THE MORBIDITY OF INSOMNIA UNCOMPLICATED BY PSYCHIATRIC-DISORDERS

The morbidity of sleep problems has been well documented; however, the y are frequently associated with and are symptomatic of several psychi atric disorders. It is unclear how much of the morbidity can be accoun ted for by the associated psychiatric and substance abuse disorders an d medical problems, and how much by the sleep problems per se. Sleep p roblems may also be an early sign of a psychiatric problem. This paper reports data from an epidemiologic community survey of over 10,000 ad ults living in three U.S. communities. A structured diagnostic assessm ent of psychiatric disorders as well as assessment of the presence of insomnia not due to medical conditions, medication, drug or alcohol ab use, and a 1-year follow-up were completed. Persons with insomnia in t he past year without any psychiatric disorders ever (uncomplicated ins omnia); with a psychiatric disorder in the past year (complicated inso mnia); and with neither insomnia nor psychiatric disorder ever were co mpared on treatment utilization and the first onset of a psychiatric d isorder in the subsequent year. Eight percent of those with uncomplica ted as compared with 14.9% with complicated insomnia and 2.5% with nei ther had sought treatment from the general medical sector for emotiona l problems in the 6 months prior to the interview. The rates of treatm ent sought from the psychiatric specialty sector were 3.8%, 9.4%, and 1.2%, respectively. These differences were significant after controlli ng for sociodemographic characteristics and were sustained when the pe rsons were interviewed 1 year later. Uncomplicated insomnia was also a ssociated with an increase in risk for first onset of major depression , panic disorder, and alcohol abuse over the following year. Insomnia, even in the absence of psychiatric disorders, is associated with incr eased use of general medical and mental health treatment for emotional problems and for the subsequent first onset in the following year of some psychiatric disorders. Early diagnosis and treatment of uncomplic ated insomnia may be useful. (C) 1997 Elsevier Science Inc.