Mild traumatic brain injury (mTBI) is highly prevalent, with an estimated occurrence in the United States of more than 1.3 million per year. While one consequence of mTBI is impulsive aggressive behavior, very few studies have examined the relationship between history of mTBI and aggressive behavior in impulsively aggressive individuals. The authors examined the relationship between history of mTBI in a healthy control group (HC; N=453), a control group with psychiatric disorders (PC; N=486), and individuals with intermittent explosive disorder (IED; N=695), a disorder of primary impulsive aggression. Results demonstrated that IED study participants were significantly more likely to have a history of mTBI (with or without history of a brief loss of consciousness [LOC]) compared with both HC and PC participants. A similar observation was made with regard to self-directed aggression (i.e., suicidal or self-injurious behavior), although group differences were only among those with mTBI with LOC. For both other- and self-directed aggression variables, the authors observed a stepwise increase in dimensional aggression and impulsivity scores across participants as a function of mTBI history. Given that impulsive aggressive behavior begins very early in life, these data are consistent with the hypothesis that lifelong presence of an impulsive aggressive temperament places impulsive aggressive individuals in circumstances that put them at greater risk for mTBI compared with other individuals with and without nonimpulsive aggressive psychopathology.
The objective of this study was to investigate the rates, predictors and correlates of insomnia in a national sample of US Army soldiers. Data were gathered from the cross-sectional survey responses of the All-Army Study, of the Army Study to Assess Risk and Resilience in Service members. Participants were a representative sample of 21 499 US Army soldiers who responded to the All-Army Study self-administered questionnaire between 2011 and 2013. Insomnia was defined by selected DSM-5 criteria using the Brief Insomnia Questionnaire. The results highlight significant functional difficulties associated with insomnia among US soldiers, as well as insights into predictors of insomnia specific to this population. Insomnia was present in 22.76% of the sample. Predictors of insomnia status in logistic regression included greater number of current mental health disorders, less perceived open lines of communication with leadership, less unit member support and less education. Insomnia had global, negative associations with health, social functioning, support, morale, work performance and Army career intentions. The results provide the strongest evidence to-date that insomnia is common in a military population, and is associated with a wide array of negative factors in the domains of health, military readiness and intentions to remain in military careers.
Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005)(2006)(2007)(2008)(2009)(2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). Results: For completers and responders, all HCU and cost variables, except number of medications, signifi cantly decreased (ps < 0.05) or trended towards decrease at posttreatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No signifi cant decreases occurred for non-completers. Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the fi ndings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in signifi cant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia. Keywords: Insomnia, health care utilization, costs, brief cognitive behavioral treatment, physician visits, medication Citation: McCrae CS; Bramoweth AD; Williams J; Roth A; Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 2014;10(2):127-135.http://dx.doi.org/10.5664/jcsm.3436 S C I E N T I F I C I N V E S T I G A T I O N SC hronic insomnia impacts approximately 8% to 10% of adults in the United States population 1 and carries substantial economic burden. Direct costs (i.e., costs directly related to treatment) have been estimated at $13.9 billion annually in the United States, with total treatment costs estimated at $77 to $92 billion. 2 When indirect costs (i.e., lost productivity, insomniarelated accidents, increased medical problems) are included, annual costs exceed $100 billion. 3 Evidence from outside the U.S. reveals a similar pattern. Specifi cally, a study in Quebec, Canada, found that the combined direct and indirect per-person costs of insomnia syndrome (insomnia complaint ≥ 3 nights/ week with > 1 month duration, dissatisfaction with sleep, and daytime impairment; prescription sleep medication ≥ 3 nights/ week) was approximately $5,010; with $293 attributed to direct costs and $4,717...
To determine the rate of insomnia among active-duty soldiers with and without a history of traumatic brain injury (TBI). Research Method and Design: Data were extracted from the All Army Study (AAS), a cross-sectional, self-report survey completed by a representative sample of 21,499 U.S. Army soldiers from 2011 to 2013 as part of the Army Study to Assess Risk and Resilience in Servicemembers. History and severity of TBI were determined by participants' responses to questions regarding postinjury symptomology (i.e., loss of consciousness [LOC], amnesia, etc.). Insomnia symptoms were defined using DSM-5 criteria as measured by the Brief Insomnia Questionnaire. Results: Approximately 63% of respondents reported lifetime history of mild TBI (mTBI), with ϳ7% endorsing a history of moderate to severe TBI. Insomnia symptom prevalence rate increased with brain injury severity and number of TBIs with LOC, with ϳ51% of those with mTBI and ϳ55% of those with moderate to severe TBI demonstrating clinically elevated insomnia symptoms, compared to ϳ37% insomnia prevalence rate among servicemembers without TBI. Conclusion/Implications: Results suggest high (Ͼ 50%) prevalence rates of insomnia symptoms among servicemembers with a lifetime history of brain injury, underscoring the need for behavioral sleep medicine interventions among active-duty personnel. Impact and ImplicationsIncreased prevalence of sleep disturbance among individuals with history of traumatic brain injury (TBI) has been well documented. The current study extends this line of research by investigating the rate and severity of insomnia symptoms in individuals with and without history of TBI among a large, representative sample of active-duty U.S. soldiers as part of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Rates of clinically elevated insomnia and lifetime-acquired TBI among active-duty servicemembers are considerably higher than the general population, and individuals with a positive history of brain injury endorsed higher rates of clinically elevated insomnia symptoms compared to peers with no history of TBI. While behavioral sleep interventions (i.e., cognitive-behavioral therapy for insomnia) are frequently employed throughout the Veterans Affairs system, application among active-duty personnel remains somewhat limited, although initial outcomes are promising. Current findings underscore the need for widespread implementation of behavioral sleep interventions among active-duty servicemembers, particularly given the known cognitive, physical, emotional, functional, and financial repercussions of untreated insomnia symptoms.
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