Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication.
BACKGROUND
Little is known about the population prevalence of sleep problems or whether the associations of sleep problems with role impairment are due to comorbid mental disorders.


METHODS
The associations of four 12-month sleep problems (difficulty initiating or maintaining sleep, early morning awakening, nonrestorative sleep) with role impairment were analyzed in the National Comorbidity Survey Replication controlling 12-month DSM-IV anxiety, mood, impulse-control, and substance disorders. The WHO Composite International Diagnostic Interview was used to assess sleep problems and DSM-IV disorders. The WHO Disability Schedule-II (WHO-DAS) was used to assess role impairment.


RESULTS
Prevalence estimates of the separate sleep problems were in the range 16.4-25.0%, with 36.3% reporting at least one of the four. Mean 12-month duration was 24.4 weeks. All four problems were significantly comorbid with all the 12-month DMS-IV disorders assessed in the survey (median OR: 3.4; 25(th)-75(th) percentile: 2.8-3.9) and significantly related to role impairment. Relationships with role impairment generally remained significant after controlling comorbid mental disorders. Nonrestorative sleep was more strongly and consistently related to role impairment than were the other sleep problems.


CONCLUSIONS
The four sleep problems considered here are of public health significance because of their high prevalence and significant associations with role impairment.
Roth
Thomas
T
Sleep Disorders Center, Department of Psychiatry and Behavioral Neurosciences, Henry Ford Hospital, Detroit, Michigan, USA.
Jaeger
Savina
S
Jin
Robert
R
Kalsekar
Anupama
A
Stang
Paul E
PE
Kessler
Ronald C
RC
D000203:Activities of Daily Living; D000328:Adult; D000339:Affect / Q000502:physiology; D000368:Aged; D001007:Anxiety / Q000523:psychology; D015897:Comorbidity; D016021:Epidemiologic Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D012893:Sleep Wake Disorders / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology