Frequent Nightmares Predictive of Adolescent Suicidality, Self-Injury

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Associations between nightmares, suicidal thoughts, and nonsuicidal self-injury were greater in girls than in boys.

There may be an association between frequent nightmares and subsequent suicidality in adolescents, according to study results published in the Journal of Clinical Psychiatry.

Investigators abstracted data from the Shandong Adolescent Behavior and Health Cohort, an ongoing prospective longitudinal study of adolescent health in Shandong, China. Eligible adolescents in middle school and high school completed a series of self-report structured questionnaires at baseline in 2015, then 1 year later in 2016. The structured questionnaires captured suicidal behavior, nonsuicidal self-injury, depression symptoms, and family demographic characteristics. Participants also reported sleep duration, sleep quality, insomnia symptoms, and nightmare frequency. Logistic regression analyses were performed to determine which sleep variables were associated with suicidality and nonsuicidal self-injury.

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Of 8629 baseline survey participants, 7072 completed the 1-year follow-up assessment. Mean (SD) participant age at baseline was 14.59 (1.45) years, and 50.0% were boys. Mean (SD) nighttime sleep duration at baseline was 7.16 (1.47) hours, with girls reporting slightly less sleep time than boys (7.11 vs 7.21; P =.006). Of the total sample, 14.3% reported insomnia symptoms and 24% rated their sleep quality as “poor” or “very poor.” At baseline, 32.8% reported experiencing nightmares several times within the previous year; 5.3% reported nightmares several times a month.

At 1-year follow-up, 190 participants (2.7%) had attempted suicide and 621 (8.8%) had engaged in nonsuicidal self-injury. After adjustments for adolescent and family demographics, depression, impulsiveness, and prior suicide attempt or self-injury, frequent nightmares in the previous year remained a significant predictor of future suicide attempt (odds ratio, 1.96; 95% CI, 1.15-3.33) and nonsuicidal self-injury (odds ratio, 1.52; 95% CI, 1.10-2.08). Sleep duration, insomnia, and poor sleep quality were not significantly associated with suicidality or self-injury after adjustments for demographic covariates. The dose-response relationship between nightmare frequency and suicide attempt was more pronounced in girls than in boys (P =.018).

The study was limited by the reliance on self-reported behavior and a follow-up period of 1 year.

These data identify frequent nightmares as an independent predictor of future suicidality and self-harm among adolescents. Mental health questionnaires that screen for nightmares may be an important tool for early identification of at-risk adolescents. Further research is necessary to elucidate the biological mechanisms behind the nightmare-suicidality link and to identify appropriate intervention methods.


Liu X, Liu ZZ, Chen RH, et al. Nightmares are associated with future suicide attempt and non-suicidal self-injury in adolescents. J Clin Psychiatry. 2019;80(4):18m12181.