Physical Health, Mental Health Associated With Insomnia in Veterans

Veterans with physical and mental health issues may experience comorbid insomnia disorder, emphasizing the importance of increasing awareness around the prevalence of insomnia in this population, according to the results of a study published in Occupational Medicine. The study found that probable insomnia disorder was associated with physical health problems and difficulty with anger in the adjusted model.

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The study authors aimed to determine the prevalence and associated demographic, military, health, and functional outcomes for veterans with probable insomnia disorder. The participants in the study were from Combat Stress, which is a mental health charity in the United Kingdom for veterans.

All individuals in the study seeking treatment received support from the charity over a 1-year period, consented to be contacted for research, and had a contact e-mail address. They were also given a 10-page questionnaire, including sections such as their military history, their social network, gambling and drinking habits, health, obsessions and compulsions, symptoms related to stressful events, and information about their childhood.

Investigators also included data on the individual’s sex, age, ethnicity, employment status, and relationship status. Furthermore, information about the military branch they served, their rank, their reason for leaving the service, and if they left service early, according to the study authors.

The individual’s sleep was also measured by the Sleep Condition Indicator, which is a scale that measures sleep issues against criteria for probable insomnia disorder comprised of 8 questions. Scores were recorded 0 to 31, with a score of 16 or less indicating insomnia disorder and high scores related to better sleep. Data were collected from August to September 2020, including 5 invitations via email over a 6-week period with non-responders being sent paper questionnaires via traditional mail in October 2020.

A total of 989 veterans were contacted, of whom 428 individuals responded for a response rate of 43%. Overall, 70% of the individuals had difficulties sleeping.

Among the study population, 97% were male, 35% and 34% were 55 and older or 45 to 54, respectively, 95% were white, 56% were working. Further, 82% were in the British Army, 11 were in the Royal Navy and 7% were in the Royal Air Force. Additionally, 11% were an officer and 89% had other ranks, with 96% not leaving service early and 55% were voluntary discharges.

The study authors reported that there was a significant association between those in the 35-to-44-years of age range and probable insomnia disorder, but there were no other significant associations between probable insomnia disorder and socio-demographics and military characteristics in the adjusted model. However, the investigators found that in the unadjusted model, there was a significant association between probable insomnia disorder and those who were not in a relationship, but that was not evident when the model was adjusted.

In another model, there were no functional outcomes significantly associated with probable insomnia disorder in the adjusted model, but in the unadjusted model, there associations with low social support and loneliness; however, the 2 factors were not significantly associated in the adjusted model.

In the last model, the investigators aimed to determine the associations of sleep difficulties and health outcomes, in which physical health problems and difficulty with anger were associated in the adjusted model. In the unadjusted model, complex post-traumatic stress disorder, obsessive-compulsive disorder, and common mental health difficulties were significantly associated with sleep difficulties, but not in the adjusted model.

Reference

Molloy N, Murphy D. Associations between sleep difficulties and health outcomes in treatment-seeking veterans. Occup Med (Lond). 2023;73(7):439-445. doi:10.1093/occmed/kqad094