Pain and Sleep Problems Predict Quality of Life for Veterans With Serious Mental Illness

Purpose: Poor sleep and pain are common in veterans with serious mental illness (SMI), yet it is unclear how these may impact dimensions of quality of life. As such, this study examined independent and additive contributions of sleep and pain difficulties on quality of life (QoL) among a sample of veterans with SMI and insomnia. Method: Participants were 57 veterans with SMI (schizophrenia spectrum, bipolar, or major depressive disorders with significant functional impairment) and at least subthreshold insomnia (Insomnia Severity Index >= 8). Measures assessed sleep quality (Pittsburgh Sleep Quality Index). pain intensity (Pain Numeric Rating Scale [PNRS]), pain interference (Short Form 12 Health Survey). and QoL (World Health Organization Quality of Life-BREF). Multivariate multiple regression analyses examined the effects of sleep quality and pain on QoL. Results: Forty-one veterans (71.9%) reported moderate-to-severe pain (PNRS >= 4). Poorer sleep quality was associated with greater pain interference and worse physical, emotional, and environmental QoL. Sleep quality, not pain, explained significant variance in environmental QoL (b = -2.30; 95% confidence interval [CI: -4.16, -.43]). Pain interference, not sleep quality, explained significant variance in physical health-related QoL (b = -.23; 95% CI [-.38, -.08]). Conclusions: Results reveal the importance of screening for insomnia and chronic pain among veterans with SMI. For these veterans who already struggle with daytime functioning, interventions such as integrated cognitive-behavioral therapy for pain-related insomnia are warranted. Such treatments must account for how sleep disturbance and chronic pain may differentially impact multiple facets of QoL.