Pain, Sleep Disturbance, and PTSD Symptoms in Women Sexual Trauma Survivors: A Cross-Lagged Panel Analysis

Posttraumatic stress disorder (PTSD) and pain are common following trauma exposure, highly comorbid, known to exacerbate one another, and together contribute to reduced quality of life. Sleep disturbance is likewise associated with both PTSD and pain and may partially explain the PTSD-pain link over time. Despite their well-documented co-occurrence, studies have yet to examine the bidirectional influences of PTSD symptoms, sleep disturbance, and pain (i.e., severity and interference) together over time among women in the acute post-trauma period. This is the aim of the present secondary analysis. Women (N = 203) recruited within 1 month of experiencing a sexual trauma completed online surveys at baseline (T1) and two follow-up periods each spaced 1 month apart (T2 and T3). Cross-lagged panel models (CLPMs) were used to test the directionality of associations between PTSD symptoms and pain over time as well as the mediating role of sleep disturbance on cross-lagged paths (between-person level). A sensitivity analysis using random-intercept cross-lagged panel models (RI-CLPMs) was conducted to isolate within-person effects. Findings from CLPMs demonstrated that PTSD symptoms at T1 predicted both sleep disturbance and pain interference (but not pain severity) at T2 (between-person level). Sleep disturbance did not mediate associations between PTSD symptoms and pain. No cross-lagged effects were observed from T2 to T3. No within-person cross-lagged effects were observed among PTSD symptoms, pain, and sleep in RI-CLPMs. Findings suggest that individuals with more severe PTSD symptoms in the month following sexual trauma experience worse physical health symptoms early-on in the post-trauma phase, including pain interference and sleep disturbance. Understanding the directionality and strength of co-occurring concerns can inform first-line treatment targets to prevent downstream negative physical and mental health sequelae following sexual trauma.