Chronic Insomnia and Healthcare Utilization in Young Adults Page: 27
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prevalence in this study was higher than the 3% found by Ohayon and Roberts (2001) using
DSM-IV criteria but lower than the 17% found by Breslau et al. (1996), which used less
restrictive insomnia criteria than the current study's. Because RDC and quantitative criteria are
intended to identify individuals with chronic insomnia, they are more conservative than many of
the operational definitions used in previous epidemiology studies which did not always account
for symptom severity, frequency, duration, and daytime complaints. However, RDC and
quantitative criteria are not as conservative as the diagnostic manuals (e.g., DSM-IV, ICSD),
which may not include all individuals with chronic insomnia and therefore underestimate the
prevalence of chronic insomnia.
Chronic Insomnia and HCU
HCU is a complex construct, is measured inconsistently throughout the literature, and
often includes one or more measures of self-report, direct costs (i.e., data collected from
insurance companies), and predicted healthcare costs using mathematical algorithms. This study
provided one of the most comprehensive assessments of HCU using a combination of measures
used in previous HCU research-self-report (i.e., physician visits, mental health visits, and
medications), direct costs (i.e., costs acquired at UNT Health & Wellness Center), and predicted
costs and office visits based on participants' medication usage (i.e., chronic disease score
[CDS]).
Number of physician visits and mental health visits were not different between the
chronic insomnia and normal sleeper groups. This finding may be due to young adults being an
overall healthy sample that uses less healthcare services. Additionally, it may be due to
insomnia patients not seeking insomnia specific medical care (Leger, 2000). Mental health visits
may not have differed due to the stigma surrounding seeking help for mental health problems,27
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Bramoweth, Adam Daniel. Chronic Insomnia and Healthcare Utilization in Young Adults, dissertation, August 2011; Denton, Texas. (https://digital.library.unt.edu/ark:/67531/metadc84179/m1/33/?rotate=270: accessed July 17, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; .