Dream and nightmare alterations in patients presenting with suicidal crisis: A prospective study in psychiatric...

Suicide is a major public health concern, and identifying early indicators of suicidal crisis remains a key clinical challenge. Nightmares have been suggested as potential early markers of suicide risk. This study aimed to investigate dream alterations preceding a suicidal crisis in patients presenting to a psychiatric emergency department. This prospective study was conducted in a psychiatric emergency center in Paris between March and April 2025.42 patients presenting with severe suicidal ideation or following a suicide attempt completed a self-administered questionnaire assessing dream characteristics, sleep disturbances, anxiety, and depressive symptoms using validated clinical instruments. The timing and evolution of bad dreams, nightmares, and suicidal-themed nightmares preceding the crisis were examined. Overall, 83.0% of patients reported at least one dream alteration. Bad dreams were reported by 61.9% of participants, nightmares by 52.4% and suicidal scenarios occurring within nightmares by 35.7%. Nightmares emerged on average 128 days before the suicidal crisis, whereas suicidal-themed nightmares appeared closer to consultation, approximately 16 days before the emergency visits. More than half of patients (54.8%) experienced an evolutionary pattern in dream content involving at least two successive dream alterations. Nightmare severity was significantly correlated with insomnia severity and anxiety symptoms. Nightmares are highly prevalent among patients presenting psychiatric emergency services during a suicidal crisis and often emerge weeks to months before the acute episode. The temporal proximity of suicidal-themed nightmares to crisis onset and their association with insomnia and anxiety suggest that systematic assessment of nightmares may enhance suicide risk in clinical practice.