Acceptability of Medication and Nonmedication Treatment for Insomnia Among Female Veterans: Effects of Age, Insomnia Severity, and Psychiatric Symptoms.
Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches.



A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know").



In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep.



Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System. Electronic address: najwa.culver@va.gov.
Najwa C
NC
Culver
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California.
Yeonsu
Y
Song
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
Sarah
S
Kate McGowan
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California.
Constance H
CH
Fung
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
Michael N
MN
Mitchell
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Medicine, Pontificia Universidad Catolica de Chile.
Juan Carlos
JC
Rodriguez
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Psychology, Virginia Commonwealth University, Virginia.
Joseph M
JM
Dzierzewski
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
Karen R
KR
Josephson
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System.
Stella
S
Jouldjian
David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Donna L
DL
Washington
VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California.
Elizabeth M
EM
Yano
David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
C Amanda
CA
Schweizer
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California.
Cathy A
CA
Alessi
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California.
Jennifer L
JL
Martin
D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014728:Veterans; D055815:Young Adult
cognitive-behavioral therapy; female veterans; insomnia; medications; sleep; treatment acceptability