Prevalence, pharmacotherapy and clinical correlates of diagnosed insomnia among Veterans Health Administration service users nationally.
OBJECTIVE
There is little information on diagnostic rates or treatment correlates of insomnia in real-world practice. Study objectives were to identify the 1-year prevalence, psychotropic pharmacotherapy and clinical correlates of diagnosed insomnia, nationally in the Veterans Health Administration (VHA).


METHODS
The study used national administrative data on all individuals receiving VHA care in 2010. Receipt of insomnia, in addition to co-morbid diagnoses, was identified using relevant International Classification of Diseases (ICD)-9 diagnostic codes. The adjusted mean number of psychotropic prescription fills and co-morbid conditions associated with insomnia were identified using bivariate and multivariable regression models.


RESULTS
Of the 5,531,379 individuals receiving VHA care in 2010, 190,378 (3.4%) received an insomnia diagnosis. Controlling for clinical characteristics, the presence of an insomnia diagnosis was associated with an average of four additional psychotropic prescription fills over the year. Among demographic characteristics, deployment to recent conflicts in Iraq/Afghanistan (adjusted odds ratio (AOR)=1.62) displayed the strongest independent association, while age, unexpectedly, did not display any association with insomnia. Among diagnostic variables, anxiety disorders other than post-traumatic stress (AOR=2.12) and depressive disorders other than major depression (AOR=2.05) displayed the strongest independent associations with insomnia.


CONCLUSIONS
The diagnosis of insomnia is associated with the filling of more psychotropic prescriptions, net of the presence of psychiatric co-morbidity in national VHA administrative data, and the prevalence of diagnosed insomnia is lower than that found in systematic surveys of the general population, a potential impediment to optimal treatment.
VA New England Mental Illness Research, Education and Clinical Center, Department of Psychiatry, Yale School of Medicine and the VA Connecticut Health Care System, 950 Campbell Ave., West Haven, CT 06516, USA. Electronic address: eric.hermes@yale.edu.
Eric
E
Hermes
VA New England Mental Illness, Research, Education and Clinical Center, Department of Psychiatry, Epidemiology and Public Health, and the Child Study Center, Yale School of Medicine and the VA Connecticut Health Care System, 950 Campbell Ave., West Haven, CT 06516, USA. Electronic address: Robert.Rosenheck@yale.edu.
Robert
R
Rosenheck
D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data
D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs
Epidemiology; Insomnia; Pharmaco-epidemiology; Psychiatric disorders; Sleep disorders; Veterans