The Swedish version of the insomnia severity index: factor structure analysis and psychometric properties in chronic pain patients
Abstract
Objective: Insomnia is the most commonly diagnosed comorbidity disorder among patients with chronic pain. This circumstance requests brief and valid instruments for screening insomnia in epidemiological studies. The main object of this study was to assess the psychometric properties and factor structure of the Swedish version of the Insomnia Severity Index (ISI). The ISI is a short instrument designed to measure clinical insomnia and one of the most common used scales both in clinical and research practice. However there is no study in Sweden that guarantees neither its factor structure nor its feasibility in chronic pain patients. We further examined the measurement invariance property of the ISI across the two sexes. Methods: The ISI was administered to 836 (269 men and 567 women) chronic pain patients from the Swedish Quality Registry for Pain Rehabilitation. This study used demographic data, the Hospital Anxiety and Depression Scale (HADS), the Mental Summary Component (MSC) of the Health Survey (SF-36) and the item 7 from Multidimensional Pain Inventory (MPI). The sample was divided into two random halves: exploratory factor analysis (EFA) was performed in the first sample (N1 = 334, 40%) and confirmatory factor analysis (CFA) in the second half of the sample (N2 = 502, 60%). The measurement and structural invariance of the proposed structure (4-item version) between the two sexes as well as reliability and validity indexes were further assessed. Results: Exploratory factor analysis using the principal axis factoring method generated one global factor structure for the ISI, explaining 63.1% of the total variance. The one factor solution was stable between the two sexes. Principal component analysis was also applied and indicated almost identical results. The structure was further assessed by CFA, resulting in an adequate fit only after omitting three items. The difference on structural and measurement invariance in the loadings by participants’ sex was not significant (Δ χ 2 = 10.6; df = 3; p = .69 and Δ χ 2 = 2.86; df = 3; p = 41 respectively). The shorter version four-item Insomnia Severity Index (ISI-4) was analysed further. The Chronbach’s alpha for the global ISI-4 score was 0.88. The construct validity of the ISI-4 was also supported by the, Hospital Anxiety and Depression Scale, the Mental Summary Component of quality of life and quality of sleep data. Pain intensity was significantly associated with the ISI-4 score (beta = .29, p < 001) whereas no significant correlation between four-item Insomnia Severity Index score and age was observed ( p > 05). Conclusions and implications: Although short, the four-item Insomnia Severity Index (ISI-4) version seemed to effectively assess insomnia in chronic pain patients. An important clinical implication is that the four-item Swedish Insomnia Severity Index can be used in chronic pain cohorts when screening for insomnia problems. Its measurement and structural invariance property across the two sexes shows that the ISI-4 is a valid measure of the insomnia across groups of chronic patients. Our results also suggest its utility both in pain clinical practice and research purposes.
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The Insomnia Severity Index has adequate psychometric properties and has been validated in Swedish for use with chronic pain patients.
“ISI has been found to have adequate psychometric properties and has been validated in Swedish for use with chronic pain patients (Dragioti et al., 2015).”
From Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up (2021) · cites this paper as Dragioti et al., 2015
The Swedish version of ISI has psychometric properties in chronic pain patients.
“For psychometric properties of the Swedish version of ISI in chronic pain patients, please see Dragioti, et al. [24].”
From Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? - A randomized controlled study (2018) · cites this paper as [24]
The Insomnia Severity Index (ISI) is a seven-item questionnaire evaluating insomnia symptoms, has satisfactory internal consistency (α = 0.74), and has been validated in a Swedish chronic pain sample.
“The ISI is a seven-item questionnaire that evaluates sleep onset, sleep latency, early awakening, the feeling of being rested, how sleep problems affect daily life, and how concerned the individual is with their sleep pattern. The 5-point scale ranges from 0 (“not at all”) to 4 (“very much”), and a higher score indicates more symptoms of insomnia. The ISI has shown satisfactory internal”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [53]
Sleep items are based on the Insomnia Severity Index.
“sleep items are based on the Insomnia Severity Index,61”
From Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project (2022) · cites this paper as [61]
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- Authors
- Dragioti, E., Wiklund, T., Alföldi, P., & Gerdle, B.
- Affiliations
- Linköping University (SE)
- Corresponding author
- Dragioti, Elena
- Venue
- Scandinavian Journal of Pain
- Publisher
- Walter de Gruyter GmbH
- Published
- 2015-10-01
- Volume
- 9
- Issue
- 1
- Pages
- 22-27
- ISSN
- 1877-8860 (ISSN-L)
- 1877-8879
- OpenAlex
- W1512987951
- Cited by
- 55
- References
- 32
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 4 · 2022: 12 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 1
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- Insomnia Severity Index, Swedish version, chronic pain, insomnia screening, factor structure, psychometric properties, measurement invariance, sex differences, insomnia severity, pain intensity, quality of life, sleep quality, anxiety and depression, cross-cultural adaptation, reliability and validity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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