Associations of war-related PTSD symptoms with sleep disturbance: The explanatory roles of emotion regulation difficulties and intolerance of uncertainty.

Abstract

Objective: Although associations between posttraumatic stress disorder (PTSD) and sleep disturbance are well-established, relatively little work has examined mechanisms that may underlie this association. This study aimed to examine the explanatory role of emotion regulation difficulties and intolerance of uncertainty (IU) in associations between PTSD symptoms and sleep disturbance among a sample of war-exposed Iraqi individuals.

Method: We used structural equation modeling in a war-exposed nonclinical sample (N = 617; M_age = 27.63; SD = 4.81; 46.03% females) to model indirect effects from PTSD symptoms to the sleep disturbance via emotion regulation difficulties and IU. Participants completed PTSD symptoms, sleep disturbance, difficulties in emotion regulation, and IU scales.

Results: Significant correlations were found between PTSD symptoms and sleep disturbance. Those who reported higher levels of PTSD symptoms also reported higher levels of sleep disturbance. The structural model was an excellent fit to the data (χ² = 166.03; degrees of freedom = 32; comparative fit index = .960; goodness-of-fit index = .954; Tucker-Lewis index = .943; root-mean-square error of approximation = .082), and all hypothesized indirect effects were significant (ps < .001).

Conclusion: Findings add to the emerging body of literature examining potential mechanisms that may help to explain the maintenance or even escalation of PTSD-related sleep disturbance. Findings have clinical implications in designing specialized treatments for individuals with PTSD and suggest focusing on emotion regulation difficulties and IU as potential therapeutic targets that putatively underlie PTSD-related sleep disturbance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).