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Perceived Unit Readiness

As shown in the second column of Table 3.8, we found three sleep measures that were significantly associated with perceived unit-level readiness with moderate effect sizes. Specifically, there was a significant association between sleep duration and unit readiness (F = 6.77, standardized beta = -0.40; p < 0.01), such that those sleeping five hours or less per night reported significantly lower mean unit readiness than those sleeping seven hours or more per night. Additionally, poorer sleep quality was associated with lower reported unit readiness, such that a one-standard-deviation change in the PSQI (i.e., increase in sleep complaints) was associated with a 0.23 decrease in perceived unit readiness (p < 0.001). Finally, reporting that sleep interferes with work or chores was also significantly associated with unit readiness (F = 6.05, p < 0.01); servicemembers reporting that sleep interfered with work or chores "a little" or "somewhat to very much" reported significantly lower unit readiness than those who reported that sleep did not interfere with chores at all; effect sizes were moderate. No specific sleep measure was notably stronger or weaker than any of the others for this outcome.

Probable Depression

8.7 percent of the sample was classified as having probable clinical depression. As shown in the first column of Table 3.9, six different measures of sleep were associated with a higher risk of probable depression, after adjusting for sociodemographic and military characteristics and TBI. Specifically, there was a significant association between sleep duration and probable depression (X2 = 20.96, p < 0.001), such that those sleeping five hours or less per night had significantly higher odds of having probable depression. Based on predicted means for this outcome, those sleeping five hours or less per night were approximately three times more likely to have probable depression than those sleeping seven hours or more per night (17 percent versus 5 percent). Additionally, poorer sleep quality (higher PSQI scores) was associated with significantly higher odds of having probable depression (OR = 4.33; p < 0.001). Greater frequency of sleep-related daytime impairment was also significantly associated with a greater likelihood of probable depression (X2 = 90.72, p < 0.001). We note here that the odds ratio comparing those reporting "somewhat to very much" is extremely large because probable depression occurred so rarely among the group of servicemembers reporting "never" having sleep-related daytime impairment. Specifically, the adjusted rates of probable depression for the groups reporting "never" having sleep-related daytime impairment versus those reporting "somewhat to very much" were 1 percent and 35 percent, respectively, though caution is warranted in interpreting these results, given the small sample sizes for those reporting that they never experienced sleep-related daytime impairment.

Greater frequency of fatigue was also associated with a greater likelihood of probable depression (X2 = 84.30, p < 0.001; see Figure 3.6 for the predicted mean percentages based on differing levels of fatigue). These odds ratios for fatigue are also very large because the rate of probable depression in the reference group (those who "never or nearly never" experience fatigue) is so small compared with the rates in the other groups. Getting out of bed at different times of the day was also associated with a greater likelihood of probable depression (X2 = 17.77, p < 0.01), such that 25 percent of those who "always" get out of bed at different times have probable depression versus 7 percent of those who "never or nearly never" get out of bed at different times. Finally, among those servicemembers who had experienced a traumatic event, greater

Figure 3.6. Percentage with Probable Depression, According to Frequency of Experiencing Fatigue

Percentage with Probable Depression, According to Frequency of Experiencing Fatigue

frequency of distress related to disturbing dreams was significantly associated with a higher likelihood of having probable depression—39 percent versus 8 percent with probable depression for those reporting being "moderately to extremely" bothered by disturbing dreams or "not at all" bothered, respectively (X2 = 28.68, p < 0.001).

Probable PTSD

Slightly more than 12 percent (12.4) of the sample was classified as having probable clinical PTSD. As shown in the second column of Table 3.9, poorer sleep quality and greater sleep-related daytime impairment were associated with higher odds of probable PTSD. Specifically, poorer sleep quality (higher PSQI scores) was associated with a higher likelihood of having probable PTSD (OR = 5.00; p < 0.001, for a one-standard-deviation increase in the PSQI). Additionally, greater sleep-related daytime impairment was also significantly associated with probable PTSD (X2 = 90.72, p < 0.001), such that 18 percent of servicemembers reporting "somewhat to very much" impairment had probable PTSD versus only 7 percent of those who reported no daytime impairment.

 
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