Clinical Drug Investigation

, Volume 18, Issue 2, pp 161–167

Psychiatric Comorbidity and Pharmacological Treatment Patterns among Patients Presenting with Insomnia

An Assessment of Office-Based Encounters in the USA in 1995 and 1996

Authors

    • Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State University
    • Pullman Memorial Hospital
  • Linda M. Robison
    • Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State University
  • David A. Sclar
    • Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State University
    • Program in StatisticsWashington State University
    • Washington Institute for Mental Illness Research and Training, Eastern Branch
  • Richard S. Galin
    • Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State University
    • Pullman Memorial Hospital
    • Neuro-Psychiatric InstituteUniversity of California at Los Angeles
Pharmacoepidemiology

DOI: 10.2165/00044011-199918020-00009

Cite this article as:
Skaer, T.L., Robison, L.M., Sclar, D.A. et al. Clin. Drug Investig. (1999) 18: 161. doi:10.2165/00044011-199918020-00009

Abstract

Background: Epidemiological studies reveal that approximately one-third of the US adult population experiences insomnia, and that nearly 10% report it to be a serious or chronic problem. Little is known as to the extent of physician diagnosis of the underlying illness, or the prescribing of pharmacotherapy for this complaint.

Objectives: To discern among US ambulatory patients presenting with insomnia as either the primary complaint, or as one of several reasons for requesting a physician-patient office-based encounter (visit), the percentage of said encounters wherein: (i) a diagnosis of insomnia was recorded [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 307.41, 307.42, 307.49, 780.50, 780.52, 780.55, 780.56, 780.59]; (ii) a diagnosis of a concomitant mental disorder (non-sleep-related) was recorded (ICD-9-CM codes 290-307.39, 307.5-319); (iii) a diagnosis of a depressive illness was recorded (ICD-9-CM codes 296.2-296.36, 300.4, 311); (iv) a regimen of a hypnosedative was continued or prescribed [National Drug Code (NDC) 0626]; (v) a regimen of antidepressant pharmacotherapy was continued or prescribed (NDC 0630); and (vi) a diagnosis of depression was recorded and a regimen of antidepressant pharmacotherapy was continued or prescribed.

Methods: Data from the National Ambulatory Medical Care Survey for the years 1995 and 1996, for adults aged 18 years or older, were utilised for this analysis.

Results: In the time-frame 1995 to 1996, an annualised mean of 3 027 312 patients presented with a complaint of insomnia as one of three reasons recorded for requesting an office-based visit. Insomnia was the primary reason for an office-based visit in 35.1% (1 061 396) of these patients. The majority of these patients were female (55.6%), White (66.2%), and had a mean age of 53.2 years (±16.8 years). Compared with patients presenting with insomnia as one of three reasons for the visit, a higher proportion of patients presenting with insomnia as the primary reason for the visit were diagnosed with insomnia (18.8%), diagnosed with a non-sleep-related mental disorder (57.4%), diagnosed with depression (31.7%), prescribed or continuing a regimen of hypnosedative pharmacotherapy (16.1%), prescribed or continuing a regimen of antidepressant pharmacotherapy (48.3%), or diagnosed with depression and prescribed or continuing a regimen of antidepressant pharmacotherapy (27.8%). Only 15.8% of the reporting physicians were psychiatric specialists.

Conclusions: Our findings indicate that fewer than 5% of US adults with insomnia reported visiting a physician specifically for this problem. The results suggest that insomnia is multifactorial in origin, with the majority of patients having been diagnosed with a non-sleep-related mental disorder, primarily depression.

Copyright information

© Adis International Limited 1999