Nightmare disorder and depression: Exploring a neglected clinical association.
Julia Maruani, Emmanuelle Clerici, Michel Lejoyeux, Pierre A Geoffroy
Journal of Psychiatric Research August 1, 2026 DOI: 10.1016/j.jpsychires.2026.08.021 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective case-control study Peer reviewed |
|---|---|
| Population | Adults diagnosed with major depressive episode according to DSM-5 criteria |
| Measures | Nightmare Severity Index (NSI) |
| Topics | Depression Dreaming |
| Key findings | A Nightmare Severity Index cutoff of 10 or higher identified nightmare disorder with high sensitivity and specificity. Depressed patients with nightmare disorder showed greater psychiatric severity, including higher suicidality and worse sleep, and anxiety mediated the association between nightmares and suicidality. |
Abstract
Nightmares are overrepresented in psychiatric disorders and are strongly associated with suicidality, especially in Major Depressive Episode (MDE). This study had two main objectives: (1) to determine an optimal diagnostic cutoff for the Nightmare Severity Index (NSI) to identify Nightmare Disorder (ND), and (2) to compare the clinical profiles of MDE patients with ND (MDE-ND) and without ND (MDE-WND). We hypothesized that MDE-ND represents a more severe depressive subtype. This prospective case-control study was conducted in routine clinical settings. Participants were adults diagnosed with MDE according to DSM-5 criteria. Two groups were defined using NSI scores. The NSI cutoff score for diagnosing ND was determined using a Receiver Operating Characteristic (ROC) curve and the Youden Index. Psychiatric symptoms, sleep quality, and circadian rhythms were assessed using self-report questionnaires. Objective sleep and circadian rhythm parameters were measured using actigraphy. The NSI demonstrated excellent diagnostic performance with a cutoff ≥10 (sensitivity:96.67%, specificity:93.94%). Nearly half (49.6%) of MDE patients met ND criteria. Compared to MDE-WND, MDE-ND patients showed greater clinical severity, including higher lifetime and current suicidality and more severe depressive, anxiety, and insomnia symptoms. Objectively, they exhibited longer sleep latency, poorer sleep continuity, and lower sleep efficiency. Logistic regression identified anxiety severity, insomnia, and female gender as significant factors associated with ND. Mediation analyses revealed indirect associations within the tested models between nightmares and suicidality with anxiety mediating the link. MDE-ND is a more severe depressive subtype, with greater psychiatric burden and sleep disturbances. Early identification may help reduce suicidality by targeting nightmares in this high-risk group.
Comparable studies
Other observational and cohort studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lucid Dreaming: a State of Consciousness with Features of Both Waking and Non-Lucid Dreaming Student volunteers trained to become lucid and signal lucidity with horizontal eye... | 2009 | Observational study | n = 6 |
| Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Young adults with a mean age of 20 years | 2002 | Prospective observational study | n = 116 |
| Long-term effects of extreme situational stress on sleep and dreaming Survivors of traumatic events who complained of sleep disturbances, compared with... | 1987 | Case-control study | n = 11 |
| The relationship of nightmare frequency and nightmare distress to well‐being Adults who reported dreams | 2004 | Observational cohort | n = 147 |
| Dreaming in NREM Sleep: A High-Density EEG Study of Slow Waves and Spindles Healthy human subjects | 2018 | Observational cohort | n = 14 |
Citations in the library
Cites 10
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders L'Encephale April 9, 2026
- Nightmares matter: rethinking suicide risk assessment and intervention in depression Sleep April 8, 2026
- Imagery Rehearsal Therapy (IRT) is associated with reduced nightmare severity and depressive, anxiety and suicidal symptoms in adults with Major Depressive Episode. International journal of clinical and health psychology : IJCHP 2026
- Bad Dreams and Nightmares Preceding Suicidal Behaviors. The Journal of Clinical Psychiatry November 23, 2022
and 5 more in the library