Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans

Journal of Clinical Psychology

Volumn 67, Issue 12, 2011, Pages 1240-1258

  Wright, Kathleen M ^a   Britt, Thomas W ^a,b   Bliese, Paul D ^a   Adler, Amy B ^a   Picchioni, Dante ^a   Moore, Dewayne ^b  

^a WALTER REED ARMY INSTITUTE OF RESEARCH   (United States)

^b CLEMSON UNIVERSITY   (United States)

Author keywords

Combat exposure; Insomnia; Longitudinal; Postdeployment mental health; Posttraumatic stress disorder

Indexed keywords

ADULT; ARTICLE; COMORBIDITY; DEPRESSION; EPIDEMIOLOGY; FACTORIAL ANALYSIS; FEMALE; HUMAN; INSOMNIA; LONGITUDINAL STUDY; MALE; POSTTRAUMATIC STRESS DISORDER; PROGNOSIS; PSYCHOLOGICAL ASPECT; PSYCHOLOGICAL MODEL; SOLDIER; UNITED STATES; VETERAN; WAR;

ADULT; CAUSALITY; COMBAT DISORDERS; COMORBIDITY; DEPRESSION; FACTOR ANALYSIS, STATISTICAL; FEMALE; HUMANS; IRAQ WAR, 2003 -; LONGITUDINAL STUDIES; MALE; MILITARY PERSONNEL; MODELS, PSYCHOLOGICAL; PROGNOSIS; SLEEP INITIATION AND MAINTENANCE DISORDERS; STRESS DISORDERS, POST-TRAUMATIC; UNITED STATES; VETERANS;

EID: 81855198866     PISSN: 00219762     EISSN: 10974679     Source Type: Journal    
DOI: 10.1002/jclp.20845     Document Type: Article

References (74)

