title: An epidemiologic study of childhood sexual abuse and adult sleep disturbances.
abstract: Childhood sexual abuse (CSA) is linked to negative consequences, including insomnia. Few studies have examined the enduring effects of CSA on adult insomnia. Given the relationship between sleep and poor health, a better understanding of these effects has clinical implications. We used a representative adult twin sample. Both sexes were assessed with a broad CSA variable, with a subset of females (n = 424) given additional items capturing escalating physical contact and abuse characteristics. A sum score of past-month insomnia symptoms was calculated from the Symptom Checklist-90 (shortened version). Logistic regression was used to estimate the effects of CSA, physical contact, and incident characteristics on insomnia symptoms. Of the full sample (N = 8,184), 9.8% reported CSA. CSA significantly predicted insomnia symptoms in the female sample (n = 1,407; odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.35-2.06, p < .0001) but the continuum of physical contact did not. Individually, more than 1 perpetrator and feeling forced/threatened increased sleep risk, whereas having a male perpetrator (vs. female or multiple) decreased risk. These associations did not hold when combined. In the mixed-sex sample (n = 6,777), we replicated our CSA finding (OR = 1.65, 95% CI = 1.34-2.04, p < .0001) and found that female gender (OR = 1.16, 95% CI = 1.03-1.30, p = .0125), but not the gender*CSA interaction, was significant. CSA predicts adult insomnia symptoms decades after abuse, but the small sample size for incident characteristics (n = 424) resulted in limited conclusions about associated risk.
authors.affiliation: Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics.
authors.forename: Mackenzie J
authors.initials: MJ
authors.lastname: Lind
authors.affiliation: Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Aggen
authors.affiliation: Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: York
authors.affiliation: Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics.
authors.forename: Ananda B
authors.initials: AB
authors.lastname: Amstadter
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012720:Severity of Illness Index; D012727:Sex Characteristics; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology; D014768:Virginia / Q000453:epidemiology