Frequent nightmares were an independent risk factor of suicide attempt and nonsuicidal self-injury among teenagers in China, according to a longitudinal study published in Journal of Clinical Psychiatry.
“Growing evidence demonstrates that sleep problems are associated with increased risk of suicidal behavior in clinical and general populations,” Xianchen Liu, MD, PhD, of Shandong University School of Public Health, China, and colleagues wrote. “Results from previous studies are inconsistent, possibly due to differences in study populations, measures used to assess sleep and suicidal behavior and covariates or confounders included for statistical adjustment.”
Researchers examined which sleep variables were significantly and independently tied to later suicidal behavior and nonsuicidal self-injury (NSSI) among 7,072 adolescents from Shandong, China. Participants received self-administered structured questionnaires to assess suicidal behavior, NSSI, night sleep duration, insomnia symptoms, sleep quality, nightmares, impulsivity, depression and family demographics in late 2015 then again 1 year later in 2016.
Overall, 190 participants (2.7%) in the sample had attempted suicide and 621 (8.8%) had engaged in NSSI at the 1-year follow-up. Also, 41.6% teenagers reported experiencing nightmares several times a year, 8.8% reported nightmares several times a month, 14.3% reported insomnia symptoms and 24% reported poor sleep quality.
Insomnia symptoms and frequent nightmares at baseline were significantly linked to later suicide attempt and NSSI assessed after 1 year, according to the findings. After adjusting for covariates, Liu and colleagues found that having nightmares several times a month in the past year was significantly associated with suicide attempt among adolescents (OR = 1.96; 95% CI, 1.15-3.33) and NSSI (OR = 1.52; 95% CI, 1.1-2.08).
After adjusting for insomnia symptoms, sleep quality and sleep duration, the associations between frequent nightmares and subsequent suicide attempt and NSSI remained the same. Furthermore, the researchers observed no independent association between insomnia, short sleep duration and poor sleep quality with later suicide attempt and NSSI.
“From clinical and public health perspective, the findings may be important for screening adolescents at risk of self-harm using a single item (ie, “How often did you have nightmares [emotionally intense dreams that awoke you from sleep]?) to ask about frequent nightmares,” Liu and colleagues wrote. “Further research needs to examine the mediators and moderators and biological mechanisms of the nightmare-self harm link and the effects of intervention programs that target coping with distress associated with frequent nightmares in adolescents.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.