Development And Preliminary Applicat Ion Of Subjective Insomnia Assess Questionnaire Based On The Theory Of Traditional Chinese Medicine

Objective1.To establish the clinically practical insomnia assess questionnaire characterized of Chinese culture,which could help to understand the physical and mental status of insomniaSystematically comb the main viewpoints and the historical development of Traditional Chinese Medicine and modern medicine in sleep theory,hold the cognition of Traditional Chinese Medicine and modern medicine on sleep physiology,pathogenesis and treatment of insomnia,dig the research on sleep psycology in Traditional Chinese Medicine psychology and modern psychology,construct the basic structure of the subjective insomnia assess questionnaire.The Chinese culture,mainly impacted by Buddhism and Taoism,influenced many aspects of the livings of the Chinese,especially the psychological aspects,which were confirmed by the interviews with the insomniacs.The "family culture" and the "dream culture" showed great significance during the development of the insomnia.Understanding the physical and mental status of insomnia could provide a reference for the next step of treatment.The questionnaire,which embodied the impact of the Chinese culture on the aspect of psychology of insomnia,and could help to understand the physical and mental status of insomnia,as a matter of fact,should improve the clinical feasibility.Because some concrete items of the questionnaire embody the culture peculiarity,the insomniacs will understand their own psychological aspects when they filled in the questionnaire and thus the psychological intervention has begun.2.To develop a questionnaire which can help to rapidly identify the subjective insomnia in clinicalThe typical characteristics of subjective insomnia is insomnia who complained of severe sleeplessness but lack of objective evidence of support,that is,the subjective insomnia assessment is higher than objective assessment.The clinical diagnosis of insomnia is based on the complain of sleeplessness,so it is difficult to distinguish subjective insomnia between objective insomnia.The existing self rating sleep scales also can not distinguish them.As subjective insomnia can not be targeted treatment which is the fundamental cause of subjective become intractable.The development of a questionnaire can rapidly identify the subjective insomnia in line with the actual needs of the clinical.3.To explore the applicable objectives and to formulate the evaluation standards based on the assess questionnaireThe questionnaire for the nonorganic insomniac is applied to understand the present psychological situation,to analyse the distribution characteristics of different people and the factors impact on it,including gender,age,occupation,financial and education situation.Some healthy people,who are sleep good and do not stay up,were picked up to finish the questionnaire for nonorganic insomniac.The assessment results were analysized in order to set standard and to explore the applying objects.Methods1.Literatures research methods:This research collected the literatures on the assess questionnaire or research data of the sleep and insomnia via the e-resources including CNKI,Wangfang Data Knowledge Service Platform,VIP,PubMed,SCIE.The development and the research methods on insomnia were studied,and the formulation and chacterisristics of the assess questionnaire were also described.Furthermore,this research clarified the conception and connotation of insomnia based on the analysis of the diagnosis and classfication on insomnia via counsulting International Classification of Sleep Disorder(3rd ed.),Diagnostic and Statistical Manual of Mental Disorder(5th ed.),ICD-10 Classification of Mental and Behavioral Disorder,Chinese Classification and Diagnostic Criteria of Mental Disorders(3rd ed.).Referencing to the sleep assess questionnaire in the Questionnaire Handbook of Behavior Medicine,Assess Questionnaire Handbook of Mental Health,Physiology,Psychology of Chinese Tradiotnal Medicine,Clinical Psychology,Counseling Psychology,and etc.,this research summarized some typical and and psychological close-related contents,which is used to establish the primary item pools of assess questionnaire for nonorganic insomnia.2.Interview MethodThis research adopted the formal interview(face to face)with the nonorganic insomniacs and their relatives to get primary data.The duration of the interview was about 30-60 min for each time,and the state of the mental,face,and emotion were recorded and further applied to understand the thinking and behavior related to insomnia.The interview contents were drawfted aforhand and included the sleep time,the symptoms,the idea and behavior related to insomnia,living status and etc.By comprehensive induction and analysis on the data achieved from the interview,the items which could applied to the primary item pools were selected.3.Delphi MethodOn the basis of previous literature research and formal interview with the insomniac and their relatives,this research established the primary item pools of assess questionnaire for insomniacs,and set up the demensionalities of the questionnaire based on the theory of Traditional Chinese Medicine psychology and modern psychology.The importance,feasibility and weight of each item and demension in the pools were evaluated using Delphi method for two times by nine experts,who had professional backgrounds of medicine,Traditional Chinese Medicine and psychology,and had clinical and psychological experiences over ten years.These experts were permitted to propose the concrete suggestion on the revision,addition and deletion to the items or demensionaties according to their cognition.Based on the statistic result of each consulting,some items reached to the modification,addition and deletion standard were modified and corrected.Finally,the items and demensionaties,the answer pattern,and the score rules of the primary questionnaire were established,and thus the primary questionnaire of nonorganic insomnia was formulated.4.Questionnaire Method.The questionnaire formulated by the Delphi method was applied to the primary investigation on the