Insomnia identity and its correlates in adolescents

Abstract

Objective

Insomnia identity, defined as a conviction that one has insomnia, is a cognitive appraisal process that influences help-seeking, diagnosis, and treatment of insomnia. Previous studies in adults showed that about 50% of poor sleepers did not label themselves as having insomnia, while 10% of good sleepers endorsed insomnia identity. This analysis aimed to examine the proportions and characteristics of complaining and noncomplaining poor and good sleepers and the factors that determine self-labeling of insomnia in adolescents.

Methods

Data from a school-based study were analyzed. We defined insomnia identity as an endorsement of “insomnia” occurring 3–7 nights per week, while 3 criteria of poor sleep were examined. A total of 1447 students were included, the mean age was 14.5 years and 55.5% were females.

Results

Using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to define poor sleep (insomnia symptoms ≥ 3 times per week), the proportions of complaining and noncomplaining poor sleepers were 2.3% and 8.8%, while complaining and noncomplaining good sleepers were 0.8% and 88.2%, respectively. The ratio between complaining and noncomplaining poor sleepers was 1 to 3.8. Complaining poor sleepers had the highest level of insomnia and daytime symptoms, while complaining good sleepers had the highest proportion of smokers and drinkers. Multivariate logistic regression showed that insomnia symptoms and sleep dissatisfaction were independent predictors of insomnia identity.

Conclusions

In view of the high proportion of noncomplaining poor sleepers, educational programs should address the under-appraisal of insomnia among adolescents.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Roane BM, Taylor DJ (2008) Adolescent insomnia as a risk factor for early adult depression and substance abuse. Sleep 31:1351–1356. https://doi.org/10.5665/sleep/31.10.1351

    Article  PubMed Central  Google Scholar 

  2. 2.

    Roberts RE, Roberts CR, Duong HT (2008) Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study. J Adolescent Health 42:294–302. https://doi.org/10.1016/j.jadohealth.2007.09.016

    Article  Google Scholar 

  3. 3.

    Titova OE, Hogenkamp PS, Jacobsson JA, Feldman I, Schiöth HB, Benedict C (2015) Associations of self-reported sleep disturbance and duration with academic failure in community-dwelling Swedish adolescents: sleep and academic performance at school. Sleep Med 16:87–93. https://doi.org/10.1016/j.sleep.2014.09.004

    Article  Google Scholar 

  4. 4.

    Wong MM, Brower KJ, Craun EA (2016) Insomnia symptoms and suicidality in the National Comorbidity Survey - adolescent supplement. J Psychiat Res 81:1–8. https://doi.org/10.1016/j.jpsychires.2016.06.004

    Article  Google Scholar 

  5. 5.

    de Zambotti M, Goldstone A, Colrain IM, Baker FC (2018) Insomnia disorder in adolescence: diagnosis, impact, and treatment. Sleep Med Rev 39:12–24. https://doi.org/10.1016/j.smrv.2017.06.009

    Article  Google Scholar 

  6. 6.

    Chung KF, Kan KK, Yeung WF (2014) Insomnia in adolescents: prevalence, help-seeking behaviors, and types of interventions. Child Adol Ment H-UK 19:57–63. https://doi.org/10.1111/camh.12009

    Article  Google Scholar 

  7. 7.

    Lichstein KL (2017) Insomnia identity. Behav Res Ther 97:230–241. https://doi.org/10.1016/j.brat.2017.08.005

    Article  Google Scholar 

  8. 8.

    Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW (2003) Quantitative criteria for insomnia. Behav Res Ther 41:427–445. https://doi.org/10.1016/S0005-7967(02)00023-2

    CAS  Article  Google Scholar 

  9. 9.

    McCrae CS, Rowe MA, Tieney C, Dautovich ND, DeFinis AL, McNamara JP (2005) Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults. J Gerontol B-Psychol 60:182–189. https://doi.org/10.1093/geronb/60.4.P182

    Article  Google Scholar 

  10. 10.

    Moses T (2009) Self-labeling and its effects among adolescents diagnosed with mental disorders. Soc Sci Med 68:570–578. https://doi.org/10.1016/j.socscimed.2008.11.003

    Article  Google Scholar 

  11. 11.

    Chung KF, Kan KK, Yeung WF (2011) Assessing insomnia in adolescents: comparison of insomnia severity index, Athens insomnia scale and sleep quality index. Sleep Med 12:463–470. https://doi.org/10.1016/j.sleep.2010.09.019

    Article  Google Scholar 

  12. 12.

    Buboltz WC Jr, Brown F, Soper B (2001) Sleep habits and patterns of college students: a preliminary study. J Am Coll Heal 50:131–135. https://doi.org/10.1080/07448480109596017

    Article  Google Scholar 

  13. 13.

    Basten CH, Vallieres A, Morin CM (2001) Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2:297–307. https://doi.org/10.1016/s1389-9457(00)00065-4

    Article  Google Scholar 

  14. 14.

    Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2000) Athens insomnia scale: validation of an instrument based on the ICD-10 criteria. J Psychosom Res 48:555–560. https://doi.org/10.1016/S0022-3999(00)00095-7

    CAS  Article  Google Scholar 

  15. 15.

    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545. https://doi.org/10.1093/sleep/14.6.540

    CAS  Article  Google Scholar 

  16. 16.

    Goldberg DP (1972) The detection of psychiatric illness by questionnaire. Oxford University Press, Oxford

    Google Scholar 

  17. 17.

    Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, Johns MW, Fukuhara S (2009) Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on item response theory. Sleep Med 10:556–565. https://doi.org/10.1016/j.sleep.2008.04.015

    Article  PubMed Central  Google Scholar 

  18. 18.

    Chung KF (2000) Use of the Epworth Sleepiness Scale in Chinese patients with obstructive sleep apnea and normal hospital employees. J Psychosom Res 49:367–372. https://doi.org/10.1016/s0022-3999(00)00186-0

    CAS  Article  Google Scholar 

  19. 19.

    Tait RJ, Huise GK, Robertson SI (2002) A review of the validity of the General Health Questionnaire in adolescent population. Aust NZ J Psychiat 36:550–557. https://doi.org/10.1046/j.1440-1614.2002.01028.x

    Article  Google Scholar 

  20. 20.

    Li HC, Chan SL, Chung OK, Chui ML (2010) Relationships among mental health, self-esteem and physical health in Chinese adolescents. An exploratory study J Health Psychol 15:96–106. https://doi.org/10.1177/1359105309342601

    CAS  Article  Google Scholar 

  21. 21.

    Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10(113). https://doi.org/10.1186/1471-244X-10-113

  22. 22.

    Sato M (2017) What have we learned from the name change for schizophrenia? Psychiat Clin Neuros 71:153. https://doi.org/10.1111/pcn.12504

    Article  Google Scholar 

  23. 23.

    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191. https://doi.org/10.3758/BF03193146

    Article  Google Scholar 

Download references

Contributors

KF-C designed the study and drafted the manuscript. WF-Y and FYY-H were responsible for data collection. KF-C conducted data analysis. All authors declare that they made substantial contributions to the study, including drafting or revising the work; read and approved the final version of the manuscript; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ka-Fai Chung.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chung, K., Yeung, W. & Ho, F.Y. Insomnia identity and its correlates in adolescents. Sleep Breath 24, 717–724 (2020). https://doi.org/10.1007/s11325-019-01913-4

Download citation

Keywords

  • Illness perception
  • Insomnia
  • Poor sleep
  • Secondary school
  • Sleep disturbance