Longing for sleep after violence: The impact of PTSD symptoms, avoidance, and pain on insomnia among female veterans.

Mahoney CT, Shayani DR, Iverson KM. Longing for sleep after violence: The impact of PTSD symptoms, avoidance, and pain on insomnia among female veterans. Psychiatry Research. 2022 Jul 1; 313:114641.

Related HSR&D Project(s)

• CDA 10-029 – Intimate Partner Violence, Health, and Health Care Among Female Veterans

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

Women survivors of intimate partner violence often struggle with mental and physical problems that arise from incidents of violence. Beyond posttraumatic stress disorder (PTSD), the most common outcome, women also may suffer from debilitating chronic pain due to physical injuries sustained during particularly violent physical and/or sexual encounters. This may be a key interaction to explore as PTSD can lead to avoidance of distressing experiences, including chronic pain, resulting in enduring medical problems such as extreme sleep difficulties. This study aimed to identify if posttraumatic stress disorder (PTSD) symptoms from intimate partner violence (IPV) experiences had a conditional indirect effect on insomnia via chronic pain severity moderated by experiential avoidance among women. Female Veterans of at least 18 years of age completed online surveys at three timepoints (T1-T3) between 2014 and 2017 that included measures of PTSD, chronic pain, experiential avoidance, and insomnia. A total of 411 women participated in the initial survey at T1; 208 had a lifetime history of IPV experiences. The conditional indirect effect of PTSD symptoms (T1) on insomnia (T3) via chronic pain (T2) contingent upon experiential avoidance (T2) was also significant, demonstrating a significant moderated mediation model. This model was not significant for women without a history of IPV at T1. The findings indicate that women with IPV-related PTSD symptoms who are highly avoidant are more likely to experience chronic pain, leading to worse insomnia. Women without IPV experiences did not exhibit this same pattern. Findings have implications for improving trauma-focused treatment, approach coping strategies, pain management, and sleep interventions to address these deleterious psychological and medical issues.