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
  • Tracy L. Skaer
  • Linda M. Robison
  • David A. Sclar
  • Richard S. Galin
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

Authors and Affiliations

  • Tracy L. Skaer
    • 1
    • 2
  • Linda M. Robison
    • 1
  • David A. Sclar
    • 1
    • 3
    • 4
  • Richard S. Galin
    • 1
    • 2
    • 5
  1. 1.Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State UniversityPullmanUSA
  2. 2.Pullman Memorial HospitalPullmanUSA
  3. 3.Program in StatisticsWashington State UniversityPullmanUSA
  4. 4.Washington Institute for Mental Illness Research and Training, Eastern BranchSpokaneUSA
  5. 5.Neuro-Psychiatric InstituteUniversity of California at Los AngelesLos AngelesUSA