Pre-existing insomnia linked to PTSD and other mental disorders after military deployment

(Press-News.org) PHILADELPHIA - A new study from the Perelman School of Medicine at the University of Pennsylvania and the Naval Health Research Center has shown military service members who have trouble sleeping prior to deployments may be at greater risk of developing posttraumatic stress disorder (PTSD), depression and anxiety once they return home. The new study, published in the July 2013 edition of the journal SLEEP, found that pre-existing insomnia symptoms conferred almost as a large of a risk for those mental disorders as combat exposure.

"Understanding environmental and behavioral risk factors associated with the onset of common major mental disorders is of great importance in a military occupational setting," said lead study author Philip Gehrman, PhD, assistant professor of Psychology in the Department of Psychiatry, member of the Penn Sleep Center, and the Philadelphia VA Medical Center. "This study is the first prospective investigation of the relationship between sleep disturbance and development of newly identified positive screens for mental disorders in a large military cohort who have been deployed in support of the recent operations in Iraq or Afghanistan."

Using self-reported data from the Millennium Cohort Study, the research team evaluated the association of pre-deployment sleep duration and insomnia symptoms on the development of new-onset mental disorders among deployers. Multivariable logistic regression was used to estimate the odds of developing PTSD, depression, and anxiety, while adjusting for relevant covariates including combat-related trauma.

They analyzed data from 15,204 service members, including only those servicemen and women on the timing of their first deployment across all branches and components of military service. They identified 522 people with new-onset PTSD, 151 with anxiety, and 303 with depression following deployment. In adjusted models, combat-related trauma and pre-deployment insomnia symptoms were significantly associated with higher odds of developing posttraumatic stress disorder, depression, and anxiety.

"One of the more interesting findings of this study is not only the degree of risk conferred by pre-deployment insomnia symptoms, but also the relative magnitude of this risk compared with combat-related trauma," says Gehrman. "The risk conferred by insomnia symptoms was almost as strong as our measure of combat exposure in adjusted models."

The researchers also found that short sleep duration (less than six hours of sleep per night), separate from general insomnia, was associated with new-onset PTSD symptoms.

"We found that insomnia is both a symptom and a risk factor for mental illness and may present a modifiable target for intervention among military personnel," says Gehrman. "We hope that by early identification of those most vulnerable, the potential exists for the designing and testing of preventive strategies that may reduce the occurrence of PTSD, anxiety, and depression.

The research team says that additional study is needed to investigate whether routine inquiry about insomnia symptoms and application of appropriate early, effective interventions reduces subsequent morbidity from mental disorders. They note that in a military population, assessment of insomnia symptoms could easily be incorporated into routine pre-deployment screening.

### The Millennium Cohort Study is funded through the Military Operational Medicine Research Program of the US Army Medical Research and Materiel Command, Fort Detrick, Maryland.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.