Adverse childhood experiences associated with adult insomnia and nightmares

Adverse childhood experiences associated with adult insomnia and nightmares

Introduction
Adverse childhood experiences can increase likelihood of hyperarousal, especially around periods of vulnerability. Survivors of trauma also experience more nightmares. These data explore whether adverse childhood events are associated with adult insomnia severity and nightmares.

Methods
Data were obtained from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults 22-60 years recruited from southeastern Pennsylvania. Adverse childhood experiences were defined as a self-reported history of child abuse, parent divorce, parent death, parent with depression, parent with anxiety disorder, and childhood poverty (yes/no). Insomnia severity was assessed using the Insomnia severity Index (ISI), evaluated both as a continuous variable and categorical: None (0-7) vs Mild (8-14) or Moderate-Severe (15+). Nightmares were assessed ordinally using the following anchors: Never, Seldom, Sometimes, Often, or Frequently. Covariates included age, sex, race/ethnicity, and education. Additional models included depression severity, assessed using a modified version of the Patient Health Questionnaire-9.

Results
Child abuse was associated with an additional 2.9 points on the ISI, and parental divorce, death, depression, and anxiety were associated with an additional 1.2, 1.7, 1.8, and 1.8 points, respectively (all p< 0.005). After adjustment for depressed mood, relationships remained for child abuse, parent divorce, and parent death. In evaluating categorical insomnia, child abuse was associated with both mild (RRR=2.64, p< 0.0005) and moderate-severe (RRR=3.37, p< 0.0005) insomnia. Parent death was associated with an increased likelihood of moderate-severe insomnia (RRR=1.94, p=0.007). Parent divorce, depression, and anxiety were all associated with increased mild (RRR=1.44 [p=0.03], RRR=1.85 [p=0.001], and RRR=1.85 [p=0.004], respectively) and moderate-severe (RRR=1.50 [p=0.03], RRR=2.24 [p< 0.0005], and RRR=2.40 [p< 0.0005], respectively) insomnia. More frequent adult nightmares were reported by those who reported a history of child abuse (oOR=1.9, p< 0.0005), parent death (oOR=1.6, p=0.007), parent depression (oOR=1.6, p< 0.0005), and parent anxiety (oOR=1.8, p< 0.0005). After adjustment for depression, relationships with child abuse and parent death were maintained. Child poverty was not associated with insomnia or nightmares.

Conclusion
Adverse childhood events may contribute to later risk for insomnia and nightmares. Further efforts are needed to establish causality and develop interventions, which may have residual effects on mental and physical health.

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