From Trauma to Suicidality: The Mediating Role of Sleep Disturbances—Evidenced from a Narrative Mini-Review
Valentina Baldini
Psychiatry International December 24, 2025 DOI: 10.3390/psychiatryint6040149 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative mini-review Longitudinal Peer reviewed |
|---|---|
| Topics | PTSD |
| Keywords | Suicidality Sleep disturbances Insomnia Nightmares |
| Key findings | Sleep disturbances, particularly insomnia and nightmares, appear to be strong markers of elevated suicide risk in trauma-exposed individuals and may represent a pathway linking trauma and suicidality. |
Abstract
Traumatic experiences are among the strongest predictors of suicidal thoughts and behaviors, but the mechanisms that account for this association are still debated. Sleep disturbances, particularly insomnia, nightmares, and fragmented sleep, are highly prevalent after trauma and have been shown to predict suicidality independently of depression and other psychiatric comorbidities. This narrative mini-review synthesizes evidence from epidemiological, clinical, and experimental studies to examine whether sleep may represent a pathway linking trauma and suicidality. Among the proposed mechanisms, alterations in REM sleep regulation, dysregulation of the hypothalamic–pituitary–adrenal axis, and impaired prefrontal control of emotional reactivity have received empirical support, although findings remain inconsistent across populations. Importantly, trauma-related nightmares and persistent insomnia appear to be especially strong markers of elevated suicide risk. Clinically, these observations suggest that routine sleep assessment could add value to suicide risk evaluation in trauma-exposed individuals. Interventions such as cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and REM-modulating pharmacological treatments have shown promise, but their specific impact on suicidality requires further testing in controlled trials. Future research should prioritize longitudinal designs, incorporate both subjective and objective sleep measures, and include culturally diverse samples to clarify causal mechanisms and refine prevention strategies.
Comparable studies
Other narrative reviews on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic Psychiatry's Brave New World. | 2020 | Review | |
| Reviewing the Potential of Psychedelics for the Treatment of PTSD | 2020 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? | 2018 | Review | |
| Clinical applications of hallucinogens: A review. | 2016 | Review |