Background
Although several diagnostic systems define insomnia, little is known about the implications
of using one versus another of them.
Methods
The America Insomnia Survey, an epidemiological survey of managed health care plan
subscribers (n = 10,094), assessed insomnia with the Brief Insomnia Questionnaire, a clinically
validated scale generating diagnoses according to DSM-IV-TR; International Statistical
Classification of Diseases, Tenth Revision (ICD-10); and Research Diagnostic Criteria/International
Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) criteria. Regression
analysis examines associations of insomnia according to the different systems with
summary 12-item Short-Form Health Survey scales of perceived health and health utility.
Results
Insomnia prevalence estimates varied widely, from 22.1% for DSM-IV-TR to 3.9% for
ICD-10 criteria. Although ICD insomnia was associated with significantly worse perceived
health than DSM or RDC/ICSD insomnia, DSM-only cases also had significant decrements
in perceived health. Because of its low prevalence, 66% of the population-level health
disutility associated with overall insomnia and 84% of clinically relevant cases of
overall insomnia were missed by ICD criteria.
Conclusions
Insomnia is highly prevalent and associated with substantial decrements in perceived
health. Although ICD criteria define a narrower and more severe subset of cases than
DSM criteria, the fact that most health disutility associated with insomnia is missed
by ICD criteria, while RDC/ICSD-only cases do not have significant decrements in perceived
health, supports use of the broader DSM criteria.
Key Words
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Article info
Publication history
Published online: January 03, 2011
Accepted:
October 24,
2010
Received in revised form:
October 18,
2010
Received:
May 28,
2010
Identification
Copyright
© 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
