Sleep Disturbances, Trauma Associated With Psychosis-Like Experiences

depressed woman on bed
depressed woman on bed
These findings may be helpful in developing treatment strategies for patients with past trauma and sleep disturbances to attenuate the possibility of future psychosis-like experiences.

Self-report questionnaires on the presence of psychosis-like experiences, prior traumatic events, and sleep problems were completed by 409 participants in Baltimore County, Maryland. The Prodromal Questionnaire-Brief was used to examine the presence or absence of attenuated symptoms of psychosis. The General Trauma Questionnaire-Revised was used to quantify trauma, and the Iowa Sleep Disturbances Inventory was used to measure sleep habits. 

The sample was 50.6% women, and of an average age of 20.10 years (standard deviation, 3.22 years). Three sets of predictors were then entered into a hierarchical multiple regression model: sociodemographic, psychosocial (including trauma), and sleep.

Of the cohort, 48.7% reported at least 1 previous traumatic experience and 81.5% endorsed at least 1 item of the prodromal questionnaire. At least 1 sleep problem was reported by every participant, most commonly nightmares (96.0%), night anxiety (89.4%), and nonrestorative sleep (85.8%).

Previous traumatic experiences were significantly correlated with both psychosis-like experiences (P <.001) and sleep dysfunction (P <.001). Sleep dysfunction was significantly correlated with the presence of psychosis-like experiences (P <.001). Specific traumas associated with psychosis-like experiences included: experiencing a life-threatening event; involvement in a fire, flood, or natural disaster; the experience of shock resulting from a traumatic event happening to someone close; or other. Sleep dysfunction was also correlated with these same 4 specific traumas, along with witnessing someone being injured or killed and sexual molestation. 

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Per the hierarchical regression analysis, sleep disturbances predicted psychosis-like experiences at an additional increment of variance above psychosocial variables. In the final model, nightmares, fragmented sleep, and depressive symptoms all uniquely predicted psychosis-like experiences. However, previous trauma exposure was no longer a significant predictor once sleep subscales were included (P =.085).

These findings build on the literature indicating a strong correlation among trauma, disrupted sleep, and psychosis-like experiences. Such data may be helpful in developing treatment strategies for patients with past trauma and sleep disturbances to attenuate the possibility of future psychosis-like experiences.

Reference

Andorko, ND, Millman ZB, Klingaman E, et al. Association between sleep, childhood trauma and psychosis-like experiences [published online March 8, 2018]. Schizophr Res. doi: 10.1016/j.schres.2018.02.052.