiety disorder (GAD; 82.6%) and current posttraumatic stress disorder (PTSD; 69.7%), respectively. Significant interactions were found between insomnia and psychiatric disorders; specifically, MDE, PTSD, and GAD status influenced the relationship between insomnia and memory/concentration problems.
LIMITATIONS:
Cross-sectional nature of the assessment and the absence of a comprehensive neurocognitive battery.
CONCLUSION:
Psychiatric disorders moderated the relationship between insomnia and memory/concentration problems, suggesting that psychiatric disorders contribute unique variance to cognitive problems even though they are associated with insomnia disorder. Results highlight the importance of considering both insomnia and psychiatric disorders in the diagnosis and treatment of cognitive deficits in military soldiers.
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