Elsevier

Biological Psychiatry

Volume 69, Issue 6, 15 March 2011, Pages 592-600
Biological Psychiatry

Archival Report
Prevalence and Perceived Health Associated with Insomnia Based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition Criteria: Results from the America Insomnia Survey

https://doi.org/10.1016/j.biopsych.2010.10.023Get rights and content

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.

Section snippets

The Sample

The AIS was carried out between October 2008 and July 2009 in a stratified probability sample of 10,094 adult (ages 18 and older) members of a large (over 34 million members) national US commercial health plan. The sample was restricted to fully insured members enrolled for at least 12 months to allow medical and pharmacy claims data to be used in substantive analyses. Sample eligibility was also limited to members who provided the plan with a telephone number, could speak English, and had no

The Estimated Prevalence of Insomnia

Insomnia prevalence estimates vary from 22.1% based on DSM-IV-TR criteria to 3.9% based on ICD-10 criteria (Table 1). The RDC/ICSD-2 estimate is 14.7%, while 23.6% of respondents meet criteria based on one or more of the different systems. The highest proportions of broadly defined cases, defined as those meeting criteria in at least one system, either meet only DSM criteria (33.9% of all cases, equivalent to 8.0% of the total sample) or DSM and RDC/ICSD but not ICD criteria (43.0% of cases,

Discussion

The above results are limited by the somewhat low AIS cooperation rate (65.0%), all respondents being members of a large national commercial health plan, and diagnoses being based on the BIQ rather than clinical interviews. The BIQ required sleep difficulties to occur at least three times per week and to last at least 30 minutes to meet criteria in any of the diagnostic systems, despite these not being DSM-IV or RDC/ICSD-2 requirements, although this issue was partially addressed by the AIS

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