Bad Dreams and Nightmares Preceding Suicidal Behaviors.

Objective: Nightmares seem to predict suicidal behaviors, and the aim of this study is to explore the chronology and trajectories of alterations in dream contents before a suicidal crisis, distinguishing 3 different experiences: bad dreams, nightmares, and suicidal scenarios during dreams. Methods: This naturalistic study included individuals hospitalized between January 2021 and May 2021 in a psychiatric post-emergency room unit for suicidal crisis (thoughts and attempts). Results: The study observed that 80% (n = 32/40) of patients had altered dreams (AD) before the suicidal crisis, including 27 (67.5%) with bad dreams, 21 (52.5%) with nightmares (bad dreams that awaken the sleeper), and 9 (22.5%) with suicidal scenarios during dreams. No differences were observed between the AD group versus patients with no altered dreams (ND) regarding sociodemographic characteristics. We observed a progression of dream content alterations: bad dreams appear 111 days (4 months) before the suicidal crisis, then nightmares appear 87.3 days before (3 months), and suicidal scenarios during dreams were reported 45.2 days before (1.5 months). For the AD and ND populations in suicidal crisis, 80% had at least 1 subtype of dream alterations, 40% had bad dreams and nightmares, and 17.5% had all 3 subtypes. The AD group, compared to the ND group, had significantly more family history of insomnia (P = .046). Almost all patients (97.5%) had depressive symptoms (Montgomery-Asberg Depression Rating Scale [MADRS] score ≥ 7; 82.5% had moderate to severe symptoms, MADRS ≥ 20), 60% had insomnia (Insomnia Severity Index > 14), 92.5% had altered sleep quality (Pittsburgh Sleep Quality Index > 5), and 57.5% reported sleepiness (Epworth Sleepiness Scale > 10). Conclusions: Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.