Higher Risk of Suicide Observed in Adolescents Suffering from Nightmare Distress

Experiencing a nightmare is a common phenomenom, particularly among the general adolescent population. Various consequences have been linked to nightmares and can have a severe impact on mental health, even leading to increased risk of suicide.

The experience has been characterized as dysphoric, frightening, or disturbing dreams that can inflict intense irritability and lead to disrupted sleep. As the prevalence of nightmares experienced by an individual increases, so does their vulnerability for insomnia, daytime sleepiness, anxiety and depressive symptoms, post-traumatic stress disorder (PTSD), behavioral problems, and impaired psychosocial function.

While previous evidence has shown that adults with major depressive disorder (MDD), bipolar disorders, or schizphrenia encounter this dysphoric dream state more frequently than the general population, there's a lack of evidence when it comes to adolescents with MDD.

Insomnia, Nightmares & Depression in Adolescents

Investigators including Shuang-Jiang Zhou; Jing-Xu Chen, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, aimed to amend the gap in literature regarding nightmare prevalence among adolescents with major depressive disorder. The team conducted a large-scalem cross-sectional investigation in outpatient centers at 4 large psychiatric hospitals in China from January-October 2021.

Participating individuals were between the ages of 12-18 years old with a diagnosis of major depressive disorder according to the DSM-IV who were not receiving any treatment at the time of their depressive episode. Those with significant physical illness, another mental illness, substance abuse or dependency, were pregnant, or had undergone treatment with electroconvulsive therapy in that last month were excluded. The healthy control group was matched by gender and age with no personal or family history of mental illness.

The analysis measures consisted of insomnia, daytime sleepiness, nightmare frequency, nightmare distress, depression severity, anxiety severity, and suicide risk.

The Relationship Between Nightmares & Suicide Risk

Findings revealed that the group with depression had a higher proportion of insomnia and suicide risk, as well as an increased frequency of nightmares compared with the control group.

Of the adolescents with depression, 67.5% experienced nightmares within the previous month, which was compared with 28.7% among the control group. On a weekly basis, the rate for the control group was 6%, while the rate among the adolescents with depression was 28.7%. Both sets of relationships were deemed statistically significant.

A statistically significant association was identified between suicide risk and nightmare frequency. Suicide risk was present in 38.1% of the group with depression, and of that subpopulation, 51.6% experienced frequent nightmares which was a significantly higer rate than those without risk of suicide.

Investigators also observed that the suicide risk was higher among adolescents in a recurrent depressive episode compared to those experiencing their first. Severe nightmare distress in those at risk for suicide (54.7%) was notable compared to those without suicide risk (24.3%).

"In conclusion, the current study, which included a large clinical population, provides evidence that nightmares occur frequently among adolescent patients with MDD," investigators wrote.

"Furthermore, the results of this study demonstrate that nightmare distress is independently associated with an increased risk of suicide. These findings may have important implications for further research on night-suicide mechanisms and for identifying individuals who are at a risk of suicide by asking about nightmare distress. Since nightmares are potentially modifiable, and the clinical efficacy of psychotherapy is well documented, intervention programs aimed at addressing nightmare-related distress may play an important role in preventing suicide among adolescents with MDD."

The study "Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder" was published in Nature and Science of Sleep.