Original ArticleHelp-seeking behaviors for insomnia in Hong Kong Chinese: a community-based study
Introduction
Insomnia is the most common sleep disorder and a major public health problem that affects about 10–20% of adults and 4–23% of adolescents [1], [2], [3], [4], [5]. The impaired sleep quality and reduced sleep quantity, as a result of insomnia, could have a negative impact on daytime cognitive performance [6], and increase the risk of developing depression [7] and cardiovascular diseases [8]. Similarly, insomnia in children and adolescents is also associated with an array of physical problems, mood disorders, and behavioral problems [9], [10], [11]. Although insomnia can lead to significant health-related consequences and cause a substantial healthcare burden to society [12], [13], [14], it is often under recognized and under treated [15], [16], [17]. A study has reported that nearly three-quarters of individuals with insomnia in the general population were not receiving appropriate treatment for their condition [16]. Therefore, from both individual and healthcare policy perspectives, it is critical to investigate the help-seeking behaviors of insomnia so as to guide better management of insomnia and to facilitate informed policy decisions about the development of healthcare and research programs for insomnia [18].
Some studies have suggested that socio-demographic and clinical characteristics, such as older age [19], [20], female gender [20], higher education level [21], daytime functioning impairments [19], [21], [22], and presence of psychiatric and medical comorbidities [19] are associated with help-seeking behaviors for insomnia. However, most of these studies were conducted in clinic-based samples [21], [22], [23], which may have been subjected to selection bias, as these individuals represent the most motivated help-seekers for their health conditions. Efforts should be taken to determine not only the correlates of treatment seeking for insomnia, but also the forms of the preferred therapies in individuals seeking treatment for their insomnia, which might be influenced by the socio-demographic, cultural, and economic factors [24]. Apart from conventional Western medicine, complementary and alternative medicines (CAM) are widely employed therapeutic methods of treating insomnia in different countries. CAM are defined as a group of diverse medical and healthcare systems, practices, and products that are developed outside of mainstream, conventional Western medicine. They include natural products (eg, Traditional Chinese Medicine [TCM] and Western herbs), acupuncture, and other forms of CAM such as Yoga, Tai Chi, and massage (http://nccam.nih.gov/health/whatiscam/#types). As TCM is commonly practiced and has a long tradition in East Asian regions [25], [26], [27], there is a need to further explore whether CAM therapies are commonly preferred treatments for insomnia in treatment-seeking individuals. Furthermore, there are few studies that have investigated help-seeking behaviors in children and adolescents with insomnia, which is not uncommon in this population [28]. Given the familial aggregation of insomnia [1], [29], the family history of insomnia and the experiences of managing insomnia in parents may influence the help-seeking behaviors of their children with insomnia. Hence, the present study aimed to determine the prevalence and correlates of help-seeking behaviors for insomnia and the forms of therapies sought for insomnia in middle-aged adults and their offspring.
Section snippets
Study design and participant recruitment
The present study was an ongoing community-based epidemiologic study initiated in 2003–2004 [1], [30], [31]. A follow-up assessment, which aimed to investigate the longitudinal course and correlates of sleep problems in children and adolescents and their parents, was conducted by mailing a package of questionnaires to the participants in 2008–2011 [4], [32], [33]. As help-seeking behaviors were only measured at follow-up, the present study focused on the cross-sectional data on help-seeking
Prevalence of insomnia symptoms and help-seeking behaviors
Among the 2231 middle-aged adults, 216 (9.6%) had insomnia during the past 12 months. However, only 87 adult participants (3.9% of the overall adult sample and 40.3% of the adults with insomnia symptoms) reported having sought help for their insomnia. Among the 2186 children and adolescents, 146 (6.7%) had insomnia during the past 12 months. However, only 15 participants (0.7% of the overall child and adolescent sample, and 10.3% of the children and adolescents with insomnia) reported having
Discussion
Several findings in the current study were worth noting. First, the majority of the community-based participants with insomnia in Hong Kong, especially the children and adolescents, did not prefer to seek help from the conventional Western medicine healthcare professionals. Second, female gender, higher family income, severity of insomnia, psychiatric disorders, and chronic medications use were found to be associated with help-seeking behaviors among the middle-aged adults with insomnia. Among
Clinical implications
Several implications should be noted in the present study. First, in light of the low prevalence of help-seeking behaviors for insomnia in Hong Kong, a key aspect of sleep education about insomnia should be focused on promoting the public awareness of insomnia (or in a broader term, promoting sleep-health literacy). Second, systematic effort from the health authorities and various healthcare sectors should be made to enhance the availability and accessibility of the evidence-based treatment of
Limitations
The current study had several limitations. First, although the present study was a community-based study with more than 4000 participants, the sample size of the selected groups was relatively small due to the low prevalence of help-seeking behaviors in the community. This limited the statistical power to analyze the findings, especially in the group of children and adolescents. Second, the assessment of insomnia and other sleep problems in this study was based on the questionnaires rather than
Conclusion
The findings of this study demonstrated that it is uncommon for Hong Kong Chinese to seek help for insomnia, despite the high prevalence of insomnia. This significant unmet need across all ages – from children to adults – argues for a timely need to promote sleep health literacy, to enhance the accessibility of the existing evidence-based treatments of insomnia, and to encourage further research examining the efficacy and safety of CAM therapies as a treatment of insomnia.
Conflicts of interest
This was not an industry-supported study. Dr. Yun Kwok Wing has received sponsorship from Lundbeck Export A/S, Servier Hong Kong Ltd, Pfizer Hong Kong Ltd and Celki Medical Company. All the other authors have indicated no conflicts of interest.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2016.01.006.
Author contributions
All authors contributed to the collection of the data, analysis and preparation of the manuscript. Dr. Yun Kwok Wing, the corresponding author, had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data analysis.
Acknowledgements
The research was supported by Health and Health Services Research Fund (HHSRF) Grant (reference number 08090011) of Hong Kong Special Administrative Region, China. Dr. Junying Zhou is partly supported by the Faculty Postdoctoral Fellowship Scheme of Faculty of Medicine, The Chinese University of Hong Kong. The funding agencies had no role in study design, methods, subject recruitment, data collection, analysis of data, or preparation of the paper.
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