The unhappy triad: Pain, sleep complaints, and internalizing symptoms

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12 Scopus citations


There is limited understanding of the etiology and temporal relations of chronic pain, sleep complaints, and depression/ anxiety. Several models have been proposed by which sleep disruption represents a common mechanism for the comorbidity of these symptoms. The goals of this study were to (a) clarify the boundaries of these domains and (b) examine the relations of these symptoms over time following exposure to stressful and potentially traumatic experiences during a combat deployment. We found support for three distinct domains of sleep complaints, internalizing symptoms, and physical complaints. We tested two competing models that have been proposed in the literature, controlling for negative and positive emotionality. Internalizing symptoms strongly mediated the relation between sleep complaints and pain (total effect = .15, direct effect = –.05). The study suggests that increases in sleep complaints immediately following deployment increase the risk of internalizing symptoms and pain several years after deployment.

Original languageEnglish (US)
Pages (from-to)96-106
Number of pages11
JournalClinical Psychological Science
Issue number1
StatePublished - Jan 1 2016

Bibliographical note

Funding Information:
This research was supported by grants to Melissa A. Polusny from the Minnesota Medical Foundation (Grant 3662-9227-06) and Department of Defense Congressionally Directed Medical Research Program (W81XWH-07-2-0033), a grant to Christopher R. Erbes from the Department of Veterans Affairs Health Services Research and Development (RRP 08-385), as well as a grant to Paul A. Arbisi from the University of Minnesota Press. This material is the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System, Minneapolis, MN. The views expressed in this article are those of the authors and do not reflect the official policy or position of the U.S. Department of Veterans Affairs.

Publisher Copyright:
© The Author(s) 2015.


  • Chronic pain
  • Insomnia
  • Internalizing disorders
  • Lassitude


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