Insomnia prevalence and mental health correlates among 18,646 users of an internet-based cognitive-behavioral therapy website: Archival real-world data from the United States, 2017–2019

Abstract

Sleep problems were examined in archival data from 18,646 users of a commercial service that provided online health risk screening, educational resources, and self-guided computerized therapy lessons for insomnia and other mental health disorders. The sample was split between college students and working adults and represents a growing modern segment of adults who voluntarily seek out digital support for common behavioral issues. The goals were to explore the prevalence and possible correlates of insomnia among this unique sample. The cognitive behavioral-based therapy from this service has evidence of its clinical effectiveness and value to users in past research. Results revealed that 36% of all users were at risk for a clinical insomnia disorder. The severity of insomnia was significantly (all p <.001) associated with the severity of depression (r = .65; 43% clinical); anxiety (r = .54; 40% clinical); stress (r = .54; 25% clinical); social phobia (r = .34; 27% clinical); and general health status (r = -.26; 15% clinical). Younger age was weakly associated with insomnia (r = -.14; avg. 32 years; range 18-83), while both gender (r = -.05; 76% female) and race (r = .00; 81% White) were unrelated to insomnia. More severe insomnia was associated with lower work performance and greater work absenteeism (r = -.30; r = .17, respectively). The conclusions are that insomnia was commonly experienced among users of digital tools, often comorbid with other common mental health conditions, and linked to work performance problems. Thus, online self-help health and related digital services should screen for multiple disorders, including insomnia, rather than focusing on the specific disorder emphasized in the care program.