Sleep as a Mediator in the Pathway From Violence-Induced Traumatic Stress to Poorer Health and Functioning: A Review of the Literature and Proposed Conceptual Model

Abstract

Millions of children are exposed to various forms of violence every year, resulting for many of them in psychological problems, decreased social functioning, and poorer overall quality of their relationships and lives. This article reviews the scientific literature investigating the role of sleep as a key mediator in the pathway between violence-induced traumatic stress and resulting negative health and behavioral outcomes. Based on evidence revealed by this review and general research on how exposure to violence influences child health and development, a conceptual model is proposed that posits sleep’s role as an important mediator of health effects and that incorporates other factors believed to shape linkages between exposure to violence and health and behavioral outcomes in children. Recommendations are given for future research to test the proposed model.

The role of sleep disturbance in the relationship between post-traumatic stress disorder and suicidal ideation

“…While contrary evidence suggests that sleep problems prior to traumatic exposure place an individual at greater risk of developing PTSD after trauma exposure by reducing the body's capacity to cope with stress (Bryant, Creamer, O'Donnell, Silove, & McFarlane, 2010;Meerlo, Sgoifo, & Suchecki, 2008). Although evidence regarding which condition manifests first is mixed, further findings reveal that sleep problems in children played a critical mediating role between traumatic stress and negative psychological and social outcomes (Spilsbury, 2009), and one exploratory study found a 6 positive association between sleep disordered breathing and movements with suicidal behavior in a small group of female sexual assault victims with PTSD (Krakow et al, 2000).…”

Adverse childhood experiences are associated with adult sleep disorders: a systematic review

“…For instance, a review of the literature concerning sleep as a mediator of the association between violence-induced trauma and poorer health found sleep to be a significant mediator for multiple outcomes, including immune dysfunction and depression, thus it is likely that this holds for associations between ACEs and poorer health [55]. Lee et al [22] found that a history of childhood abuse is statistically significantly associated with metabolic syndrome symptoms and diagnosis in adults: poor sleep quality explained 24% of the association between abuse and risk of metabolic syndrome diagnosis in women and 20% in men.…”

Linking childhood abuse and hypertension: sleep disturbance and inflammation as mediators

“…nightmares, sleep deprivation; (Germain, Buysse, & Nofzinger, 2008)). Stress from childhood abuse may also lead to poor sleep behaviors as coping mechanisms that may preclude sleeping soundly such as sleeping at irregular times and locations to avoid victimization (Spilsbury, 2009). In turn, a dysregulated sleep/wake cycle may lead to greater circulating levels of pro-inflammatory biomarkers that affect hemodynamics.…”