title: Differences between patients' and clinicians' report of sleep disturbance: a field study in mental health care in Norway.
abstract: BACKGROUND
  The aims of the study was to assess the prevalence of diagnosed insomnia and the agreement between patient- and clinician-reported sleep disturbance and use of prescribed hypnotic medication in patients in treatment for mental disorders.
  
  
  METHODS
  We used three cross-sectional, multicenter data-sets from 2002, 2005, and 2008. Data-set 1 included diagnostic codes from 93% of all patients receiving treatment in mental health care in Norway (N = 40261). Data-sets 2 (N = 1065) and 3 (N = 1181) included diagnostic codes, patient- and clinician-reported sleep disturbance, and use of prescribed hypnotic medication from patients in 8 mental health care centers covering 10% of the Norwegian population.
  
  
  RESULTS
  34 patients in data-set 1 and none in data-sets 2 and 3 had a diagnosis of insomnia as a primary or comorbid diagnosis. In data-sets 2 and 3, 42% and 40% of the patients reported sleep disturbance, whereas 24% and 13% had clinician-reported sleep disturbance, and 7% and 9% used hypnotics. Patients and clinicians agreed in 29% and 15% of the cases where the patient or the clinician or both had reported sleep disturbance. Positive predictive value (PPV) of clinicians' evaluations of patient sleep disturbance was 62% and 53%. When the patient reported sleep disturbance as one of their most prominent problems PPV was 36% and 37%. Of the patients who received hypnotic medication, 23% and 29% had neither patient nor clinician-rated sleep disturbance.
  
  
  CONCLUSIONS
  When patients meet the criteria for a mental disorder, insomnia is almost never diagnosed, and sleep disturbance is imprecisely recognized relative to the patients' experience of sleep disturbance.
authors: Division of Psychiatry, Department of Research and Development, St Olav's University Hospital, Trondheim, Norway. havard.kallestad@ntnu.no
authors: Håvard
authors: H
authors: Kallestad
authors: Bjarne
authors: B
authors: Hansen
authors: Knut
authors: K
authors: Langsrud
authors: Torleif
authors: T
authors: Ruud
authors: Gunnar
authors: G
authors: Morken
authors: Tore C
authors: TC
authors: Stiles
authors: Rolf W
authors: RW
authors: Gråwe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008603:Mental Health; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D057566:Self Report; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D006993:Hypnotics and Sedatives