Nightmares and Capability for Suicide: Implications in Adolescents at High-Risk for Suicide

Sleep disturbances are established risk factors for suicidal thoughts and behaviors (STB) in adolescents. Nightmares are understudied in this context. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that suicide ideation (SI) alone is not a risk factor for suicide attempt (SA); instead, high levels of SI interact with capability (i.e., factors that enable ideators to make attempts). Through the lens of the IPTS, this study explored the role of nightmares as correlates of variables associated with STB and as potential indicators of capability.

We assessed nightmare frequency and severity in 340 adolescents at entry into intensive treatment for STB.

For the group at large, nightmares did not have direct relationships with SI and SA but were correlated with variables associated with these outcomes. The pattern of associations suggested that nightmares are distal risk factors for SI mediated by insomnia, depression, and emotional dysregulation. In the presence of high SI, nightmares were associated with SA, even after controlling for STB-related variables.

Nightmares may be an indicator of capability potentiating SA in youth with high SI. Our findings highlight the importance of assessing nightmares in the management of suicidal youth and exploring interventions that decrease nightmares as a suicide prevention strategy.