1. Abelson, R.P. (1985). A variance explanation paradox: When a little is a lot. Psychological Bulletin, 97, 129-133.
2. Adler, A.B., Castro, C.A., Bliese, P.D., McGurk, D., & Milliken, C. (2007, August). The efficacy of Battlemind training at 3-6 months postdeployment. In: C.A. Castro (Chair), The Battlemind training system: Supporting soldiers throughout the deployment cycle. Symposium conducted at the meeting of the American Psychological Association, San Francisco, CA.
3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
4. Babkoff, H., Sing, H.C., Thorne, D.R., Genser, S.G., & Hegge, F.W. (1989). Perceptual distortions and hallucinations reported during the course of sleep deprivation. Perceptual and Motor Skills, 68, 787-798. doi:10.2466/pms.1989.68.3.387.
5. Bastien, C.H., Vallières, A., & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297-307. doi:10.1016/S1389-9457(00)00065-4
6. Benca, R.M. (2005). Diagnosis and treatment of chronic insomnia: A review. Psychiatric Services, 56, 332-343. Retrieved from
7. Blanchard, E.B., Jones-Alexander, J., Buckley, T.C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavioral Research and Therapy, 34, 669-673. doi:10.1016/0005-7967(96)00033-2
8. Bliese, P.D., Adler, A.B., & Castro, C.A. (2011). Research-based preventive mental health care strategies in the military. In: A.B. Adler, P.B. Bliese, & C.A. Castro (Eds.), Deployment psychology: Evidence-based strategies to promote mental health in the military (pp. 103-124). Washington, DC: American Psychological Association.
9. Bliese, P. Wright, K., Adler, A., Hoge, C., & Prayner, R. (2005). Postdeployment psychological screening: Interpreting and scoring DD Form 2900 (U.S. Army Medical Research Unit-Europe. Research Report 2005-003). Heidelberg, Germany: USAMRU-E.
10. Bliese, P.D., Wright, K.M., Adler, A.B., Cabrera, O., Castro, C.A., & Hoge, C.W. (2008). Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272-281. doi:10.1037/0022-006X.76.2.272
11. Bliese, P.D., Wright, K.M., Adler, A.B., Thomas, J.L., & Hoge, C.W. (2007). Timing of postcombat mental health assessments. Psychological Services, 4, 141-148. doi:10.1037/1541-1559.4.3.141
12. Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996). Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biological Psychiatry, 39, 411-418. Retrieved from
13. Creamer, M., O'Donnell, M.L., & Pattison, P. (2004). The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors. Behaviour Research and Therapy, 42, 315-328. doi:10.1016/S0005-7967(03)00141-4
14. Curran, P.J., West, S.G., & Finch, J.F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16-29. Retrieved from
15. Dement, W., Zarcone, V., Ferguson, J., Cohen, H., Pivik, T., & Barchas, J. (1969). Some parallel findings in schizophrenic patients and serotonin-depleted cats. In: D.V. Siva Sankar (Ed.), Schizophrenia: Current concepts and research (pp. 775-811). Hicksville, NY: PJD Publications.
16. Dow, B.M., Kelsoe Jr., J.R., & Gillin, C. (1996). Sleep and dreams in Vietnam PTSD and depression. Biological Psychiatry, 39, 42-50. doi:10.1016/000-3223(95)00103-4
17. Forbes, D., Creamer, M., & Biddle, D. (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research and Therapy, 39, 977-986.
18. Germain, A., Buysse, D.J., & Nofzinger, E. (2008). Sleep-specific mechanisms underlying posttraumatic stress disorder: Integrative review and neurobiological hypotheses. Sleep Medicine Reviews, 12, 185-195. doi:10.1016/j.smrv.2007.09.003
19. Giesbrecht, T., Smeets, T., Leppink, J., Jelicic, M., & Merckelbach, H. (2007). Acute dissociation after 1 night of sleep loss. Journal of Abnormal Psychology, 116, 599-606. doi:10.1037/0021-843X.116.3.599
20. Gillin, J.C., & Wyatt, R.J. (1975). Schizophrenia: perchance a dream? International Review of Neurobiology, 17, 297-342.
21. Harvey, A.G. (2001). Insomnia: Symptom or diagnosis? Clinical Psychology Review, 21, 1037-1059. doi:10.1016/S0272-7358(00)00083-0
22. Haynes, S.N., Adams, A., & Franzen, M. (1981). The effects of presleep stress on sleep-onset insomnia. Journal of Abnormal Psychology, 90, 601-606. Retrieved from
23. Hobson, J.A. (1997). Dreaming as delirium: A mental status analysis of our nightly madness. Seminars in Neurology, 17, 121-128. Retrieved from
24. Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13-22. Retrieved from
25. Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., & Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453-463. Retrieved from
