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bowel, Crohn's); autoimmune (e.g., lupus, Guillain-Barre, psoriasis); endocrine (e.g., hypo/hyper
thyroid, adrenal), migraines/chronic headaches; sexually transmitted diseases; and other. For
each medical problem, participants were asked to write in the specific problem, the date of onset,
how long the problem had lasted (years and months), and if the problem was current. Participants
were considered to have a medical problem if any of the above problems were current at the time
of the study.
Mental Health Problems
Participants reported symptoms of depression and anxiety using two self-report measures,
the Quick Inventory of Depressive Symptomatology (QIDS) and the State-Trait Anxiety
Inventory, trait scale (STAI), respectively. A score > 11 on the QIDS was indicative of moderate
to severe symptoms of depression. Since the primary independent variable of this study is
chronic insomnia and sleep disturbance is a component of the QIDS total score, the sleep
questions were removed from the total score of the QIDS. This modification was intended to
better distinguish young adults with chronic insomnia with symptoms of moderate to severe
depression without inflated scores due to already present insomnia symptoms. Participants
needed a score > 11, after removing the sleep questions, to meet criteria for moderate to severe
symptoms of depression (Rush et al., 2003). A score > 59 on the STAI (two standard deviations
above a normative mean) was considered indicative of clinical symptoms of anxiety. No sleep
related questions were part of the STAI.
Healthcare Utilization (HCU)
HCU was measured in three ways. First, participants reported their use of health-related
services over the past six months. Services included physician visits, emergency room visits,
visits to a psychologist, psychiatrist, or other mental health care clinician, visits to a physical
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