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Sleep Quality Among U.S. Military Veterans With PTSD: A Factor Analysis and Structural Model of Symptoms

Authors

  • Kimberly A. Babson,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
    • Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
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  • Daniel M. Blonigen,

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
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  • Matthew Tyler Boden,

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
    2. National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
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  • Kent D. Drescher,

    1. National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
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  • Marcel O. Bonn-Miller

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA
    2. National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
    3. Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, Pennsylvania, USA
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  • This work was supported, in part, by the following: A VA Clinical Science Research and Development (CSR&D) Career Development Award-2 (Bonn-Miller), a VA HSR&D SUD-QUERI grant (RRP 10-192; Bonn-Miller), and Health Services Research and Development Service funds provided to the first author. Daniel M. Blonigen was supported by a Career Development Award-2 from The VA Office of Research and Development (Clinical Sciences Research & Development). The expressed views do not necessarily represent those of the Department of Veterans Affairs.

Correspondence concerning this article should be addressed to Kimberly Babson, 795 Willow Road (152-MPD), Menlo Park, CA 94025. E-mail: Kimberly.Babson@va.gov

Abstract

Poor sleep quality among individuals with posttraumatic stress disorder (PTSD) is associated with poorer prognosis and outcomes. The factor structure of the most commonly employed measure of self-reported sleep quality, the Pittsburgh Sleep Quality Index (PSQI), has yet to be evaluated among individuals with PTSD. The current study sought to fill this gap among a sample of 226 U.S. military veterans with PTSD (90% with co-occurring mood disorders, 73.5% with substance use disorders). We evaluated the factor structure of the PSQI by conducting an exploratory factor analysis (EFA) in approximately half of the sample (n = 111). We then conducted a second EFA in the other split half (n = 115). Lastly, we conducted a path analysis to investigate the relations between sleep factors and PTSD symptom severity, after accounting for the relation with depression. Results suggested sleep quality can best be conceptualized, among those with PTSD, as a multidimensional construct consisting of 2 factors, Perceived Sleep Quality and Efficiency/Duration. After accounting for the association between both factors and depression, only the Perceived Sleep Quality factor was associated with PTSD (β = .51). The results provide a recommended structure that improves precision in measuring sleep quality among veterans with PTSD.

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