26. Hoge, C.W., Terhakopian, A., Castro, C.A., Messer, S.C., & Engel, C.C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164, 150-153. Retrieved from
27. Howland, R.H. (1997). Sleep-onset rapid eye movement periods in neuropsychiatric disorders: Implications for the pathophysiology of psychosis. Journal of Nervous and Mental Disease, 185, 730-738. Retrieved from
28. Hu, L., Bentler, P.M., & Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychological Bulletin, 112, 351-362. Retrieved from
29. Hublin, C., Kaprio, J., Partinen, M., & Koskenvuo, M. (1999). Nightmares: familial aggregation and association with psychiatric disorders in a nationwide twin cohort. American Journal of Medical Genetics, 88, 329-336.
30. Inman, D.J., Silver, S.M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3, 429-437. doi:10.1007/BF00974782
31. Jacobs, B.L. (1978). Dreams and hallucinations: a common neurochemical mechanism mediating their phenomenological similarities. Neuroscience and Biobehavioral Reviews, 2, 59-69. doi:10.1016/0149-7634(78)90007-6
32. Kim, P.Y., Thomas, J.L., Wilk, J.E., Castro, C.A., & Hoge, C.W. (2010). Stigma, barriers to care, and use of mental health services among active duty and national guard soldiers after combat. Psychiatric Services, 61, 582-588. Retrieved from
33. Kline, R.B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York, NY: Guilford Press.
34. Lavie, P. (2001). Sleep disturbances in the wake of traumatic events. New England Journal of Medicine, 345, 1825-1832. Retrieved from
35. Lavie, P., Katz, N., Pillar, G., & Zinger, Y. (1998). Elevated awaking thresholds during sleep: Characteristics of chronic war-related posttraumatic stress disorder patients. Biological Psychiatry 44, 1060-1065. doi:10.1016/S0006-3223(98)00037-7
36. Levi, L. (1974). Psychosocial stress and disease: A conceptual model. In: E.K. Gunderson & R.H. Rahe (Eds.), Life stress and illness (pp. 8-33). Springfield, IL: Charles C. Thomas.
37. Lichstein, K.L. (2006). Secondary insomnia: A myth dismissed. Sleep Medicine Reviews, 10, 3-5. doi:10.1016/j.smrv.2005.10.001
38. Lim, J., & Dinges, D.F. (2008). Sleep deprivation and vigilant attention. Annals of the New York Academy of Sciences, 1129, 305-322. doi:10.1196/annals.1417.002
39. MacCallum, R.C., Roznowski, M., & Necowitz, L.B. (1992). Model modifications in covariance structure analysis: The problem of capitalization on chance. Psychological Bulletin, 111, 490-504. Retrieved from
40. Mahowald, M.W., Woods, S.R., & Schenck, C.H. (1998). Sleeping dreams, waking hallucinations, and the central nervous system. Dreaming 1998. Journal of the Association for the Study of Dreams, 8, 89-101. Retrieved from
41. Mellman, T.A., Kulick-Bell, R., Ashlock, L.E., & Nolan, B. (1995). Sleep events among veterans with combat-related posttraumatic stress disorder. American Journal of Psychiatry, 152, 110-115. Retrieved from
42. Morin, C.M. (1993). Insomnia: Psychological assessment and management. New York: The Guilford Press.
43. Morin, C.M., & Espie, C.A. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Kluwer Academic/Plenum Publishers.
44. Morin, C.M., Rodrigue, S., & Ivers, H. (2003). Role of stress, arousal, and coping skills in primary insomnia. Psychosomatic Medicine, 65, 259-267. doi:10.1097/01.PSY.0000030291.09558.A3
45. National Institutes of Health. (2005). NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consensus and State-of-the-Science Statements Vol. 22(2) 1-30. Retrieved from
46. Neylan, T.C., Marmar, C.R., Metzler, T.J., Weiss, D.S., Zatzick, D.F., Delucchi, K.L., ... Schoenfeld, F.B. (1998). Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 115, 929-933. Retrieved from
47. Ouellet, M.-C., Beaulieu-Bonneau, S., & Morin, C.M. (2006). Insomnia in patients with traumatic brain injury: Frequency, characteristics, and risk factors. The Journal of Head Trauma Rehabilitation, 21, 199-212. Retrieved from
48. Pace-Schott, E.F., Milad, M.R., Orr, S.P., Rauch, S.L., Stickgold, R., & Pitman, R.K. (2009). Sleep promotes generalization of extinction of conditioned fear. Sleep, 32, 19-26. Retrieved from
49. Payne, J.D., Stickgold, R., Swanberg, K., & Kensinger, E.A. (2008). Sleep preferentially enhances memory for emotional components of scenes. Psychological Science, 19, 781-788. Retrieved from
