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. 2021 May:81:80-85.
doi: 10.1016/j.sleep.2021.01.045. Epub 2021 Feb 4.

Validation of the Insomnia Severity Index (ISI) for identifying insomnia in young adult cancer survivors: comparison with a structured clinical diagnostic interview of the DSM-5 (SCID-5)

Alexis L Michaud  1 , Eric S Zhou  2 , Grace Chang  3 , Christopher J Recklitis  4
Affiliations

Validation of the Insomnia Severity Index (ISI) for identifying insomnia in young adult cancer survivors: comparison with a structured clinical diagnostic interview of the DSM-5 (SCID-5)

Alexis L Michaud et al. Sleep Med. 2021 May.

Abstract

Objectives: Insomnia is a common problem affecting young adult cancer survivors (YACS) even years after treatment, yet it often goes unidentified and untreated. The Insomnia Severity Index is a widely-used insomnia measure, but has not been studied as an insomnia screener for YACS. The goal of this study was to validate the ISI in YACS by determining its utility in identifying YACS with insomnia disorder diagnosed with the Structured Clinical Interview for the DSM-5 (SCID-5).

Methods: 250 YACS completed the ISI and SCID-5 Insomnia Module. Area under the curve (AUC) was calculated to reflect the ISI's discrimination between YACS with and without SCID-5 insomnia disorder. An ISI cut-off score with sensitivity ≥0.85 and specificity ≥0.75 was deemed acceptable.

Results: Of 250 participants, 52 met criteria for SCID-5 insomnia disorder diagnosis. The ISI had excellent discrimination, with an AUC = 0.91. A cut-off score ≥8 met study clinical screening criteria with sensitivity of 0.85 and specificity of 0.77. A cut-off score ≥7 with a higher sensitivity (0.96) but lower specificity (0.70) was noted as a potential alternative. Cut-off scores ≥12 and ≥ 14 were recommended for applications prioritizing overall accuracy.

Conclusions: Results support validity of the ISI for identifying YACS with insomnia disorder. For clinical screening, data support the use of an ISI cut-off score ≥8 in YACS, and additional cut-off scores were found for research purposes or higher sensitivity. Results of this study and prior studies of the ISI offer important reminders that cut-off scores derived from different populations are not generalizable.

Keywords: Cancer survivors; Diagnostic and statistical manual of mental disorders; Sensitivity and specificity; Sleep; Sleep initiation and maintenance disorders; Young adult.

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Conflict of interest statement

Competing Interests Statement: No financial arrangements or connections are pertinent to this manuscript. No non-financial interests are relevant to this manuscript.

Figures

Figure 1a.
Figure 1a.
Expected clinical decisions using the Insomnia Severity Index (ISI) to screen for a diagnosis of Insomnia (cut-off ≥ 8).
Figure 1b.
Figure 1b.
Expected clinical decisions using the Insomnia Severity Index (ISI) to screen for a diagnosis of Insomnia (cut-off ≥ 7).
Figure 1c.
Figure 1c.
Expected clinical decisions using the Insomnia Severity Index (ISI) to screen for a diagnosis of Insomnia (cut-off ≥ 10).
See this image and copyright information in PMC

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References

    1. Close AG, Dreyzin A, Miller KD, Seynnaeve BKN, Rapkin LB. Adolescent and young adult oncology-past, present, and future. CA Cancer J Clin. 2019;69(6):485–496. - PubMed
    1. Zeltzer LK, Recklitis C, Buchbinder D, et al. Psychological status in childhood cancer survivors: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27(14):2396–2404. - PMC - PubMed
    1. Fidler MM, Frobisher C, Hawkins MM, Nathan PC. Challenges and opportunities in the care of survivors of adolescent and young adult cancers. Pediatr Blood Cancer. 2019;66(6):e27668. - PubMed
    1. Oeffinger KC, Hudson MM, Landier W. Survivorship: childhood cancer survivors. Primary care. 2009;36(4):743–780. - PubMed
    1. Götze H, Taubenheim S, Dietz A, Lordick F, Mehnert A. Comorbid conditions and health-related quality of life in long-term cancer survivors-associations with demographic and medical characteristics. J Cancer Surviv. 2018;12(5):712–720. - PubMed

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