Abstract Introduction Women are disproportionately affected by sexual trauma (ST) and commonly experience subsequent significant sleep difficulties, notably PTSD symptoms and severe insomnia. Cognitive pre-sleep arousal (i.e. thinking before bed, worrying, anxiety) contributes directly to insomnia symptoms. Addressing research gaps among women and ST, we investigated the role of cognitive arousal before sleep as a mediator of insomnia and ST history in women. Methods Women (n=759) recruited at the University of Kansas completed a battery of questionnaires including the Insomnia Severity Index (ISI), Cognitive Pre-Sleep Arousal Scale (PSAS-C), and ST history questions. A mediation analysis was conducted using Hayes PROCESS Model 4, controlling for age. Results Women with a sexual assault history reported higher pre-sleep cognitive arousal (b = 0.46, SE = 0.10, p .001). Higher pre-sleep cognitive arousal was associated with more severe insomnia symptoms (b = 0.02, SE = 0.001, p .001). Sexual assault history also demonstrated a significant direct effect on insomnia severity (b = 0.009, SE = 0.004, p = .020). The indirect effect through pre-sleep cognitive arousal was significant (b = 0.01, BootSE = 0.003, 95% CI 0.0058, 0.0172), indicating evidence of mediation. Conclusion These results indicate cognitive arousal plays a role in the perpetuation of insomnia symptoms following ST. Though this seems intuitive, there is importance of further understanding the mechanisms of how sexual violence affects the health of women, especially as sleep is determinant of physical and mental wellbeing. Support (if any)
Quesada et al. (2026) studied this question.