Validation of the Insomnia Severity Index in Primary Care
Open accessAbstract
BACKGROUND: Although insomnia is a prevalent complaint with significant consequences on quality of life, health, and health care utilization, it often remains undiagnosed and untreated in primary care settings. Brief, reliable, and valid instruments are needed to facilitate screening for insomnia in general practice. This study examined psychometric indices of the Insomnia Severity Index (ISI) to identify individuals with clinically significant insomnia in primary care settings. METHODS: A sample of 410 patients recruited from 6 general medical clinics completed the ISI before their appointment with a primary care physician. A subsample of 101 individuals also completed a semistructured clinical interview by telephone to determine the presence or absence of an insomnia disorder. Reliability and validity indices were computed, as was the discriminative capacity of each individual item. Convergence between ISI total score and the diagnosis derived from the interview was investigated. Receiver operator characteristic analyses were used to determine the optimal ISI cutoff score that correctly identified individuals with an insomnia disorder. RESULTS: ISI internal consistency was excellent (Cronbach α = 0.92), and each individual item showed adequate discriminative capacity (r = 0.65-0.84). The area under the receiver operator characteristic curve was 0.87 and suggested that a cutoff score of 14 was optimal (82.4% sensitivity, 82.1% specificity, and 82.2% agreement) for detecting clinical insomnia. Agreement between the ISI cut score and the diagnostic interview was moderate (κ = 0.62). CONCLUSIONS: These findings suggest that the ISI is a valid screening instrument for detecting insomnia among patients consulting in primary care settings.
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The ISI has high internal consistency (α=0.90 to 0.92) and adequate discriminative validity of the individual items.
“The questionnaire has been validated in clinical and community samples and is characterised by high internal consistency (α=0.90 to 0.92) and adequate discriminative validity of the individual items.77 78”
From Clinical and cost-effectiveness of a guided internet-based Acceptance and Commitment Therapy to improve chronic pain-related disability in green professions (PACT-A): Study protocol of a pragmatic randomised controlled trial (2020) · cites this paper as [78]
The Reliability and Item Response Pattern section reports high internal consistency (Cronbach’s α = 0.92), and the Abstract says each item had adequate discriminative capacity. This paper does not report α = 0.90 for the ISI, so it supports the upper end of the cited range but not the full range. (LLM, conf=0.87)
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- Authors
- Gagnon, C., Belanger, L., Ivers, H., & Morin, C. M.
- Affiliations
- Université Laval (CA)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2013-11-01
- Volume
- 26
- Issue
- 6
- Pages
- 701-710
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2131444989
- Cited by
- 319
- References
- 50
- Citations by year
- 2026: 20 · 2025: 29 · 2024: 34 · 2023: 34 · 2022: 37 · 2021: 51 · 2020: 36 · 2019: 23 · 2018: 14 · 2017: 15 · 2016: 16 · 2015: 5 · 2014: 3 · 2013: 2
- FWCI
- 11.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- Insomnia Severity Index, insomnia screening, primary care, psychometric validation, internal consistency, cut-off values, diagnostic accuracy, insomnia diagnosis, general practice
- MeSH terms
- Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Primary Health Care, Psychometrics, Quality of Life, Quebec, Surveys and Questionnaires, Retrospective Studies, ROC Curve, Severity of Illness Index, Prevalence
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