Frequent nightmares tied to greater suicidal and self-harm thoughts in high-risk teens

A study of adolescents discharged from acute psychiatric care found that those who generally reported more frequent and intense nightmares also tended to have higher overall levels of negative affect. In turn, higher negative affect was associated with greater intensity of suicidal thoughts and nonsuicidal self-injury (NSSI) thoughts. The paper was published in the Journal of Affective Disorders.

Self-injurious thoughts and behaviors (SITBs) include a range of experiences, from thinking about intentionally harming oneself to engaging in acts with that aim. They encompass suicidal ideation, suicide attempts, and nonsuicidal self-injury such as cutting, burning, or hitting oneself. SITBs can arise from intense emotional distress, feelings of hopelessness, or a desire to regulate overwhelming emotions.

Nonsuicidal self-injury is often used as a coping mechanism to relieve emotional pain, express anger, or regain a sense of control. Suicidal thoughts and behaviors, in contrast, involve intent to end one’s life. Risk factors for SITBs include mental health disorders, trauma, abuse, social isolation, and significant life stressors. While they can occur at any age, these behaviors are especially common during adolescence and young adulthood.

Study author Kinjal K. Patel and her colleagues sought to examine whether negative affect—a state of heightened unpleasant emotions—is a mechanism linking nightmares to SITBs in adolescents. Prior research has linked nightmares to SITBs, but the psychological pathways connecting the two remain less understood. Nightmares are vivid, distressing dreams that result in awakening from sleep, and they are considered a specific type of sleep disturbance.

Participants were 86 adolescents aged 12–18 who had been hospitalized in the past three months due to suicide risk. Their average age was 14 years, and about 49% were girls.

The study used ecological momentary assessment (EMA), a method that captures participants’ experiences in real time. At baseline, participants completed structured interviews and self-report questionnaires assessing suicidal ideation, other SITBs, and sleep problems. They then used a smartphone application (Catalyst by MetricWire) to complete EMA surveys for 28 days. Adolescents without smartphones were provided with a loaner device.

Surveys were scheduled according to each participant’s sleep/wake patterns and school hours. Morning surveys, completed within two hours of waking, assessed the presence and intensity of nightmares from the previous night. Other surveys, delivered up to four times per day, assessed current negative affect, suicidal thought intensity, and NSSI thought intensity. Participants had one hour from the first notification to complete each survey. They received $40 for the baseline assessment and $25 per week for at least 75% survey adherence.

During the 28-day monitoring period, 54.7% of participants reported at least one nightmare, totaling 153 nightmare instances.

Adolescents who, on average across the month, experienced more frequent or more intense nightmares also tended to report higher average negative affect. Higher average negative affect, in turn, was associated with greater average intensity of both suicidal thoughts and NSSI thoughts.

These associations were evident in between-person analyses—comparisons across different individuals—but not in within-person analyses, which track day-to-day changes within the same person. This pattern suggests that stable individual differences, rather than short-term fluctuations, drove the observed relationships.

“Results identify NA [negative affect] intensity as a person-level mechanism linking nightmares and self-injurious thoughts. Future research should investigate additional mechanisms and employ temporally sensitive designs to clarify dynamic (within-person) processes underlying suicidal and non-suicidal self-injurious thoughts in adolescents,” the authors wrote.

While the findings highlight a potential pathway connecting nightmares and SITBs, the study’s design does not establish causation. The associations were observed in average differences between participants, not in immediate changes from one day to the next.

The paper, “Nightmares and self-injurious thoughts among clinically acute adolescents: Examining negative affect as a potential mechanism,” was authored by Kinjal K. Patel, Annabelle M. Mournet, Abigail J. Luce, Emelyn C. Auad, Richard T. Liu, Evan M. Kleiman, and Catherine R. Glenn.