Illness representation in chronic insomnia: exploratory study of social and cultural beliefs in RussiaстатьяТезисы
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Аннотация:Introduction: Chronic insomnia is characterized by specific beliefs about sleep (Morin, 2010) and sleep-related behavior (Perlis et al., 2011) that perpetuate its course. According to common-sense model (Leventhal et al., 2003) social and cultural context is an important source of such beliefs and behavior. However, rare research on insomnia based on this model (Morgan et al., 2003, Jorgensen, 2008) does not concentrate on culture- or country-specific beliefs. In Russia where more than 70% of patients with chronic insomnia continue to have disturbed sleep hygiene (Rasskazova, 2008) such studies are of high importance.
The aim was to reveal beliefs about reasons and ways of coping with insomnia that are wide-spread in Russia and are related to poorer sleep in patients with insomnia.
Materials and methods: Checklists of reasons and ways of coping with insomnia were created based on analysis of Russian-language popular and scientific publications and media (24 and 31 items respectively). 82 patients with primary chronic insomnia (25 males, 16-65 years old) and 105 good sleepers (32 males, 16-60 years old) appraised their beliefs by Likert scale and filled Hospital Scale of Anxiety and Depression (Zigmond, Snaith, 1983), Glasgow Content of Thoughts Inventory (Harvey, Espie, 2004), Dysfunctional Beliefs about Sleep Scale and Insomnia Severity Index (Morin, 1993). Objective sleep of the subsample of 62 patients matching initial sample by age and gender was registered using polysomnography.
Results: Factor analysis differed 4 types of reasons for insomnia (psychological, situational, behavioral and secondary) and 4 types of ways of coping (medication, passive ways, active pre-sleep actions and life-style changes). In the case of sleep difficulties good sleepers attribute them to psychological and situational but not behavioral factors and prefer passive strategies and actions right before sleep. In chronic insomnia the role medications increases. In clinical group emphasis on psychological reasons was related to poorer subjective sleep, higher anxiety, depression and dysfunctional beliefs (r=.27-.45, p<.05). Belief in secondary reasons correlated to pre-sleep cognitive activity and anxiety (r=.38-.58, p<.01) as well as longer stage 1 (r=.28, p<.05) and shorter stage 2 (r=-.30, p<.05). Emphasis on situational reasons correlated to longer delta-sleep (r=.35, p<.01) and shorter awakenings during night (r=-.29, p<.05). Belief in behavioral reasons was related to depression only (r=.39, p<.01). Subjectively effective ways of coping were unrelated to subjective sleep but active actions before sleep and life-style changes were associated to shorter stages 1 and 2 and less night awakenings (r=-.37 - -.27, p<.05). Preference of passive ways of coping correlated to less night awakenings only (r=-.34, p<.05).
Conclusions: Beliefs in exclusively psychological and situational but not behavioral reasons of insomnia as well as beliefs in the effectiveness of passive and “just before sleep” actions are wide-spread in Russian population. In insomnia these beliefs could lead to poorer sleep and illness perpetuation distracting attention from the triggers that patients are responsible for and can change while promoting use of passive coping strategies.
Acknowledgement. Research is supported by the Russian Foundation for Basic Research, project No. 17-06-00363.