1063 Depression Moderates the Association Between Posttraumatic Stress Disorder and Nightmare Severity in Nurses
T Shapiro, B Messman, Danica C. Slavish, C Alkire, Sophie Wardle‐Pinkston, Jessica R. Dietch, Kimberly Kelly, C Ruggero, D Taylor
Sleep May 27, 2020 DOI: 10.1093/sleep/zsaa056.1059 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Peer reviewed |
|---|---|
| Sample size | 461 |
| Population | Nurses recruited from two hospitals (91% female; 77% white; mean age 38.39 years) |
| Duration | 14 days of sleep diaries |
| Measures | Patient Health Questionnaire (PHQ-9), Post-traumatic Stress Disorder Checklist (PCL-5), 14-day sleep diaries |
| Topics | Depression Dreaming PTSD |
| Key findings | PTSD and depressive symptoms were each associated with more severe nightmares, and depressive symptoms moderated the association between PTSD symptoms and nightmare severity: the link was stronger for nurses with lower depressive symptoms and weaker for those with higher depressive symptoms. The authors suggest depression, PTSD, and nightmares may represent a partially overlapping symptom cluster. |
Abstract
Abstract:
Introduction: Nurses report a higher prevalence of posttraumatic stress disorder (PTSD) than the general population, and approximately 18% of nurses report having depression. Nightmares are a common symptom of PTSD, and both nightmares and PTSD are correlated with depression. Nightmares may represent a possible clinical target for improving outcomes in both disorders. This study assessed associations between PTSD and depressive symptoms with nightmare severity, and whether depressive symptoms moderated associations between PTSD and nightmare severity.
Methods: Participants were 461 nurses (91% female; 77% white, mean age = 38.39 years) recruited from two hospitals for a parent study. Participants completed the Patient Health Questionnaire (PHQ-9), Post-traumatic Stress Disorder Checklist (PCL-5), and 14 days of sleep diaries to assess daily nightmare frequency and severity (on a scale of 0 = not at all severe to 3 = very severe).
Results: 22.1% of participants reported at least one nightmare across the 14 days, with a mean daily nightmare frequency of 1.17 (SD = 2.15) and a mean severity of 0.11 (SD = 0.18). PCL-5 and PHQ-9 scores were significantly correlated with nightmare severity (r = 0.27; r = 0.24, respectively) and each other (r = 0.69). PHQ-9 scores moderated the association between PCL-5 scores and nightmare severity (β = -.01, SE = <0.01, p = 0.015). For individuals 1 SD below the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity. For individuals 1 SD above the PHQ-9 mean, higher PCL-5 scores were associated with higher nightmare severity, but to a lesser degree.
Conclusion: Both depressive and PTSD symptoms were associated with more severe nightmares. Surprisingly, the association between PTSD symptoms and nightmare severity was stronger for those with lower depressive symptoms. Results suggest depression, PTSD, and nightmares may represent a partially overlapping symptom cluster. Research should investigate how nightmare treatment may reduce PTSD and depressive symptoms. Support: NIAID R01AI128359-01
Comparable studies
Other observational and cohort studies on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault | 2008 | Observational cohort | n = 6 |
| An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... | 2017 | Observational study using ambulatory polysomnography | n = 35 |
| Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares | 2004 | Observational cohort | n = 44 |
| Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs | 2001 | Observational study | |
| Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD | 2018 | Retrospective review | n = 37 |