Elsevier

Biological Psychiatry

Volume 60, Issue 12, 15 December 2006, Pages 1364-1371
Biological Psychiatry

Original article
Sleep Problems, Comorbid Mental Disorders, and Role Functioning in the National Comorbidity Survey Replication

https://doi.org/10.1016/j.biopsych.2006.05.039Get rights and content

Background

Little is known about the population prevalence of sleep problems or whether the associations of sleep problems with role impairment are due to comorbid mental disorders.

Methods

The associations of four 12-month sleep problems (difficulty initiating or maintaining sleep, early morning awakening, nonrestorative sleep) with role impairment were analyzed in the National Comorbidity Survey Replication controlling 12-month DSM-IV anxiety, mood, impulse-control, and substance disorders. The WHO Composite International Diagnostic Interview was used to assess sleep problems and DSM-IV disorders. The WHO Disability Schedule-II (WHO-DAS) was used to assess role impairment.

Results

Prevalence estimates of the separate sleep problems were in the range 16.4–25.0%, with 36.3% reporting at least one of the four. Mean 12-month duration was 24.4 weeks. All four problems were significantly comorbid with all the 12-month DMS-IV disorders assessed in the survey (median OR: 3.4; 25th–75th percentile: 2.8–3.9) and significantly related to role impairment. Relationships with role impairment generally remained significant after controlling comorbid mental disorders. Nonrestorative sleep was more strongly and consistently related to role impairment than were the other sleep problems.

Conclusions

The four sleep problems considered here are of public health significance because of their high prevalence and significant associations with role impairment.

Section snippets

Sample

The NCS-R is a nationally representative, face-to-face household survey of adults (ages 18+) based on a multi-stage clustered area probability sampling design (Kessler et al 2004c). A total of 9282 respondents participated in the survey (February 2001 to December 2003). The response rate was 70.9%. Participants received a $50 honorarium. After complete description of the study to potential respondents, verbal informed consent was obtained. Consent was verbal rather than written in order to be

Prevalence, Inter-Correlations and Duration

Twelve-month prevalence estimates are 16.4% for DIS, 19.9% for DMS, 16.7% for EMA, and 25.0% for NRS (Table 1). The proportion of the sample with one or more of these four problems is 36.3%. The fact that the latter proportion is much less than the sum of the four problem-specific proportions (which would be the prevalence of having any of the four if no single individual had more than one sleep problem) indirectly indicates that the four problems are strongly interrelated. This can be seen

Discussion

These results have to be interpreted with three limitations in mind. First, while duration of sleep problems was assessed over the past 12 months in order to study the extent to which these problems are persistent over the course of a year, concerns about recall bias in reports about days out of role and role functioning led us to assess impairment over the shorter recall period of the past 30 days. This lack of comparability in time frames is likely to have introduced a conservative bias into

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