Sleep and Health Service Use In Survivors of Intimate Partner Violence - A Longitudinal Feminist Analysis

Abstract

The lifetime prevalence of intimate partner violence (IPV) in Canada is estimated to be 25% (Ellsberg & Heise, 2005; Seager, 2003). Survivors of IPV report experiencing sleep difficulties (M. A. Woods, & Hampton, 2008) that impact their health, subsequently increasing health service use (Bonomi, Andreson, Rivara, & Thompson, 2009; Colten & Altevogt, 2006; Moorcroft, 2005; Rosa, 2006; Soares, 2005). Being able to isolate the effect of IPV on health service and long term sleep disruption may shed light on the economic as well as social cost of IPV to society. The purpose of the present study was to measure the relationship between sleep, IPV, and health service use in a sample of survivors of IPV from Alberta, Saskatchewan, and Manitoba, participating in the Healing Journey Project (Social Sciences and Humanities Research Council/Community University Research Alliance). The Healing Journey Project is a longitudinal study including seven waves of data collection, and the data from the current study was drawn from Waves 1, 2, and 4. At Wave 1, 665 women participated in the study, with 595 women participating at Wave 2 and 484 at Wave 4. A subsample of 205 women who had not been in a violent intimate partner relationship since Wave 2 was created at Wave 4 to test two of the hypotheses. Overall, three hypotheses were tested: (1) sleep problems due to abuse predict frequency of health service utilization, (2) survivors of IPV experience long term sleep problems due to abuse, and (3) that long term health service use frequency is predicted by long term sleep problems due to abuse. The following information was collected to test these hypotheses: demographic characteristics (age, working status, educations status, presence of children in the home, childhood abuse, and cultural background), symptoms of post-traumatic stress disorder (PTSD) as assessed using the Post-traumatic Stress Disorder Checklist (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Weathers, Litz, Herman, Huska, & Keane, 1993), depression symptoms as assessed using a short form of the Center for Epidemiological Studies Depression Scale (Andresen, Carter, Malmgren, & Patrick, 1994; Radloff, 1977), selfreport ratings of health status, number of injuries in the previous 12 months, IPV as assessed using the Composite Abuse Scale (Hegarty, Bush, & Sheehan, 2005), sleep problems due to abuse as assessed using a brief measure of sleep problems in survivors of IPV, and reports of frequency of health service access in the previous 12 months. The three hypotheses were each tested using hierarchical multiple regression. The second hypothesis was also tested using frequency counts and comparison between reports of sleep problems due to abuse at Waves 2 and 4. The first hypothesis, that sleep problems due to abuse predicated health service use, and the third hypothesis, that sleep problems due to abuse predicted long-term health service use, were both rejected. The second hypothesis, that past abuse predicted long-term sleep problems due to abuse, was supported. The findings suggest that health service use is not related to sleep problems due to abuse, despite evidence that survivors of IPV experience significant disruption to their sleep as a result of the violence. It appears that while survivors of IPV are not using health services in association with sleep problems due to abuse that clinicians should avoid over-treating sleep problems in survivors of IPV as not sleeping may be a protective strategy when victims of IPV are avoiding sleep to avoid danger (Colten & Altevogt, 2006; Stepanski, 2006). The implications of these findings and future direction are discussed.