Sleep disturbances and unmet mental health or substance use needs are associated with high levels of presenteeism and persistent presenteeism among active-duty service members (ADSMs), according to study results published in the Journal of Sleep Research.
In this cross-sectional study, researchers aimed to understand the associations between sleep disturbance profiles and presenteeism, the links between unmet healthcare needs and presenteeism, and the relationships between the combined effect of sleep and unmet healthcare needs on presenteeism among US service members.
The researchers used data from the 2018 Health-Related Behaviors Survey, an anonymous, cross-sectional survey run by the US Department of Defense. They categorized the participants’ presenteeism into 4 categories: 0 days, 1-3 days, 4-14 days, and 15-30 days. A high presenteeism level is defined as 15-30 days of presenteeism, and persistent presenteeism is defined as 5 and more days of presenteeism during the last 30 days.
In a latent class analysis (LCA), the investigators classified the participants’ sleep behaviors into 4 sleep disturbance profiles: high sleep disturbance, short sleep duration, trouble sleeping, and little to no sleep disturbance.
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[T]his study highlights the significant combined (between additive and multiplicative) effect on presenteeism and persistent presenteeism.
In the final sample, there were 17,166 surveys of usable data. Among these, 83.3% of participants were men, 58.0% were white, 22.3% were 35 years and older, 65.2% had an educational level of high school and lower, and 53.8% were married.
Approximately 21% of service members reported at least one presentee day (95% CI, 19.8-21.8%), with 13.6% experiencing persistent presenteeism (95% CI, 12.7-14.4%). More service women experienced presenteeism than men (P<.0001). Further, 22.5% of service members reported high sleep disturbances, 26% experience short sleep duration, 6.9% had trouble sleeping, and 44.6% had little to no sleep disturbances.
The sociodemographic and military covariables with increased odds of high presenteeism levels and persistent presenteeism include: female sex and marital status of separated, divorced, or widowed (all P=.05). The covariables with lower odds are those with an educational level of a bachelor’s degree and higher, between 25 and 34 years of age, Hispanic or Latinx, officer rank, and service branch of Air Force or Coast Guard (all P=.05).
Compared to service members with no unmet healthcare needs, those with unmet needs had significantly increased odds of high presenteeism levels (adjusted odds ratio [aOR], 7.910; 95% CI, 6.516-9.603) and persistent presenteeism (aOR, 8.445; 95% CI, 6.781-10.52).
In the combined effect of unmet healthcare needs and sleep profiles, the researchers found that high presenteeism levels and persistent presenteeism were significantly more likely among service members in the unmet healthcare needs only cohort, the inadequate sleep only group, and the cohort with both unmet needs and inadequate sleep vs those with sufficient sleep and no unmet needs (all P =.05).
“[T]his study highlights the significant combined (between additive and multiplicative) effect on presenteeism and persistent presenteeism,” the study authors concluded.
Study limitations included reliance on self-reported data, potential for confounding bias due to unmeasured variables, possible selection bias from low survey response rate, and the inability to determine causality due to the cross-sectional nature of the study.
Disclosure: A study author declared an affiliation as an employee with the United States Government, and this work was completed as part of the study author’s official responsibilities. Please see the original reference for a full list of author disclosures.
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