50. Perlis, M.L., Giles, D.E., Buysse, D.J., Tu, X., & Kupfer, D.J. (1997). Self-reported sleep disturbance as a prodromal symptom in recurrent depression. Journal of Affective Disorders, 42, 209-212. doi:10.1016/S0165-0327(96)01411-5
51. Peterson, A.L., Goodie, J.L., Satterfield, W.A., & Brim, W.L. (2008). Sleep disturbance during military deployment. Military Medicine, 173, 230-235.
52. Peterson, M.J., & Benca, R.M. (2006). Sleep in mood disorders. Psychiatric Clinic of North America, 29, 1009-1032. doi:10.1016/j.psc.2006.09.003
53. Picchioni, D., Cabrera, O.A., McGurk, D., Thomas, J.L., Castro, C.A., Balkin, T.J., ... Hoge, C.W. (2010). Sleep symptoms as a partial mediator between combat stressors and other mental health symptoms in Iraq War veterans. Military Psychology, 22, 340-355.doi:10.1080/08995605.2010.491844
54. Pigeon, W.R., & Perlis, M.L. (2007). Insomnia and depression: Birds of a feather? International Journal of Sleep Disorders, 1, 82-91.
55. Pilcher, J.J., & Huffcutt, A.I. (1996). Effects of sleep deprivation on performance: A meta-analysis. Sleep, 19, 318-326. Retrieved from doi:10.1080/00140139.2011.592599
56. Raskind, M.A., Peskind, E.R., Hoff, D.J., Hart, K.L., Holmes, H.A., Warren, D., ... McFall, M.E. (2007). A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biological Psychiatry 61, 928-934. doi:10.1016/j.biopsych.2006.06.032
57. Riemann, D., & Voderholzer, U. (2003). Primary insomnia: A risk factor to develop depression? Journal of Affective Disorders, 76, 255-259. doi:10.1016/S0165-0327(02)00072-1
58. Satorra, A., & Bentler, P.M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In: A. von Eye & C.C. Clogg (Eds.), Latent variables analysis: Applications for developmental research (pp. 399-419). Thousand Oaks, CA: Sage.
59. Satorra, A., & Bentler, P.M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507-514. doi:10.1007/BF02296192
60. Saucerman, S.A. (1997). Dissociation of W/REM/NREM states might cause psychotic symptoms. Schizophrenia Research, 25, 261-263. Retrieved from
61. Schell, T.L., Marshall, G.N., & Jaycox, L.H. (2004). All symptoms are not created equal: The prominent role of hyperarousal in the course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113, 189-197. doi:10.1037/0021-843X.113.2.189
62. Shin, T., Davison, M.L., & Long, J.D. (2009). Effects of missing data methods in structural equation modeling with nonnormal longitudinal data. Structural Equation Modeling: A Multidisciplinary Journal, 16, 70-98.
63. Spitzer, R.L., Kroenke, K., Williams, J.B.W., & the Patient Health Questionnaire Priamary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282, 1737-1744. Retrieved from
64. Stepanski, E.J., & Rybarczyk, B. (2006). Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Medicine Reviews, 10, 7-18. doi:10.1016/j.smrv.2005.08.002
65. Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75. doi:10.1002/jclp.1129
66. Stretch, R.H. (1986). Incidence and etiology of post-traumatic stress disorder among active duty Army personnel. Journal of Applied Social Psychology, 16, 464-481. doi:10.1111/j.1559-1816.1986.tb01153.x
67. Taylor, D.J., Lichstein, K.L., & Durrence, H.H. (2003). Insomnia as a health risk factor. Behavioral Sleep Medicine, 1, 227-247. doi:10.1207/S15402010BSM0104_5
68. Taylor, D.J., Lichstein, K.L., Durrence, H.H., Reidel, B.W., & Bush, A.J. (2005). Epidemiology of insomnia, depression, and anxiety. Sleep, 28, 1457-1464. Retrieved from
69. Tranter, R., O'Donovan, C., Chandarana, P., & Kennedy, S. (2002). Prevalence and outcome of partial remission in depression. Journal of Psychiatry and Neuroscience, 27, 241-247.
70. Van Dongen, H.P.A., Maislin, G., Mullington, J.M., & Dinges, D.F. (2003). The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26, 117-126. Retrieved from
71. Weathers, F.W., Litz, B.T., Herman, D.S., Huska, J.A., & Keane, T.M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.
72. Weissman, M.M., Greenwald, S., Niño-Murcia, G., & Dement, W.C. (1997). The morbidity of insomnia uncomplicated by psychiatric disorders. General Hospital Psychiatry, 19, 245-250.
73. Walker, M.P. (2009). The role of sleep in cognition and emotion. Annals of the New York Academy of Sciences, 1156, 168-197. doi:10.1111/j.1749-6632.2009.04416.x
74. Watson, D. (2001). Dissociations of the night: Individual differences in sleep-related experiences and their relation to dissociation and schizotypy. Journal of Abnormal Psychology, 110, 526-535. doi:10.1037//0021-843X.110.4.526