nonorganic insomniacs reached to the standard,which were treated in the outpatient department of psychology and encephalopathy.The answer pattern,score rules and completion time were futher improved during the investigation.5.Methematical StatisticsThs data colleted were recorded and sorted out in excel(version 2010)and analyzed by SPSS(version 20.0).The reliability and authority of counseling were evaluated with the expert coefficients of activity,authority degree,opinion coordination and variation in Delphi method.The analysis are mainly descriptive statistics,mean comparision and nonparametric test on some related samples.The relationship between variables and the content validity of the questionnaire are explored and tested by descriptive statistics,mean comparision,item analysis and variance analysis.Furthermore,the test-retest reliability of the questionnaire is evaluated by paired sample T-test and correlation analysis,the internal reliability by Cronbach’αcoefficient and correlation analysis.The construct validity of questionnaire is evaluated and the theory frame structure and demension are established using screened items by exploratory factor analysis and correlation analysis.The criterion validity and the confirmatory factor were analyzed by paired sample T-test and correlation analysis.Results1.The development on the sleep and insomnia from the viewpoint of TCM and modern medicine wee systematically combedThis research systematically combed the literatures on the sleep physiology,and the pathogenesis,therapeutic principle and formulations on insomnia.The general mechanism of sleep lies in the change of Yin Yang,and the sleep is influenced by the change of Qi and blood,the function of viscera and pathogenic factor.Thus,the insomnia pathogenesis is considered as Yang-preponderance-Yin-deficiency.The failure of Qi and blood,the dysfuction of viscera,and exopathy or internal pathogenic factor can also lead to insomnia.The therapeutic pricinple lies in the adjustment of viscera,Qi and blood,and Yin Yang,and the therapeutic mode include syndrom differentiation,acupuncture and massage and etc.Furthermore,the Traditional Chinese Medicine psychology proposed the viewpoint of that the emotion lesions and insomnia could be reciprocal causation,emphasized the importance of psychotherapy,and proposed series of psychotherapeutic treatment characterized of Traditional Chinese Medicine.As cognition of insomnia in Traditional Chinese Medicine,modern medicine also underwent the transform from biomedicine to psychosomatic medicine,from pure medicine-therapy to the combination-therapy of drugs and psychology.The role of psychological factors in the occurrence and development of insomnia attracted more attention from both doctors and patients.2.The assess questionnaire characterized by Chinses culture for the evaluation on the symptoms of the nonorganic insomniac were establishedFollowing the principle and procedure of psychology measurements questionnaire,this research establishes the theoretical framework of the formal questionnaire,which is comprised of twenty-six items and six demensiones of symptom,cognition,behavior,emotion,society function and dream-relation of the nonorganic insomniac.The feasibility,reliability,and validity of the questionnaire are tested.The rate of acceptance and recovery are both 100%,the mean completion time is 4.73±2.18 minutes,and over 90%insomniacs finished this questionnaire in 3-8 minutes,indicating the preferable clinical feasibility.The test-retest reliability is above 0.9 and the values of Crobach’ α and split-half reliability are both greater than 0.7,suggesting the good reliability of the questionnaire.Despite the value of correlation coefficient between the score with the third item is a bit lower than 0.20,the others are lies in 0.222-0.570,the coefficients between each demension with the whole questionnaire are lies in 0.488-0.639,the coefficient between each item and its demension belonged lies in 0.317-0.917.The values of correlation coefficient of each item with the score of other demension are less than that of the score of the demension its belonged,the P value is lower than 0.01,indicating the significant correlation and futher demonstrating the good content validity of the questionnaire.The value of correlation coefficient of the questionnaire and the Pittsburgh sleep quality index is greater than 0.8,suggesting the good calibration-standard correlation validity.The common factors of the exploratory factor analysis are essentially corresponding to the six demensions of emotion,symptom,behavior,dream-correlation,cognition and soicety function,indicating the good structure validity of the questionnaire.The effect scale is 2.84,suggesting its favorable response.The score of objective insomnia index in the questionnaire less than 3 is divided into subjective insomnia,and the correlation coefficient of Actigraphy results is greater than 0.7,suggesting the questionnaire can quickly identify subjective insomnia.Conclusion1.Sleep is affected by many factors.The social psychology plays a very importance role in the development and outcome of insomnia,especially to those who are nonorganic insomniac.2.The questionnaire for nonorganic insomniac proposed in this research is verfied by many statistical tests and compared with Pittsburgh sleep quality index.The results indicate its good reliability,validity,and clinical feasibility.It is useful to understand the irrational thinking and behavior mode of the nonorganic insomniacs,and provide a measurement tool characterized by Chinese culture and be good accordance with the custom of Chinese language.3.The results of this research indicate the psychology factor is colse-related with the development of insomnia according to this investigation on the nonorganic insomniacs.The scores are significantly decreased when the insomnia get better.The correlations between questionnaire for nonorganic insomaniac with the Pittsburgh Sleep Quality Index is favourable,which verified the reliability of the questionnaire and can provide convenient and efficient evaluation in clinical on the aspects of psychological factor of the nonorganic insomniacs.