(PS2-23) Identifying Factors Associated with Sleep Disturbance Among Adults Seeking Outpatient Psychiatric Services for Anxiety and Related Disorders

Purpose: Current research indicates that sleep disturbance is prevalent among people with anxiety and related disorders. This is notable as sleep is an important biopsychological mechanism for affective regulation. Although there have been a variety of studies exploring sleep difficulties across anxiety and related disorders, many gaps remain in this area. Therefore, the present study sought to identify predictors and moderators of sleep disturbance among adults seeking psychiatric treatment for anxiety and related disorders.

Methods: Participants were adults initiating outpatient psychiatric services at an anxiety-specialty clinic (N = 418; 74% female; Mean age 36.6, SD=12.7; 76% white). Participants had a principal diagnosis of generalized anxiety disorder (n = 179), obsessive-compulsive disorder (n = 71), panic disorder / agoraphobia (n = 67), and social anxiety disorder (n = 101). Diagnosis was identified using the Diagnostic Assessment and Research Tool (DART), a semi-structured clinical interview administered by a mental health professional. Participants completed a comprehensive baseline battery at treatment initiation. This battery included the Pittsburgh Sleep Quality Index (PSQI), the Depression Anxiety Stress Scale-21 (DASS21), Cannabis Use Disorder Identification Test (CUDIT), and anxiety-specific outcome measures tailored to diagnosis. Linear regression was conducted to identify predictors and moderators of sleep quality.

Results: At baseline most participants endorsed poor sleep quality (mean PSQI = 10.3, SD = 3.39), moderate stress (mean DASS-S = 22.7, SD = 9.25) and depressive symptoms (mean DASS-D = 19.3, SD = 11.1), and low risk for hazardous cannabis use (mean CUDIT = 3.06, SD = 5.76). There were no differences in sleep quality across diagnostic groups. Main effects in positively predicting sleep quality were observed for age (β = 0.20, p < .01), anxiety-specific symptom severity (β = 0.12, p = .03) and stress (β = 0.25, p < .01). Depressive symptoms, cannabis use difficulties, and sex did not predict sleep disturbance. The effect of age on sleep disturbance was consistent across diagnostic groups as well as biological sex with the exception of male participants in the generalized anxiety disorder group where this effect was reversed (β = -0.12, p = .01). The effect of anxiety-specific severity on sleep disturbance was more pronounced in younger individuals and this effect attenuated in older individuals (β = -0.09, p = .05).

Conclusions: These findings highlight the importance of screening for sleep disturbance in adults seeking treatment for anxiety and related disorders as the majority of participants in this study endorsed poor sleep quality. This is notable given that sleep affects affective regulation and thus could play a role in anxiety and related disorder treatment outcomes. As this study was cross-sectional in nature, future studies investigating the role of sleep in anxiety and related disorder treatment outcomes is warranted.