title: Psychosocial correlates of insomnia severity in primary care.
abstract: OBJECTIVE
  Insomnia is a substantive primary care issue that leads to adverse outcomes. These can be improved by addressing factors that accentuate insomnia severity. Accordingly, this study identifies correlates of insomnia severity and determines whether these relationships vary with sociodemographic attributes.
  
  
  METHODS
  This correlational cross-sectional study was conducted in a hospital-sponsored primary care clinic and 2 urban, academic family practice centers. Participants consisted of 236 patients 18 years old or older with clinically significant insomnia (Insomnia Severity Index scores of 7 or more). Surveys instruments included the Insomnia Severity Index, SF-8 (Medical Outcomes Study SF-8 global health status measure), CES-D (Center for Epidemiologic Studies-Depression Scale), DBAS (Dysfunctional Beliefs about Sleep scale), SE-S (Self-Efficacy for Sleep Scale), and a researcher-designed demographic survey. Analytic techniques included descriptive statistics to characterize the study sample, Pearson or Spearman Correlation Coefficients to examine individual associations with insomnia severity, and step-wise linear regression to identify net predictors.
  
  
  RESULTS
  Insomnia severity was significantly correlated with health status, depression, self-efficacy, and dysfunctional beliefs (P < .001) but not with sociodemographic attributes. Linear regression demonstrated insomnia severity was best predicted by low self-efficacy and high depression scores.
  
  
  CONCLUSIONS
  These findings indicate that clinicians treating insomnia should not only manage comorbid depression but also facilitate self-efficacy for sleep-inducing behavioral change.
authors.affiliation: Department of Family and Community Medicine, Geriatrics Division, Eastern Virginia Medical School, Norfolk, VA 23507, USA. bluestda@evms.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Bluestein
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutledge
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Healey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001521:Behavior Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D020377:Self Efficacy; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014768:Virginia; D055815:Young Adult