title: Healthcare use in adults with insomnia: a longitudinal study.
abstract: BACKGROUND
  Insomnia is common and associated with high rates of anxiety and depression.
  
  
  OBJECTIVE
  To determine the association of insomnia with future primary care for sleep and mood problems, and explore the link with psychological distress.
  
  
  METHODS
  Questionnaire survey of adults aged >/=18 years, linked to primary care records.
  
  
  METHODS
  Five UK general practices.
  
  
  METHODS
  Survey responses were linked to recorded consultations and prescribed medication for sleep and mood problems for 12 months following the survey. Baseline self-reported insomnia was defined as the presence of at least one of four sleep problems. Psychological distress was measured using the Hospital Anxiety and Depression Scale.
  
  
  RESULTS
  A total of 2662 (56%) responded and 2192 (82%) consented to record review. Nineteen per cent had a subsequent recorded consultation or prescription for sleep or mood problems ('relevant healthcare use'). Self-reported insomnia was related to future relevant healthcare use (odds ratio = 1.77; 95% confidence interval = 1.35 to 2.33). This relationship was stronger in those with psychological distress. Sixty-three per cent of those with baseline insomnia and psychological distress had no relevant healthcare use. 'Trouble falling asleep' was most strongly associated with relevant healthcare use in persons without psychological distress; in persons with psychological distress, it was waking after a usual amount of sleep feeling tired and worn out.
  
  
  CONCLUSIONS
  Specific symptoms of insomnia are associated with consultation for sleep or mood problems, regardless of the presence of anxiety and depression. There is a large group of people who have combined insomnia and anxiety or depression who do not contact primary care about either sleep or mood problems.
authors.affiliation: Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, UK. r.hayward@cphc.keele.ac.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Hayward
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.forename: Peter
authors.initials: P
authors.lastname: Croft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D013315:Stress, Psychological / Q000150:complications; D055815:Young Adult
chemical_list: D055553:Prescription Drugs