Type of Nightmare Increases Risk for Suicide Reattempt, Health Care Utilization Among Veterans

Trauma-related nightmares were associated with suicide reattempt among veterans, according to results of a study presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held from June 4 to 8, 2022, in Charlotte, North Carolina.

The specific type of nightmare has been the subject of recent scientific interest. Idiopathic nightmares with no known origin, trauma-related nightmares recurring after a traumatic event, and complex nightmares which are related with trauma and sleep disordered breathing may be associated with different symptom severity and outcomes.

In order to evaluate whether the type of nightmare may have implications for suicide and health care utilization among veterans, data for all veterans who attempted suicide in fiscal year 2013-2014 were extracted. Veterans who also had documentation of a nightmare disorder (n=3207) were matched in a 1:1 ratio with those who did not in order to form case-control pairs. Risk for suicide reattempt and increased mental health care utilization were evaluated on the basis of the presence and type of nightmare.

The veterans with nightmare disorder had idiopathic (n=589), trauma (n=3207), and complex (n=576) nightmare types. Idiopathic nightmares were defined as medical coding for nightmare disorder alone, trauma nightmares as coding for nightmare disorder and posttraumatic stress disorder (PTSD), and complex nightmares as coding for nightmare disorder, PTSD, and sleep-related breathing disorder.

In a multiple logistic regression, no relationships were observed between idiopathic or complex nightmares with suicide reattempt, but trauma-related nightmares were positively related (β, 0.16; P <.01). Veterans who had trauma-related nightmares were associated with increased risk for suicide reattempt (odds ratio [OR], 1.27; 95% CI, 1.02-1.57).

For mental health care utilization, both trauma-related (β, 0.31; P <.05) and complex (β, 0.36; P <.05) nightmares are associated with an increase in total days of mental health care received.

This study had similar limitations as all studies relying on medical coding data, in which there is risk for missing or miscoded information.

The study authors concluded, “Our results revealed that both complex and trauma-related nightmares are associated with mental health treatment utilization. Only trauma-related nightmares were significantly associated with suicide reattempts.”

Reference

Bishop T, Youngren W, Ashrafioun L, Carr M, Pigeon W. Nightmare type and its association with suicide attempts among veterans. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Abstract 671.