Sleep Problems in United States Military Veterans

Approximately two-thirds of United States military Veterans who served in Iraq or Afghanistan report sleep problems. Left untreated, sleep problems may contribute to incident mental health disorders. This three-paper dissertation aimed to fill three gaps in existing literature and clinical practice through the following contributions: the introduction of a prospective, long-term model of insomnia; examination of the relationship between poor sleep, resilience, and psychological distress; and the evaluation of single-item screeners to identify sleep disturbance. Through the presentation of an integrated theoretical model, Paper One addressed gaps in existing theory by examining short and long-term consequences of insomnia-like symptoms and advocating for a reconceptualization of sleep problems as chronic and cyclical rather than an acute, unidirectional problem. Papers Two and Three utilized a large research registry of Veterans with at least one overseas deployment to Iraq or Afghanistan and who were free of a past-month DSM-defined mental health disorder at the time of the interview (N=1,118). Paper Two utilized hierarchical linear regression and moderation analyses to explore the relationship between poor sleep, resilience factors and psychological distress. Controlling for demographic, health, and military characteristics, poor sleep explained an additional 16% of the variance in psychological distress. The relationship between poor sleep and psychological distress was moderated by two psychological resilience factors – adaptability and self-efficacy. Paper Three examined the utility of single-item sleep measures commonly embedded in existing psychological assessments. Three commonly used items, trouble falling asleep, awakening in the early morning, and sleep that is restless and disturbed, demonstrated moderate sensitivity and specificity in predicting poor sleep. Initial findings suggest that Veterans who report sleep problems as a little distressing (response score ≥ 1) may benefit from additional sleep assessment. Together, these three dissertation papers highlighted the importance of screening and treating sleep problems in U.S. military Veterans early in their course as a potential means for reducing risk for incident mental health disorders and other negative consequences. In addition, these three papers built a foundation for future longitudinal studies which may help elucidate the mechanisms through which sleep problems become chronic and/or contribute to mental health disorders.Doctor of Philosoph