REVIEW OF: Geoffroy PA et al, J Clin Psychiatry 2022;84(1):22m14448 

STUDY TYPE: Naturalistic observational study

In 2001, Finnish researchers published the first evidence of an association between nightmares and suicide (Tanskanen A et al, Sleep 2001;24(7):844–847). Since then, nearly a dozen studies have confirmed that link, but we do not know more specifics about the dreams that signal a suicide risk. In this article, psychiatrists in France looked at how dreams change prior to a suicidal crisis (thoughts and attempts). 

Researchers collected dream information from 40 adult patients who were voluntarily hospitalized for suicidality between January 2021 and May 2021 in a psychiatric unit in Bichat Hospital in Paris. The authors interviewed patients using standardized questions regarding “bad dreams” (defined as disturbing dreams without awakening), “nightmares” (defined as disturbing dreams with awakening), and suicidal scenarios in dreams. Patients were asked to recall their dreams from previous months prior to the hospitalization. Researchers used standard rating scales for assessment of suicidal ideation, insomnia, depression, and anxiety.

Of the 40 patients, 80% had experienced altered dreams prior to suicidal behavior. Among those with altered dreams, 68% reported bad dreams, 53% reported nightmares, and 23% reported dreams with suicidal content. Chronologically, bad dreams began 111 days before the suicidal crisis, nightmares began 87 days before, and suicidal dreams began 45 days before. 

Limitations include the small sample size and retrospective design, which can promote recall bias as patients attempt to remember dreams from months ago.

CARLAT TAKE 

These tentative results suggest that nightmares, bad dreams, and dreams with suicidal content are common in the months leading up to a suicide attempt.