Abstract
BACKGROUND: Insomnia is common and associated with high rates of anxiety and depression. AIM: To determine the association of insomnia with future primary care for sleep and mood problems, and explore the link with psychological distress. DESIGN OF STUDY: Questionnaire survey of adults aged >/=18 years, linked to primary care records. SETTING: Five UK general practices. METHOD: Survey responses were linked to recorded consultations and prescribed medication for sleep and mood problems for 12 months following the survey. Baseline self-reported insomnia was defined as the presence of at least one of four sleep problems. Psychological distress was measured using the Hospital Anxiety and Depression Scale. RESULTS: A total of 2662 (56%) responded and 2192 (82%) consented to record review. Nineteen per cent had a subsequent recorded consultation or prescription for sleep or mood problems ('relevant healthcare use'). Self-reported insomnia was related to future relevant healthcare use (odds ratio = 1.77; 95% confidence interval = 1.35 to 2.33). This relationship was stronger in those with psychological distress. Sixty-three per cent of those with baseline insomnia and psychological distress had no relevant healthcare use. 'Trouble falling asleep' was most strongly associated with relevant healthcare use in persons without psychological distress; in persons with psychological distress, it was waking after a usual amount of sleep feeling tired and worn out. CONCLUSION: Specific symptoms of insomnia are associated with consultation for sleep or mood problems, regardless of the presence of anxiety and depression. There is a large group of people who have combined insomnia and anxiety or depression who do not contact primary care about either sleep or mood problems.