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American Journal of Epidemiology Advance Access published online on April 12, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj145
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received September 19, 2005
Accepted January 5, 2006

ORIGINAL CONTRIBUTIONS

The Long-term Effect of Insomnia on Work Disability

Børge Sivertsen 1, Simon Overland 2, Dag Neckelmann 3, Nicholas Glozier 4, Steinar Krokstad 5, Ståle Pallesen 6, Inger Hilde Nordhus 7, Bjørn Bjorvatn 8, and Arnstein Mykletun 9 *

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; Norwegian Competence Center for Sleep Disorders, University of Bergen, Bergen, Norway
7 Department of Clinical Psychology, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, University of Bergen, Bergen, Norway
8 Norwegian Competence Center for Sleep Disorders, University of Bergen, Bergen, Norway; Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
9 Research Centre for Health Promotion, University of Bergen, Bergen, Norway; Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom; Department of Mental Health, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

* To whom correspondence should be addressed.
Arnstein Mykletun, E-mail: Arnstein.Mykletun{at}psyhp.uib.no


  Abstract

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.

Keywords: cohort studies; disability evaluation; logistic models; risk factors; sleep initiation and maintenance disorders; work.
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