Determinants of help-seeking behaviors for insomnia in Hong Kong Chinese: Community-based survey

Introduction: Insomnia is a prevalent sleep problem with various negative consequences. However, the rate of help seeking for insomnia is relatively low. Our previous data collected in 2003–2004, indicated that only about 30% of adults sought help for insomnia in Hong Kong. The purpose of this study is to provide an updated assessment of the prevalence and factors associated with help-seeking behaviors for insomnia.

Method: This is a cross-sectional online community-based survey conducted during August 2023–February 2024. A total of 6646 responses were received and 3483 (mean age: 39.0 ± 14.6, female: 76.7%) provided valid data on insomnia symptoms (Insomnia Severity Inventory), health status, attitudes towards sleep and help-seeking behaviors.

Results: The prevalence of moderate insomnia symptoms (defined by Insomnia Severity Index >14) was 31%. Among individuals experiencing moderate and severe insomnia symptoms, 51% had actively sought treatment for insomnia for past 1 year including doctor prescribed medication, over-the-counter medication, Chinese medicine, and psychological interventions. Only 11% of individuals had tried psychological intervention such as cognitive behavioral therapy for insomnia, which is considered as the first line treatment for chronic insomnia disorder. Factors associated with increased help-seeking behaviors included female (Odd Ratio [OR]: 1.74, 95% CI: 1.42–2.12), more severe insomnia symptoms (OR: 3.12, 95% CI: 2.15–3.68), co-existing psychiatric illnesses (OR: 3.80, 95% CI: 3.17–4.56), recognising the importance of sleep (OR: 1.32, 95% C.I. 1.10–1.57), and prioritizing their sleep over other activities: OR: 1.22, 95% CI: 1.04–1.44), while education and martial status were not associated with help-seeking behaviors (p's > 0.05)

Conclusion: There has been a modest increase in help-seeking behaviors for insomnia compared to two decades ago. However, the utilization of cognitive behavioral therapy for insomnia, which is considered the first-line treatment for adults with insomnia, remains relatively low. The findings also highlight the significance of promoting a healthy sleep culture within the community, as individuals with a favorable attitude towards sleep are more likely to seek help for their insomnia symptoms. Fostering a supportive environment that values and prioritizes healthy sleep practices can contribute to improved help-seeking behaviors and overall sleep health in the population.