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Comorbid Posttraumatic Stress Disorder, Pain, and Insomnia Disorder Among Post-9/11 Veterans Enrolling in Veteran
Anne Malaktaris1,2,3, Breanna M Holloway3, Brandon Nokes4,5
1VA Center of Excellence for Stress and Mental Health, San Diego, California, United States.
Abstract:
Posttraumatic stress disorder (PTSD) and chronic pain (CP) are prevalent among Veterans, and insomnia disorder often accompanies both disorders, potentially exacerbating their severity. The study aimed to examine the prevalence of and associations between PTSD, CP, and insomnia disorder, and to test whether insomnia severity moderates the relationship between PTSD and pain. We examined cross-sectional data from post-9/11 Veterans (N = 3,331); Veterans were an average age of 35.8 years old (SD = 8.96) and were primarily male (82.1%). Measures included the insomnia severity index, Patient-Reported Outcomes Measurement Information System pain intensity and interference, and the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (fifth ed.). A one-way analysis of variance was performed with planned contrasts (PTSD only, pain only, both pain and PTSD, or neither). Moderation analysis examined whether insomnia severity influenced the strength of the relationship between PTSD severity and CP intensity and interference. Significant positive correlations were observed among insomnia severity index, PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (fifth ed.), and Patient-Reported Outcomes Measurement Information System intensity and interference scores (ps < .05). Insomnia disorder rates differed significantly between groups (p < .001), with insomnia affecting 53.2% with pain only, 87.6% of those with PTSD only, and 95.5% with comorbid PTSD/CP, compared with 23.9% in the group neither condition. Insomnia severity marginally moderated the relationship between PTSD and pain severity but not pain interference.
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