Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation

Patients with acute trauma are vulnerable to suicidality following hospitalization. Research suggests nightmares and insomnia may interact to potentiate suicidality, possibly due to nightmares worsening co-occurring insomnia. Nightmares and insomnia are common stress reactions to acute trauma and might compound suicide risk within acutely traumatized patients. We tested the prospective relationship between nightmares and insomnia immediately after trauma on future suicidal ideation (SI).

Patients hospitalized in Detroit, Michigan following traumatic injury (mean_age = 39.53 ± standard deviation 14.31 years, 67.0% male, 67.0% Black) completed surveys at 3 posttrauma timepoints: 1 week (time 1 [T1]; n = 88), 1 month (time 2 [T2]; n = 61), and 2 months (time 3 [T3]; n = 59).

Patients with clinically significant nightmares and comorbid insomnia symptoms at T2 reported the highest rates of SI at T3 (42.9%), whereas patients with insomnia alone (8.0%) or neither sleep disturbance (6.7%) had the lowest SI rates (Ps < .05). We observed an interaction effect wherein insomnia symptoms at T2 predicted increased SI at T3, but only among patients with comorbid nightmares at T2. This interaction remained after accounting for acute stress symptoms at T2. Post hoc analyses showed nighttime awakenings and total wake time at T2 predicted increased SI at T3 with nightmares also moderating this prospective effect.

These novel results suggest clinically significant nightmares strengthen the association between insomnia and suicidality after trauma. As nearly half of acute trauma patients with nightmares and insomnia experience SI 2 months after trauma, early interventions that target both may curb SI rates.

Reffi AN, Kalmbach DA, Cheng P, et al. Nightmares and insomnia within the acute aftermath of trauma prospectively predict suicidal ideation. J Clin Sleep Med. 2025;21(9):1519-1527.