# A cross‐sectional study of the association between sleep disturbance profiles, unmet mental health or substance use needs, and presenteeism among United States activity‐duty service members using the 2018 health‐related behaviours survey (HRBS)

## TL;DR

This study explores how sleep problems and unmet mental health needs are linked to presenteeism among US military members, identifying distinct sleep profiles and their impact on work performance.

## Contribution

The study introduces a novel approach by combining sleep disturbance profiles with unmet mental health needs to assess their combined effect on presenteeism in active-duty service members.

## Key findings

- Four sleep disturbance profiles were identified, with high sleep disturbance affecting 22.5% of service members.
- Unmet mental health needs and inadequate sleep were strongly associated with higher odds of high presenteeism.
- Persistent presenteeism was reported by 13.6% of service members, indicating a significant impact on readiness.

## Abstract

Inadequate sleep, unmet mental health or substance use needs (unmet needs), and presenteeism are prevalent among military populations. This study aimed to cross‐sectionally determine the association between sleep disturbance profiles, unmet needs, and presenteeism in US active‐duty service members, both separately and combined. Data were collected from the 2018 Health‐Related Behaviours Survey. The response rate was 9.6%. Presenteeism was collected as the number of days (0–30) then collapsed for analysis. Latent class analysis (LCA) was used to classify service members into sleep disturbance profiles. Odds ratios and confidence intervals (CIs) were estimated by binary and ordinal logistic models. Approximately 21% of the 17,166 service members reported at least one presentee day (95% CI: 19.8%–21.8%). Persistent presenteeism was 13.6% (95% CI: 12.7–14.4%). Four sleep disturbance profiles were identified by LCA: (1) high sleep disturbance (reported in 22.5%), (2) short sleep duration (26%), (3) trouble sleeping (6.9%), and (4) none to slight sleep disturbance (reference, 44.6%). Female sex, being separated/divorced/widowed, short sleep duration, trouble sleeping, high sleep disturbance, unmet needs, and both unmet needs and inadequate sleep together were associated with higher odds of high presenteeism levels and persistent presenteeism. Bachelor's or higher educated, 25–34‐year‐old, Hispanic/Latinx, Officer, Air Force, and Coast Guard service members were associated with lower odds of high presenteeism levels and persistent presenteeism. Despite the decreasing trends between 2015 and 2018, the high prevalence of presenteeism presents a significant burden on work productivity and readiness that behavioural modification may alter.