Self-assessed sleep quality partially mediates the relationship between PTSD symptoms and functioning and quality of life in U.S. veterans: results from the National health and resilience in veterans study
Abstract
OBJECTIVE: Sleep difficulties are among the most common symptoms reported by trauma survivors with posttraumatic stress disorder (PTSD). Problems with sleep have been associated with a wide range of physical, mental, cognitive difficulties, as well as reduced quality of life (QOL). The purpose of this study was to evaluate whether self-assessed sleep quality mediated the relationship between PTSD symptoms and functioning and QOL in a nationally representative sample of U.S. military veterans. METHOD: Data were analyzed from a population-based sample of 3,157 U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS). Path analyses were conducted to assess whether sleep quality mediated the relationship between PTSD symptoms and measures of functioning and QOL. RESULTS: A total of 714 veterans (weighted 27.6%) reported poor sleep quality. The prevalence of poor sleep quality was significantly higher among veterans who screened positive for probable PTSD compared with those who did not (84.2% vs. 24.7%). Path analyses revealed significant associations between greater severity of PTSD symptoms and sleep quality, β = 0.42, as well as significant associations between greater severity of PTSD symptoms and scores on measures of cognitive functioning, β = -0.54, mental health functioning, β = -0.57, physical functioning, β = -0.19, and overall QOL, β = -0.40. Poorer sleep quality partially mediated these associations, with the strongest effects observed for physical functioning, β = -0.28, and QOL, β = -0.27. CONCLUSIONS: Results of this study extend prior research on the relationship between PTSD symptoms, sleep, and functioning and QOL in a nationally representative sample of U.S. veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Sleep difficulties are a common symptom for those with PTSD.
“We found sleep to be associated with better health, sleep difficulties being a common symptom for those with PTSD. McCarthy et al37 reported on the 3157 US military Veterans enrolled in the National Health and Resilience in Veterans Study, in which 27.6% reported poor sleep quality.”
From Factors associated with self-reported health among New Zealand military veterans: A cross-sectional study (2022) · cites this paper as [37]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989) · Psychiatry Research · doi:10.1016/0165-1781(89)90047-4 · Cited by 35,234 · see citing works
Diagnostic and Statistical Manual of Mental Disorders, 3rd ed
Cooper, A. M., & Michels, R. (1981) · American Journal of Psychiatry · doi:10.1176/ajp.138.1.128 · Cited by 7,417 · see citing works
Bayesian model selection in social research
Raftery, A. E. (1995) · Sociological Methodology · doi:10.2307/271063 · Cited by 6,823 · see citing works
Akaike, H. (1987) · Springer Series in Statistics · doi:10.1007/978-1-4612-1694-0_29 · Cited by 4,027 · see citing works
European guideline for the diagnosis and treatment of insomnia
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia‐Borreguero, D., Gjerstad, M., Gonçalves, M., et al. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12594 · Cited by 2,049 · see citing works
(1993) · PubMed · Cited by 1,900 · see citing works
Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
(2006) · PsycEXTRA Dataset · doi:10.1037/e719732007-001 · Cited by 1,333 · see citing works
Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011) · Depression and Anxiety · doi:10.1002/da.20837 · Cited by 946 · see citing works
Self-citationQuality-of-Life Impairment in Depressive and Anxiety Disorders
Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.6.1171 · Cited by 914 · see citing works
Sleep disorders as core symptoms of depression
Nutt, D., Wilson, S., & Paterson, L. (2008) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2008.10.3/dnutt · Cited by 839 · see citing works
Ware, J., Kosinski, M., Dewey, J., Gandek, B., Kisinski, M., Ware, J. E., & Dewey, J. M. (2001) · Cited by 824 · see citing works
The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review
Pacella, M. L., Hruska, B., & Delahanty, D. L. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.08.004 · Cited by 677 · see citing works
Sleep disturbances as the hallmark of PTSD: where are we now?
