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Identifying the Demographic and Mental Health Factors That Influence Insomnia Treatment Recommendations Within a Veteran Population.

Bramoweth AD, Renqvist JG, Hanusa BH, Walker JD, Germain A, Atwood CW. Identifying the Demographic and Mental Health Factors That Influence Insomnia Treatment Recommendations Within a Veteran Population. Behavioral sleep medicine. 2019 Mar 1; 17(2):181-190.

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Insomnia is a pervasive and costly disorder that is particularly prevalent within the U.S. Veteran population. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment for insomnia, high rates of sedative-hypnotic prescribing continue. There is little research investigating the rates and factors impacting insomnia treatment recommendations, both behavioral and pharmacological. A cohort of 5,254 Veterans referred for either CBT-I or prescribed a sedative-hypnotic medication at a single VA Medical Center composed the group of participants. The current study evaluated the rates of insomnia treatment recommendations and the extent to which demographic variables, psychiatric disorders, and sleep disorders contributed to referrals for CBT-I or prescriptions for sedative-hypnotic medications within a large administrative data set. Military service-related disability, insomnia diagnosis, and having one or more psychiatric diagnoses were associated with a greater likelihood of receiving a CBT-I referral (alone or in addition to a sedative-hypnotic medication) rather than a sedative-hypnotic prescription alone. A diagnosis of posttraumatic stress disorder was associated with a greater likelihood of receiving a sedative-hypnotic medication alone versus a CBT-I referral. Overall, the findings suggest that sedative-hypnotic medications were overwhelmingly the primary treatment recommendation despite evidence to support CBT-I as the recommended first-line treatment. However, key factors were identified that increased the likelihood of Veterans being referred for CBT-I. Suggestions for better identifying and understanding key factors that impact treatment recommendations are discussed.

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