Aim

The overall aim of this thesis was to increase knowledge about self‑reported health among persons who have survived cardiac arrest, with a particular focus on insomnia, in order to contribute to improved care and the development valid measurement methods.

Methods

The thesis comprises four quantitative studies, all based on a shared data collection using questionnaires. The first three studies employed a non‑experimental design (I–III): Studies I and II were based on cross‑sectional data, whereas study III used longitudinal data. Study IV was a psychometric evaluation. The dataset originated from a Swedish survey study with data collected 6, 12, and 24 months after cardiac arrest (n = 212). For Study IV, additional participants from a neuropsychological sub-study of the TTM2 trial were included, allowing analyses of a total of 269 individuals. 

The questionnaire included background variables and seven validated instruments covering general, physical, mental, and social health, as well as life satisfaction and insomnia: EQ‑5D‑5L, Health Index, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Satisfaction With Life Scale, and Minimal Insomnia Symptom Scale. Analyses included descriptive statistics, standard statistical tests, multiple regression analyses, mixed models, Rasch analysis, and ROC analysis. 

Results

Survivors generally reported good health. Six months after the cardiac arrest, the median scores were 80 on the EQ VAS and 29 on the Health Index. At the same time, symptoms of tiredness (37%), reduced energy (26%), pain (22%), and sleep difficulties (21%) were common. Mental health was overall good, although 18% of survivors showed signs of anxiety and 9% signs of depression. Social support and life satisfaction were rated high. Insomnia was common, and 20% met the criteria for clinical insomnia. Insomnia was strongly associated with self‑reported health. General health and depressive symptoms worsened over time, between 6 and 24 months. The Minimal Insomnia Symptom Scale showed good psychometric properties, and a score of ≥ 6 was deemed an appropriate cut‑off for clinical insomnia. 

Conclusion

People who survive cardiac arrest generally report good health, but many experience persistent specific health problems. Insomnia is a clear and long‑lasting issue with a strong association to self‑reported health. The Minimal Insomnia Symptom Scale is a reliable screening instrument, and the findings support systematic long‑term follow‑up of insomnia, physical, mental, and social health among cardiac arrest survivors.