Latent patterns of sleep disturbance, pain impact, and depressive symptoms in residential substance use treatment

Abstract

Aim: Sleep disturbance, clinically significant pain, and depressive symptoms commonly occur together among individuals with substance use disorders. The purposes of the present study were to 1) identify subgroups of individuals with heterogenous patterns of pain, sleep disturbance, and depressive symptoms, and 2) identify demographic and clinical correlates of profile membership.

Material and methods: The present study assessed a sample (N = 8621) of individuals seeking residential substance use treatment in 2020 and 2021 in the United States. We examined whether unique sub-groups could be identified based on patterns of sleep disturbance, pain impact, and depressive symptoms during the first four weeks of treatment, using longitudinal latent profile analysis. Next, we explored demographic, substance use, and clinical correlates (i.e., distress intolerance) of profile membership, as well as whether profile membership was associated with treatment attrition.

Results: The identified classes were: 1) Low sleep disturbance, pain impact, and depressive symptoms, 2) High pain, remitting depressive symptoms, and mild sleep disturbance, 3) High depressive symptoms, low pain, and remitting sleep disturbance, and 4) High sleep disturbance, pain impact, and depressive symptoms. Individuals with high pain, depressive symptoms, and sleep disturbance were more likely to be older, use opioids as their primary substance, have high distress intolerance, and discontinue treatment.

Conclusion: Results highlight the importance of comprehensive care and management of physical health conditions, particularly among older adults. Further, results highlight that distress intolerance may be a modifiable risk factor for co-occurring sleep disturbance, pain impact, and depressive symptoms.

Keywords: Depression; Pain impact; Sleep disturbance; Substance use disorder; Treatment.