American Journal of Epidemiology Advance Access originally published online on April 12, 2006
American Journal of Epidemiology 2006 163(11):1018-1024; doi:10.1093/aje/kwj145
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Original Contribution |
The Long-term Effect of Insomnia on Work Disability
The HUNT-2 Historical Cohort Study
1 Department of Clinical Psychology, University of Bergen, Bergen, Norway
2 Research Centre for Health Promotion, University of Bergen, Bergen, Norway
3 Affective Disorder Section, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
4 Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
5 HUNT Research Centre, Norwegian University of Technology and Science, Trondheim, Norway
6 Department of Psychosocial Science, University of Bergen, Bergen, Norway
7 Norwegian Competence Center for Sleep Disorders, University of Bergen, Bergen, Norway
8 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
9 Department of Mental Health, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
Reprint requests to Arnstein Mykletun, Research Centre for Health Promotion, University of Bergen, Christiesgt 13, N-5015 Bergen, Norway (e-mail: A.Mykletun{at}iop.kcl.ac.uk; Arnstein.Mykletun{at}psyhp.uib.no).
Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995–1997. The outcome was subsequent award of a disability pension (18–48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio = 3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had little confounding effect (adjusted odds ratio = 3.69, 95% confidence interval: 3.00, 4.53), and this association remained significant after adjustment for psychiatric and physical morbidity and for health-related behaviors (adjusted odds ratio = 1.75, 95% confidence interval: 1.40, 2.20). This study suggests that insomnia should receive increased attention as a robust predictor of subsequent work disability.
cohort studies; disability evaluation; logistic models; risk factors; sleep initiation and maintenance disorders; work
Abbreviations: CI, confidence interval; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; HUNT-2, Nord-Trøndelag Health Study; OR, odds ratio
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