The Utility of the Patient Health Questionnaire (PHQ-9) Sleep Disturbance Item as a Screener for Insomnia in Individuals With Moderate to Severe Traumatic Brain Injury.
Anthony H Lequerica, Eric Watson, Marcel P Dijkers and 6 others
PMID 35125428WHAT IT FOUND
For adults with moderate-to-severe TBI, a score of 2 or higher on the PHQ-9 sleep item accurately flags insomnia.
This single question can trigger further evaluation without needing lengthy sleep questionnaires.
Key findings
01A PHQ-9 sleep item score of 2 or greater (problems more than half the days) maximized sensitivity and specificity for identifying insomnia.
02Participants scoring 2 or higher had average scores on standard insomnia measures that exceeded clinical cut-offs, confirming the item's link to actual sleep pathology.
03The item did not correlate well with daytime sleepiness, so a positive screen indicates insomnia specifically, not general sleepiness.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study only included patients who had recovered enough cognitively to participate in a telephone interview, so findings may not apply to those with more severe cognitive impairments. Participants were excluded if they had active substance use issues, which are common in the TBI population, potentially limiting generalizability. The study was cross-sectional, capturing a single point in time between 10 and 29 months post-injury, so it does not show how sleep changes over the longer term. The PHQ-9 sleep item includes wording about 'sleeping too much' (hypersomnia), but the item performed poorly as a screener for daytime sleepiness (ESS), suggesting it is specific to insomnia rather than all sleep disorders.
Declared interests
The authors have no conflicts of interest to disclose. The study was supported by the U.S. Government, Non-P.H.S.
The easy way to misread this
Do not use the PHQ-9 sleep item to screen for daytime sleepiness or narcolepsy. The study found a weak correlation with the Epworth Sleepiness Scale, meaning a patient can score high on the PHQ-9 sleep item for insomnia while having normal daytime alertness, or vice versa.