Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation

Document Type

Article

Publication Date

4-23-2025

Publication Title

J Clin Sleep Med

Abstract

STUDY OBJECTIVE: Acute trauma patients are vulnerable to suicidality following hospitalization. Research suggests nightmares and insomnia may interact to potentiate suicidality, possibly due to nightmares worsening co-occurring insomnia. Nightmares and insomnia are common stress reactions to acute trauma and might compound suicide risk within acutely traumatized patients. We tested the prospective relationship between nightmares and insomnia immediately after trauma on future suicidal ideation (SI).

METHODS: Patients hospitalized in Detroit, MI following traumatic injury (M (age) = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black) completed surveys at three post-trauma timepoints: one week (T1; N = 88), one month (T2; n = 61), and two months (T3; n = 59).

RESULTS: Patients with clinically significant nightmares and comorbid insomnia symptoms at T2 reported the highest rates of SI at T3 (42.9%), whereas patients with insomnia alone (8.0%) or neither sleep disturbance (6.7%) had the lowest SI rates (ps < .05). We observed an interaction effect wherein insomnia symptoms at T2 predicted increased SI at T3, but only among patients with comorbid nightmares at T2. This interaction remained after accounting for acute stress symptoms at T2. Post-hoc analyses showed nighttime awakenings and total wake time at T2 predicted increased SI at T3 with nightmares also moderating this prospective effect.

CONCLUSIONS: These novel results suggest clinically significant nightmares strengthen the association between insomnia and suicidality after trauma. As nearly half of acute trauma patients with nightmares and insomnia experience SI two months after trauma, early interventions that target both may curb SI rates.

Medical Subject Headings

dreams; longitudinal; mental health; posttraumatic stress; sleep disorder; sleep disturbance; suicidal thoughts and behaviors; trauma-induced insomnia

PubMed ID

40265245

ePublication

ePub ahead of print

Volume

21

Issue

9

First Page

1519

Last Page

1527

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