PTSD: Nightmares increase risk of suicide

Having recurrent nightmares is linked to an increased risk of suicide, in particular amongst people who suffer from post-traumatic stress disorder (PTSD). This is the conclusion of a study, published in the Journal Of Clinical Sleep Medicine, which examined the psychological state of 91 PTSD patients.

While previous research had already gathered evidence of a link between sleep problems and suicidal behaviours, the psychological processes underpinning this relationship remained unclear. Likewise, the fact that people with PTSD are more prone to nightmares and that they have higher suicide risks had not been studied in relation to one another.

In this study, the researchers not only found evidence that PTSD patients were more likely to consider suicide if they had nightmares, but they also uncovered psychological mechanisms explaining why bad dreams had such a destructive effect.

Hopelessness, entrapment and defeat

For each of the 91 participants, the researchers assessed the severity of their nightmares by measuring their frequency, their intensity and the level of distress caused, using a clinician-administrated PTSD scale. They also asked the patients to fill in questionnaires, which measured risks of suicidal behaviour, as well as feelings of defeat, entrapment and hopelessness.

They found that 62% of people who reported having nightmares had suicidal thoughts, compared to 20% of those who didn't. These results were unchanged when the scientists accounted for the effects of depression and insomnia. Additionally, they observed that the bad dreams appeared to cause stronger feelings of hopelessness, entrapment and defeat in people with frequent nightmares.

Reasons for suicide

"Detrimental perception of defeat and entrapment drive suicidal behaviours as a mean from escaping from extreme negative feelings and distress", the authors write, whereas hopelessness represents "pessimism for the future".

All three feelings are thus closely associated with suicide in scientific literature. The researchers believe it is the combination of distressing emotions that nightmares invoke that could lead to suicidal behaviours.

Commenting on the study, Michel Nadorff, from the department of psychology at Mississippi State University said this discovery had important clinical implications. "The study presents us with several potential new targets for intervention in order to ameliorate the effects of nightmares in relation to suicide," he said.

Though further research is needed, the study shows the importance of addressing the problem of nightmares and negative feelings in people suffering from PTSD, in order to lower suicide risk.