Intimate partner violence
(IPV) is a public health issue. Approximately 20% of individuals who responded to a national telephone survey reported IPV.1
Abuse ranges have been reported to be greater than 44% nationally and abroad.2–5
The abuse can be physical, psychological, or sexual. However, all three types of abuse are known to result in negative health consequences.6–9
Mental health consequences of IPV include depression, anxiety, posttraumatic stress disorder (PTSD), and chronic fatigue.10,11
Suicidal ideation and suicide attempts are more prevalent for those who report being victimized than those who report no IPV.12
Approximately half of the women admitted for inpatient psychiatric care in the wake of suicide attempts, disclose IPV.13
Thus, both the epidemiology of and the clinical relationships between IPV and its mental health consequences have been studied.
One area that has received more limited attention in the IPV literature is the issue of sleep disturbance. Moreover, the intersection of IPV, mental health, and sleep disturbance has been largely ignored. This is an important intersection given the potential impact of sleep disturbance on decision-making and self-care, especially for victims navigating the court systems who need to make decisions related to safety, visitation, and custody.
There is a sizable literature demonstrating a strong relationship between sleep disturbances and mental health.14
The strongest and most striking of this evidence exists with respect to depression and insomnia, which frequently co-occur in all cohorts, but especially in older adults and in women (including in women of childbearing age who are also at risk for depression).15
Although, it is perhaps best viewed as a bidirectional relationship, a number of longitudinal studies support the designation of insomnia as a risk factor for the development or maintenance of depression with some indications that this risk is stronger in women (including in women of childbearing age who are at increased risk for depression).16
In addition, sleep disturbances have historically been considered a hallmark of PTSD.17
In the broader literature, ample data underscore a strong association between trauma exposure or PTSD and nightmares,18
whereas insomnia (difficulty initiating or maintaining sleep) is the most commonly endorsed symptom among PTSD patients.19
Insomnia occurs in 60–90% of patients with PTSD, whereas approximately 50% report nightmares.20
Nightmares and insomnia were each independently associated with PTSD in a trial used to establish DSM-IV PTSD criteria21
and have even been found to be risk factors for developing PTSD.22
Finally, both insomnia and nightmares have been identified as risk indicators for suicidality and suicide.23
Despite studies characterizing associations between IPV and mental health issues and between mental health issues and sleep disturbances, there are somewhat limited data examining sleep in the context of IPV victimization. Data that do exist suggest that IPV victims experience high rates of sleep disturbances.24,25
Uncontrolled studies report frequent complaints of nightmares26,27
and fear of sleep24
; in population-based surveys victims report more difficulty getting enough sleep than IPV-negative women.28
In a controlled investigation that included objective measures of sleep, battered women in transitional housing had poorer sleep than healthy controls.29
These seminal publications alert us to the prevalence and importance of sleep disturbances in IPV victims and call for additional inquiry using validated measures. These studies also call for investigation of the sleep–IPV–mental health connection, given that sleep disturbances, depression, and PTSD are treatable conditions with evidence-based interventions.
The current study expands the nascent literature addressing sleep and IPV in four important ways by (1) incorporating community-based participatory research principles; (2) conducting the study among an IPV court-based sample; (3) utilizing a validated sleep instrument (the Insomnia Severity Index [ISI]30,31
) to characterize sleep disturbances; and (4) assessing whether nightmares and insomnia were associated with either depression or suicidality controlling for socio-demographic and/or clinical factors. Policy and clinical implications for the findings are discussed.