Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI-A) in U.S. Male Military Veterans
ABSTRACT Sleep disturbances are core symptoms of posttraumatic-stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI-A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI-A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI-A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI-A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost-effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).
SourceAvailable from: Yair Sharav[Show abstract] [Hide abstract]
ABSTRACT: Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life. Copyright © 2014 Elsevier Ltd. All rights reserved.Journal of Psychiatric Research 12/2014; 61. DOI:10.1016/j.jpsychires.2014.11.015 · 4.09 Impact Factor
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ABSTRACT: Sleep routines that develop as an adaptation or reaction to deployment can persist upon return stateside. Sleep problems intensify and are intensified by psychiatric distress. This research presents the findings of a comprehensive survey of sleep impairment in relation to demographic data, military history, combat exposure, and mental illness symptoms among a general sample of 375 servicemembers and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) at a wide range of times postdeployment. Sleep impairment was assessed with the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for PTSD. Posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were evaluated, with the PTSD Checklist-Military, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7. Sleep problems were common across the sample, with 45.4% of participants reporting sleep onset greater than 30 minutes, 21.4% typically achieving less than 4.5 hours of total sleep time, and 56% reporting being awake in bed more than 15% of the night. Global PSQI scores classified 89% of the sample as "poor sleepers." Sleep problems were more severe among servicemembers with less education, from lower ranks (E1-E3), with greater combat exposure, and greater depression, anxiety, and PTSD symptoms. These findings suggest the need for routine screening of sleep problems among veterans and increased professional training in interventions for insomnia and nightmares. For individuals experiencing sleep problems with concurrent psychiatric symptoms, addressing sleep concerns may be one less-stigmatizing way to transition servicemembers and veterans into needed mental health services. (PsycINFO Database Record (c) 2013 APA, all rights reserved).Psychological Services 11/2013; 11(2). DOI:10.1037/a0034958 · 1.08 Impact Factor
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ABSTRACT: Objective Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Method Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Results Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Conclusion Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required. ClinicalTrials.gov Identifier: NCT00840255.Behaviour Research and Therapy 10/2014; 61. DOI:10.1016/j.brat.2014.07.016 · 3.85 Impact Factor