Bad dreams and nightmares: A prodrome of suicidal behavior?

The Journal of Clinical PsychiatryScott Cunningham MD PhD, et al. | December 08, 2022



Whether or not bad dreams and nightmares are predictive of suicidal behavior is controversial; however, the consensus favors such an association. Patients with sleep disorders (insomnia and sleep disturbances caused by bad dreams and nightmares) are at increased risk for suicide and the more severe the depression in patients who are depressed, the greater the risk of suicidal behavior.

The current study has added to the relevant literature by confirming that an association exists between bad dreams and nightmares and suicidal crises, as well as suicidality.

Forty patients admitted to a psychiatric post-emergency room for a suicidal crisis were enrolled in this naturalistic study.

Thirty-two of the 40 patients enrolled in the study (80%) had bad dreams and/or nightmares before a suicidal crisis; 27 (67.5%) had bad dreams, 21 (52.5%) had nightmares, and 9 (22.5%) had bad dreams that included suicidal scenarios.

There was no difference in sociodemographic characteristics between the patients who had and did not have bad dreams and/or nightmares.

Bad dreams, nightmares, and bad dreams with a suicidal scenario preceded a suicidal crisis by 111, 87.3, and 45.2 days, respectively. Eighty percent, 40%, and 17.5% of patients had bad dreams or nightmares, bad dreams and nightmares, and bad dreams, nightmares, and bad dreams with suicidal scenarios, respectively.

Patients with bad dreams and/or nightmares had an increased frequency of a family history of insomnia. Of patients who had bad dreams and/or nightmares, 97.5% had depressive symptoms, 82.5% had moderate-to-severe depression, 60% had insomnia, 92.5% had altered sleep quality, and 57.5% complained of sleepiness.