Summary
Over one third of women in the US report a lifetime history of intimate partner violence (IPV). Although a recent review found that IPV is related to poor subjective sleep, the majority of studies involved reproductive-aged women and used suboptimal measures of IPV and/or insomnia. Recently, Goldstein et al. [1] examined the relationship between lifetime IPV and current clinical insomnia in a cross-sectional sample of 232 midlife women (45 to 64 years, of the Midlife Women Veterans Health Survey) who completed an adapted version of the Extended-Hurt, Insult, Threaten, Scream tool to assess lifetime history tool (screening threshold score and any physical, sexual, and psychological IPV) and the Insomnia Severity Index (ISI) to assess current insomnia. The authors found that upon multivariable analyses, lifetime history of IPV was associated with a twofold to fourfold odds of current clinical insomnia, including overall IPV (OR 3.24, 95% confidence interval, 1.57-6.69), physical IPV (OR 2.01, 95% CI, 1.09-3.70), psychological IPV (OR 3.98; 95% CI, 2.06-7.71), and sexual IPV (OR 2.09; 95% CI, 1.08-4.07). According to this the investigators conclude that lifetime history of IPV is common and may be related to clinical insomnia during midlife; results that highlight the importance of screening IPV among midlife women and recognizing the potential role of this traumatic exposure on women’s health.
Commentary
Despite the growing importance of IPV on women’s overall health, there is a lack of literature that properly investigates its long-term impact, particularly concerning the health problems that may develop during mid-life and the postmenopausal period. It is estimated that, for every woman that dies due to IPV, more than 400 suffer some degree of severe disability; a figure that rises dramatically if one considers other less severe or “silent” disabilities, many of which have a similar clinical presentation to menopausal symptoms. IPV has been associated with increased long-term health risk, in multiple aspects ranging from chronic pain in different locations to severe sexual and psychological disorders. In addition, menopausal symptoms experienced by women who have experienced IPV at any time in their lives have also been observed to worsen (2).
Particularly interesting is the data on insomnia, as shown in this article (1). This article is further evidence that women who have suffered from IPV and have reached menopause are at greater risk of suffering deterioration of their health, not only physical or psychological sequelae, most will also have other less severe, but no fewer distressing disabilities that one must consider when caring for them (1). In addition, questions about IPV are largely hidden from women who experience IPV and are rarely asked by their doctors (3).
In Goldstein’s multivariate analysis (1), a lifetime history of IPV was associated with a two- to four-fold increased risk of current insomnia in mid-life women who have experienced a life time history of IPV, regardless of the type. As we can also see, not only physical yet also psychological IPV (odds ratio, 3.98; 95% CI, 2.06-7.71) worsen insomnia.
It is plausible that the sleep disturbances are due to problems other than night sweats, which are common in many women during menopause, and may be explained by heart rate variability or involve disturbances of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis secondary to IPV. Much remains unknown about the neurobiology of vasomotor symptoms and their nocturnal manifestations, but what is relevant is that a history of IPV may condition on the long term the appearance or intensity of these symptoms.
In conclusion, we should investigate a history of IPV in our clinical routine when treating menopausal women with insomnia or other menopausal symptoms. Any type of IPV, at any time in women’s life will have a negative impact on many aspects of her health in general, and her mid-life and postmenopausal health in particular.
Nicolas Mendoza, MD, PhD & Loreto Mendoza-Huertas, MD
Department of Obstetrics and Gynecology,
University of Granada, Granada, Spain
References
- Goldstein LA, Jakubowski KP, Huang AJ, et al. Lifetime history of interpersonal partner violence is associated with insomnia among midlife women veterans. Menopause. 2023;30(4):370-375.
https://pubmed.ncbi.nlm.nih.gov/36753121/ - Mendoza-Huertas L, Garcia Jabalera I, Mendoza N. Effects of violence against women on health during menopause: a systematic review and metanalysis. Clin Exp Obstet Gynecol. 2021;48(6):1292–1299.
https://www.imrpress.com/journal/CEOG/48/6/10.31083/j.ceog4806205 - Moraes SD, da Fonseca AM, Soares JM Jr, et al. Construction and validation of an instrument that breaks the silence: the impact of domestic and/or sexual violence on women’s health, as shown during climacterium. Menopause. 2012;19(1):16-22.
https://pubmed.ncbi.nlm.nih.gov/21926928/
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