Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics

Abstract

Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression models were used to identify variables associated with insomnia or sedative-hypnotic use. Key findings include low insomnia diagnosis rates (3.5–5.6%) and high rates of sedative-hypnotics (44.2–49.0%). Younger Veterans and those without a breathing-related sleep disorder (BRSD) were more likely to receive an insomnia diagnosis. Veterans with greater service connection and those with an alcohol/substance use disorder were more likely to be prescribed sedative-hypnotics. Interaction terms may have identified potential groups at risk of being under-diagnosed with insomnia (i.e. non-black Veterans with psychiatric co-morbidity, black Veterans without psychiatric co-morbidity) as well as groups at risk for sedative-hypnotic use (i.e. younger Veterans without BRSD). In sum, Veterans with PTSD have high rates of sedative-hypnotic use despite minimal evidence they are effective. This is counter to recommendations indicating behavioral interventions are the first-line treatment. Policy changes are needed to reduce use of sedative-hypnotics and increase access to behavioral insomnia interventions.     

Health Insurance,Health Conditions,and Veteran Health Care Utilization

Abstract

The utilization of health care services by veterans has received much attention in recent years. However, the impact of the large array of factors affecting the veterans’ demand for health care services remains understudied. These factors include individual socio-demographic and economic characteristics, the availability of various sources of health insurance, and the prevalence of medical conditions. We use public data to analyze how veterans’ utilization of health care services varies with these factors. We also analyze how the reliance on VA services varies when alternative sources of health insurance are available to veterans. Based on the estimated relationships, we use a micro-simulation model to forecast future health care utilization, both inside and outside of VA.     

Military and Veterans’ Health,Health Care,and Wellbeing

Abstract

The U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) need to bridge a gap in their understanding of service members’ health outcomes and the issues involved in treatment, such as cost. In addition, clinicians and policy analysts must overcome existing knowledge barriers. Clinicians need to be aware of policy changes that will affect their patient load in numbers and in treatment needs. Policy analysts need to be aware of issues relevant to clinical treatment, such as quality and timeliness of care. Given the need for services and support to military personnel and families, and the fact that the fastest growing expenses in defense are health care costs, a multi-disciplinary line of research will help lawmakers understand the most efficient and effective resource use across the health care services.