Clinical ReviewSelf-report measures of insomnia in adults: rationales, choices, and needs
Section snippets
Measurement domains and criteria
Testing self-report instruments psychometrically is important because the average research subject might provide imprecise or biased responses in relation to a questionnaire's measurement objectives. These problematic responses impair accurate scaling of the latent dimensions (e.g. sleep quality, usual sleep length, sleepiness) that the instrument proposes to measure. Several authors discuss general methods of assessing instruments.*6., *7. In addition, assessment of an instrument's
Pro and Con: making your own instrument, or using an established one
Why not just make up ad hoc questions for one's study, as needed? In some cases this is a good strategy, particularly if one is venturing into a new and unique area. Pioneers of new areas need to invent new questions and instruments, since new topics require new measures. Designing one's own instrument gives one flexibility. However, when similar studies already exist, overuse of study-specific measures generally lowers the scientific value of a particular study, and of studies in general. An
Study aims: some general types
A specific study's research design might fit into one of several general categories that occur commonly and that share rationales for instrument selection. Several considerations can be reviewed when selecting instruments for a particular study. First, what general kind of research question is being asked, considering the study's specific aims? Second, given the general kind of question, what are the usual measurement priorities for this study type? Third, what are the practical constraints of
Scenario 1: efficacy studies
One common study design tests the efficacy of a particular hypnotic medication or defined behavioral intervention, compared to another medication, another intervention, or placebo.
What is the general kind of question that is asked in efficacy studies for insomnia? The general question is whether one can detect a statistically significant difference in one or more defined outcome variables between comparable samples of subjects ideally differing only by the specific medication or intervention to
Scenario #2: testing a theory-based intervention
Several behavioral and psychological interventions are available for helping insomnia patients. These include sleep hygiene interventions, relaxation training, stimulus control, sleep restriction, and cognitive therapy. Studies have documented the efficacy of each of these interventions with the exception of sleep hygiene. From a medical point of view, these interventions must, on principle, be related to physiological improvements in the sleep of insomnia patients. Medical theories explaining
Scenario #3: epidemiological, case control, and genetic studies: observational studies
An ‘observational study’ generally refers to a study in which the investigator collects information largely without manipulating therapeutic or other exposures: The researcher just ‘observes.’ Observational studies fall into two general types. The first type of study focuses on population descriptions, ideally using samples drawn randomly from probability-weighted population strata. The second kind of study focuses on analyzing available data to find risk factors for a particular disease or
Scenario #4: geriatric insomnia
What is the general kind of question that is asked in studies of geriatric insomnia? The heterogeneity in health statuses in aging populations makes it unlikely that there is one general kind of question. Even by itself, normal aging reduces slow-wave sleep, increases the number of awakenings, lightens sleep, and possibly reduces the homoeostatic drive for sleep. Extrinsically, retirement from work generally results in fewer daily scheduled events, which may also influence the timing of sleep
Questionnaire development needs for the insomnia field
Insomnia research at this time probably is in a similar situation to psychiatric research in the 19th century in that even the definitions of the terms employed remains open to debate. Resolution of such debates will depend partly on review of data provided by self-report questionnaires, as designed for different populations and from differing theoretical perspectives. Thus, progress in insomnia research will depend in part upon advancements in questionnaire design. From this review, several
Conclusion
Designing studies about insomnia in adult populations begins with the problem of the definition of insomnia itself. Even after an investigator decides what definition to select for a study, he or she must still consider carefully what self-report measures to use. The process of selecting an ensemble of questionnaires wisely begins with consideration of factors that include the population sampled, the kind of study anticipated, and the theory of insomnia that is modeled. Where reasonable, there
Acknowledgements
The authors thank David Kupfer, M.D., Ronald Dahl, M.D. and Anne Germain, Ph.D. for helpful suggestions. This work was supported by grants AG15138, AG00972, MH30915, MH16804 and MH01554. The authors also thank the peer reviewers of this article for helpful suggestions.
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