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Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness


Journal of Psychiatric Practice®: July 2017 - Volume 23 - Issue 4 - p 270–280
doi: 10.1097/PRA.0000000000000240

Study Objectives: Insomnia is pervasive among people with serious mental illnesses (SMI) and has a profound negative impact on their psychiatric symptom management and recovery. However, little is known about the factors that affect severity of insomnia in those with SMI. In addition, very few studies have explored whether evidence-based interventions developed for those without SMI are appropriate for or applicable to individuals with SMI. The purpose of this study was to test the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs and who reported subjective insomnia. In addition, information was collected regarding the types of insomnia treatments provided to these Veterans.

Methods: Participants completed assessments of insomnia severity and sleep-related arousal, behaviors, and cognitions. Medical records were reviewed to determine whether participants had been screened/assessed for insomnia and whether treatments for insomnia were provided before the date of referral to the study. Multiple regression was used to predict insomnia severity on the basis of these factors.

Results: Most participants (81.7%) reported moderate to severe insomnia, although only 3.3% had a diagnosis of insomnia in their medical records. Worry and helplessness about sleep were predictive of insomnia severity; better self-reported sleep hygiene and higher levels of arousal were also associated with greater severity of insomnia. Education about sleep hygiene and medication were the only types of insomnia treatment received.

Conclusions: Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges.

KLINGAMAN and BENNETT: Department of Veterans Affairs, Capitol Health Care Network (VISN 5) and University of Maryland School of Medicine, Baltimore, MD

MCCARTHY: University of Maryland, College Park, MD

SCHWARTZ: Louisiana State University, Baton Rouge, LA

GEHRMAN: Department of Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA

This presentation reflects the authors’ personal views and in no way represents the official view of the Department of Veterans Affairs or the U.S. Government.

Supported by a US Department of Veterans Affairs Health Services Research and Development (HSR&D) Mental Health Quality Enhancement Research Initiative (MH QUERI) Locally Initiated Project (LIP) (QLP 55-016) and the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment. E.A.K.: time was supported by a VA Rehabilitation R&D Career Development Award (1IK2RX001836). It is the result of work supported with resources and the use of facilities at the VA Capitol Health Care Network (VISN 5) MIRECC.

The authors declare no conflicts of interest.

Please send correspondence to: Elizabeth A. Klingaman, PhD, VA Maryland Health Care System, Baltimore VA Medical Center, 10 North Greene Street (Annex Suite 720), Baltimore, MD 21201 (e-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.