title: Sleep disturbances and their association with mental health among women exposed to intimate partner violence.
abstract: BACKGROUND
  Intimate partner violence puts the victim at risk for substantial medical and psychiatric morbidity. As with other stress- and trauma-related experiences, intimate partner violence is associated with sleep disturbance, particularly insomnia and nightmares. This association, however, has not been well characterized in terms of general prevalence or its further relationship with depression, suicidality, and posttraumatic stress disorder (PTSD).
  
  
  METHODS
  The present study used validated instruments to characterize insomnia and nightmares among 121 women exposed to intimate partner violence. Participants with and without depression were compared on demographic, abuse, and sleep characteristics as were those with and without suicidality. Logistic regression models were constructed to test sleep variables as independent predictors of depression controlling for demographic factors, abuse severity, and PTSD severity.
  
  
  RESULTS
  Clinically significant insomnia and nightmares were observed in 46% and 32% of participants, respectively. Depressed women had more severe PTSD and were more likely to have insomnia and to have nightmares than nondepressed women. In models controlling for PTSD severity, the presence of insomnia was associated with an approximately eightfold greater risk of being depressed; nightmares were associated with a twofold increase in risk.
  
  
  CONCLUSIONS
  Sleep disturbances were prevalent among women experiencing intimate partner violence, with both insomnia and nightmares predicting the presence of depression even after controlling for PTSD severity. In addition to the need to address common mental health issues such as depression, given that sleep problems are modifiable and potentially less stigmatizing than mental health problems, assessing and addressing insomnia and nightmares in survivors of interpersonal violence warrants strong clinical consideration and further investigation.
authors: Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA. wilfred_pigeon@urmc.rochester.edu
authors: Wilfred R
authors: WR
authors: Pigeon
authors: Catherine
authors: C
authors: Cerulli
authors: Heidi
authors: H
authors: Richards
authors: Hua
authors: H
authors: He
authors: Michael
authors: M
authors: Perlis
authors: Eric
authors: E
authors: Caine
mesh_terms: D000328:Adult; D018585:Battered Women / Q000523:psychology* / Q000706:statistics & numerical data; D015897:Comorbidity; D019548:Crime Victims / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D004325:Dreams; D005260:Female; D006801:Humans; D016015:Logistic Models; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000523:psychology; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology