title: A Comparison of Sleep Difficulties among Iraq/Afghanistan Theater Veterans with and without Mental Health Diagnoses.
abstract: OBJECTIVE
  Sleep disturbance is among the most common complaints of veterans and military personnel who deployed to the conflicts in Iraq and Afghanistan. A growing body of research has examined cross-sectional and longitudinal relationships between sleep disturbance and mental health symptoms and specific diagnoses in this population. However, prior research has not examined these relationships in terms of the presence or absence of any mental health diagnosis. The objective of the current study is to characterize the sleep complaints (sleep characteristics, sleep quality, insomnia symptoms, and distressing dreams and nightmares) of previously deployed military personnel in terms of the presence or absence of a mental health disorder, diagnosed using structured clinical diagnostic interviews.
  
  
  METHODS
  Participants (n = 1,238) were veterans and active duty military personnel serving in the military since September 11, 2001, and deployed at least once. Scale scores and item-level data from the Pittsburgh Sleep Quality Index (PSQI), the PSQI-Addendum, the Davidson Trauma Scale, and the Symptom Checklist-90 were used to compare sleep across mental health status (with/without mental health disorder).
  
  
  RESULTS
  As expected, self-reported sleep impairments were worse among those meeting criteria for a mental health disorder. However, findings also revealed very poor sleep among those without a mental health diagnosis as well. Mean values for both groups were suggestive of short sleep duration, low sleep efficiency, long sleep onset latencies, poor sleep quality, frequent insomnia symptoms, and nightmare frequencies that are well above norms for the general population.
  
  
  CONCLUSIONS
  Given the evidence for adverse mental and physical health sequelae of untreated sleep disturbance, increased attention to sleep in this population may serve as a primary prevention strategy.
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: Christi S
authors.initials: CS
authors.lastname: Ulmer
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Van Voorhees
authors.affiliation: University of Pittsburgh, Departments of Psychiatry and Psychology, Pittsburgh, PA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Germain
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC.|Department of General Internal Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.|VISN 6 Mental Illness Research, Education, and Clinical Center, Durham, NC.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015897:Comorbidity; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D057566:Self Report; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*
keywords: mental health disorders; prevention; sleep; veterans