Germain, A. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12040432 · Cited by 634 · see citing works
Ohayon, M. M., & Shapiro, C. M. (2000) · Comprehensive Psychiatry · doi:10.1053/comp.2000.16568 · Cited by 483 · see citing works
Carlson, E. B., Smith, S. R., Palmieri, P. A., Dalenberg, C., Ruzek, J. I., Kimerling, R., Burling, T. A., & Spain, D. A. (2011) · Psychological Assessment · doi:10.1037/a0022294 · Cited by 415 · see citing works
User's Manual for the Medical Outcomes Study (MOS) Core Measures of Health-Related Quality of Life
Hays, R. D., Sherbourne, C. D., & Mazel, R. M. (1995) · Cited by 351 · see citing works
Residual insomnia following cognitive behavioral therapy for PTSD
Zayfert, C., & DeViva, J. C. (2004) · Journal of Traumatic Stress · doi:10.1023/b:jots.0000014679.31799.e7 · Cited by 340 · see citing works
Self-citationGehrman, P., Seelig, A. D., Jacobson, I. G., Boyko, E. J., Hooper, T. I., Gackstetter, G. D., Ulmer, C. S., Smith, T. C., & Millennium Cohort Study Team (2013) · Sleep · doi:10.5665/sleep.2798 · Cited by 339 · see citing works
Sleep Disturbances in Patients with Post-Traumatic Stress Disorder
Maher, M. J., Rego, S. A., & Asnis, G. M. (2006) · CNS Drugs · doi:10.2165/00023210-200620070-00003 · Cited by 337 · see citing works
Sleep and posttraumatic stress disorder: a review
Harvey, A. G., Jones, C., & Schmidt, D. A. (2003) · Clinical Psychology Review · doi:10.1016/s0272-7358(03)00032-1 · Cited by 337 · see citing works
STEVANOVIC, D. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01735.x · Cited by 278 · see citing works
Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample
Ramsawh, H. J., Stein, M. B., Belik, S.-L., Jacobi, F., & Sareen, J. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.01.009 · Cited by 237 · see citing works
Psychological treatment of secondary insomnia.
Lichstein, K. L., Wilson, N. M., & Johnson, C. T. (2000) · Psychology and Aging · doi:10.1037//0882-7974.15.2.232 · Cited by 234 · see citing works
Schnurr, P. P., Hayes, A. F., Lunney, C. A., McFall, M., & Uddo, M. M. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.4.707 · Cited by 219 · see citing works
Casement, M. D., & Swanson, L. M. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.06.002 · Cited by 192 · see citing works
A meta-analysis of cognitive functioning in older adults with PTSD
Schuitevoerder, S., Rosen, J. W., Twamley, E. W., Ayers, C. R., Sones, H. M., Lohr, J. B., Goetter, E. M., Fonzo, G. A., Holloway, K. J., & Thorp, S. R. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.01.001 · Cited by 177 · see citing works
Psychological Distress/Well-Being and Cognitive Functioning Measures
Stewart, A. L., Ware, J. E., Sherbourne, C. D., & Wells, K. B. (1992) · Cited by 170 · see citing works
Residual sleep disturbances following PTSD treatment in active duty military personnel.
Pruiksma, K. E., Taylor, D. J., Wachen, J. S., Mintz, J., Young‐McCaughan, S., Peterson, A. L., Yarvis, J. S., Borah, E. V., Dondanville, K. A., Litz, B. T., et al. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000150 · Cited by 164 · see citing works
Residual symptoms following empirically supported treatment for PTSD.
Larsen, S. E., Fleming, C. J. E., & Resick, P. A. (2018) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000384 · Cited by 149 · see citing works
Vogt, D. S., Smith, B. N., Fox, A. B., Amoroso, T., Taverna, E. C., & Schnurr, P. P. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1321-5 · Cited by 141 · see citing works
Selecting Path Models in SEM: A Comparison of Model Selection Criteria
Lin, L.-C., Huang, P., & Weng, L. (2017) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705511.2017.1363652 · Cited by 129 · see citing works
Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial
Cook, J. M., Harb, G. C., Gehrman, P., Cary, M. S., Gamble, G. M., Forbes, D., & Ross, R. J. M. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20569 · Cited by 120 · see citing works
Galovski, T. E., Harik, J. M., Blain, L. M., Elwood, L. S., Gloth, C. A., & Fletcher, T. D. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000059 · Cited by 112 · see citing works
Clinical correlates of poor sleep quality in posttraumatic stress disorder
Germain, A., Buysse, D. J., Shear, M. K., Fayyad, R., & Austin, C. (2004) · Journal of Traumatic Stress · doi:10.1007/s10960-004-5796-6 · Cited by 107 · see citing works
Psychometric properties of the PTSD Checklist with older primary care patients
Cook, J. M., Elhai, J. D., & Areán, P. A. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20038 · Cited by 101 · see citing works
Sleep problems and the risk for sleep disorders in an outpatient veteran population
Mustafa, M., Erokwu, N., Ebose, I., & Strohl, K. P. (2005) · Sleep And Breathing · doi:10.1007/s11325-005-0016-z · Cited by 101 · see citing works
Zisman‐Ilani, Y., Barnett, E. R., Harik, J. M., Pavlo, A. J., & O’Connell, M. J. (2017) · Mental Health Review Journal · doi:10.1108/mhrj-01-2017-0002 · Cited by 96 · see citing works
