Validity and reliability of the Brief Insomnia Questionnaire in the general population in Hong Kong.
The Brief Insomnia Questionnaire (BIQ) was first validated in the U.S. for insomnia disorders according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), International Classification of Diseases, Tenth Edition (ICD-10) and research diagnostic criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2). We aimed to determine the validity and reliability of a Hong Kong Chinese version of the BIQ to derive the DSM-5 in addition to other insomnia diagnoses in a general population sample.
Probability subsamples of population-based epidemiological survey respondents (n=2011) completed test-retest (n=120) and clinical reappraisal (n=176) interviews.
Short-term test-retest reliability was moderate for most BIQ items (Pearson r>0.40), except for the number of nights with problems staying asleep, amount of time awake, duration of sleep problems and sleep onset latency. The areas under the receiver operating characteristic curve for the DSM-IV-TR, DSM-5, ICD-10 and RDC/ICSD-2 insomnia disorder ranged from 0.76 to 0.86, indicating high individual-level concordance between BIQ and clinical-interview diagnoses. The use of super-normal control and BIQ symptom-level data further improves the diagnostic concordance. Prevalence estimates based on the BIQ dichotomous classification were comparable with estimates based on clinical interviews for the DSM-5, RDC/ICSD-2 and any of the DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia disorders.
The Hong Kong Chinese version of the BIQ generates accurate prevalence estimates for insomnia disorders in the general population. Modification of the BIQ scoring algorithms and use of trained interviewers may further improve its diagnostic performance.
Chung KF
，Yeung WF
，Ho FY
，Ho LM
，Yung KP
，Yu YM
，Kwok CW
... -
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Comparison of scoring methods for the Brief Insomnia Questionnaire in a general population sample.
The Brief Insomnia Questionnaire (BIQ) is a lay-administered, structured interview to derive insomnia disorders according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), International Classification of Diseases, Tenth Edition (ICD-10) and research diagnostic criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2). The concordance between diagnoses derived from the BIQ and clinical interviews was only moderate and the prevalence estimates based on the BIQ were significantly different from estimates based on clinical interviews. We hypothesized that a modification of the scoring algorithm closer to the diagnostic criteria would improve the performance of the BIQ.
Probability subsample of population-based epidemiological survey respondents (n=2011) completed clinical reappraisal (n=176) interviews. We compared the modified scoring with the original scoring in sensitivity, specificity, positive and negative predictive values, areas under the characteristic curve, and Cohen's kappa to detect DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia diagnoses by the BIQ against clinical interviews.
The diagnostic accuracy was improved with the modified scoring. The areas under the receiver operating characteristic curve for the DSM-IV-TR, ICD-10, RDC/ICSD-2 and any of the insomnia diagnoses ranged from 0.76 to 0.87. Using the modified scoring, there was no significant difference between prevalence estimates based on the BIQ classification and clinical interviews.
The BIQ with modified scoring enhanced case detection and produced more accurate prevalence estimates of DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia disorders. With scoring algorithms now extended to DSM-5 and ICSD-3 diagnoses, the BIQ should be more widely used in clinical and research settings.
Chung KF
，Yeung WF
，Ho FY
，Ho LM
，Yung KP
，Yu YM
，Kwok CW
... -
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Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and statistical manual (DSM), International classification of diseases (ICD) and International classification of sleep disorders (ICSD).
To compare the prevalence of insomnia according to symptoms, quantitative criteria, and Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th Edition (DSM-IV and DSM-5), International Classification of Diseases, 10th Revision (ICD-10), and International Classification of Sleep Disorders, 2nd Edition (ICSD-2), and to compare the prevalence of insomnia disorder between Hong Kong and the United States by adopting a similar methodology used by the America Insomnia Survey (AIS).
Population-based epidemiological survey respondents (n = 2011) completed the Brief Insomnia Questionnaire (BIQ), a validated scale generating DSM-IV, DSM-5, ICD-10, and ICSD-2 insomnia disorder.
The weighted prevalence of difficulty falling asleep, difficulty staying asleep, waking up too early, and non-restorative sleep that occurred ≥3 days per week was 14.0%, 28.3%, 32.1%, and 39.9%, respectively. When quantitative criteria were included, the prevalence dropped the most from 39.9% to 8.4% for non-restorative sleep, and the least from 14.0% to 12.9% for difficulty falling asleep. The weighted prevalence of DSM-IV, ICD-10, ICSD-2, and any of the three insomnia disorders was 22.1%, 4.7%, 15.1%, and 22.1%, respectively; for DSM-5 insomnia disorder, it was 10.8%.
Compared with 22.1%, 3.9%, and 14.7% for DSM-IV, ICD-10, and ICSD-2 in the AIS, cross-cultural difference in the prevalence of insomnia disorder is less than what is expected. The prevalence is reduced by half from DSM-IV to DSM-5. ICD-10 insomnia disorder has the lowest prevalence, perhaps because excessive concern and preoccupation, one of its diagnostic criteria, is not always present in people with insomnia.
Chung KF
，Yeung WF
，Ho FY
，Yung KP
，Yu YM
，Kwok CW
... -
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ResearchGate
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