Investigating Intimate Partner Violence in the Context of Sleep Among Survivors

About This Grant

Intimate partner violence (IPV) is a major public health issue. Over 35% of U.S. women report lifetime IPV. To date, IPV measurement has focused on physical, sexual, and psychological abuse, yet IPV can also involve attempts to control a partner’s decisions and behaviors, such as access to finances or contraception. Sleep is another behavior that abusive partners may attempt to restrict, interrupt, or control to exert power and/or inflict abuse. Our preliminary data suggest that violent and controlling behaviors that intentionally target or impact sleep reflect a previously unexplored type of IPV (“sleep coercion”). Sleep problems often follow traumatic events, and IPV survivors consistently report poor sleep health. However, sleep coercion may be uniquely damaging, as it involves violations of relationship safety specifically during sleep, a biologically necessary state of vulnerability. Thus, sleep coercion may require a novel treatment approach beyond standard interventions for sleep problems that result from other types of trauma (including other types of IPV). It is well-known that poor sleep health is related to worse mental and physical health and cognitive function. Critically, the cognitive consequences of poor sleep may adversely impact women’s safety and even increase risk for further abuse. Moreover, poor sleep health is related to cardiovascular disease (CVD) risk factors and clinical CVD. Assessment of sleep coercion may improve our ability to diagnose and intervene upon sleep and long-term physical health problems among survivors. However, our understanding of sleep coercion, its impacts on health, and intervention strategies are limited by the absence of a psychometrically-validated patient reported measure of sleep coercion. The goal of this study is to develop the first measure of sleep coercion (Sleep Coercion Scale; SCS). We will recruit a diverse sample of women aged 18+ including racial and ethnic minorities. We will focus on women, as IPV risk is often associated with an expected female gender role. Community partners and IPV survivors will provide input to ensure this research is rigorous, equitable, and survivor-centered. This study aims to: (1) develop a sleep coercion item pool, (2) test and refine the SCS item pool, and (3) determine SCS reliability and validity. We will conduct five focus groups with IPV survivors and advocates to refine our conceptual model and enrich the initial item pool developed from our pilot work. We will conduct cognitive interviews with 15 IPV survivors as they review the initial item pool and iteratively refine or remove items. We will conduct field testing to examine SCS factor structure, reliability, validity, prevalence, and risk and protective factors in N=2,000 women (50% with ongoing or prior IPV) accrued via a nationally-representative internet panel and enriched with survivors recruited directly from IPV agencies. Results have the potential to significantly improve our understanding of sleep problems among IPV survivors and to inform tailored sleep interventions, with the goal of improving sleep and reducing CVD risk among women.