Presenting Concerns of Veterans Entering Treatment for Posttraumatic Stress Disorder
Rosen, C. S., Adler, E. P., & Tiêt, Q. Q. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21841 · Cited by 88 · see citing works
Hermes, E. D. A., Rosenheck, R. A., Desai, R. A., & FONTANA, A. F. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100432 · Cited by 72 · see citing works
Mota, N., Tsai, J., Kirwin, P. D., Harpaz-Rotem, I., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2016) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.15m10101 · Cited by 57 · see citing works
Self-citationFrueh, B. C., Grubaugh, A. L., Acierno, R. E., Elhai, J. D., Cain, G. D., & Magruder, K. M. (2007) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3180487cc2 · Cited by 53 · see citing works
Martindale, S. L., Morissette, S. B., Rowland, J. A., & Dolan, S. L. (2016) · Neuropsychology · doi:10.1037/neu0000312 · Cited by 51 · see citing works
Picchioni, D., Cabrera, Ó., McGurk, D., Thomas, J. L., Castro, C. A., Balkin, T. J., Bliese, P. D., & Hoge, C. W. (2010) · Military Psychology · doi:10.1080/08995605.2010.491844 · Cited by 50 · see citing works
Matteson-Rusby, S. E., Pigeon, W. R., Gehrman, P., & Perlis, M. L. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.08r00743bro · Cited by 50 · see citing works
Kobayashi, I., & Mellman, T. A. (2012) · Behavioral Sleep Medicine · doi:10.1080/15402002.2011.654296 · Cited by 49 · see citing works
El-Solh, A., Vermont, L. N., Homish, G. G., & Kufel, T. J. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.12.025 · Cited by 45 · see citing works
Harb, G. C., Phelps, A. J., Forbes, D., Ross, R. J., Gehrman, P. R., & Cook, J. M. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21854 · Cited by 41 · see citing works
Espie, C. A., Luik, A. I., Cape, J., Drake, C. L., Siriwardena, A. N., Ong, J. C., Gordon, C., Bostock, S., Hames, P., Nisbet, M., et al. (2016) · Trials · doi:10.1186/s13063-016-1364-7 · Cited by 41 · see citing works
Gellis, L. A., & Gehrman, P. R. (2011) · Journal of Aggression, Maltreatment & Trauma · doi:10.1080/10926771.2011.613448 · Cited by 37 · see citing works
Reist, C., Gory, A., & Hollifield, M. A. (2017) · Journal of Traumatic Stress · doi:10.1002/jts.22168 · Cited by 29 · see citing works
Age differences in PTSD among Canadian veterans: age and health as predictors of PTSD severity
Konnert, C. A., & Wong, M. (2014) · International Psychogeriatrics · doi:10.1017/s1041610214001884 · Cited by 24 · see citing works
Cox, R. C., McIntyre, W. A., & Olatunji, B. O. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000336 · Cited by 23 · see citing works
DeViva, J. C., McCarthy, E., Bieu, R. K., Santoro, G. M., Rinaldi, A., Gehrman, P., & Kulas, J. (2018) · Traumatology · doi:10.1037/trm0000152 · Cited by 8 · see citing works
Self-citationWilliams, R. C., Holliday, R. P., Holder, N. D., & Surís, A. (2017) · Military Psychology · doi:10.1037/mil0000166 · Cited by 3 · see citing works
DeViva, J. C., & Capehart, B. P. (2014) · American Psychological Association eBooks · doi:10.1037/14522-009 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Prevalence and Risk Factors for Acute Posttraumatic Stress Disorder during the COVID-19 Outbreak
Sun, L., Sun, Z., Wu, L., Zhu, Z., Zhang, F., Shang, Z., Jia, Y., Gu, J., Zhou, Y., Wang, Y., et al. (2020) · doi:10.1101/2020.03.06.20032425 · Cited by 319 · see citing works
McGranahan, M. J., & O'Connor, P. J. (2021) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2021.100385 · Cited by 28 · see citing works
Hill, M. L., Loflin, M., Nichter, B., Na, P. J., Herzog, S., Norman, S. B., & Pietrzak, R. H. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22823 · Cited by 15 · see citing works
Self-citationMcBride, D., Samaranayaka, A., Richardson, A., Gardner, D., Shepherd, D., Wyeth, E., de Graaf, B., & Derrett, S. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056916 · Cited by 9 · see citing works
- Authors
- McCarthy, E., DeViva, J. C., Norman, S. B., Southwick, S. M., & Pietrzak, R. H.
- Affiliations
- United States Department of Veterans Affairs (US)
- Venue
- Psychological Trauma Theory Research Practice and Policy
- Published
- 2019-11
- Volume
- 11
- Issue
- 8
- Pages
- 869-876
- ISSN
- 1942-9681 (ISSN-L)
- 1942-969X
- OpenAlex
- W2918645970
- Cited by
- 21
- References
- 56
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 2
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Trauma Theory Research Practice and Policy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- post-traumatic stress disorder, sleep quality, sleep disorders, military veterans, quality of life, functioning, cognitive function, physical function, mental health functioning, mediation, PTSD symptom severity, National Health and Resilience in Veterans Study
- MeSH terms
- Female, Health Surveys, Humans, Male, Middle Aged, Quality of Life, Severity of Illness Index, Sleep Wake Disorders, Stress Disorders, Post-Traumatic, United States, Veterans, Diagnostic Self Evaluation, Cognitive Dysfunction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
