How are you dreaming? A very simple question to screen for suicide risk
Bipolar Disorders April 9, 2023 DOI: 10.1111/bdi.13325 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Commentary Peer reviewed |
|---|---|
| Topics | Dreaming |
| Key points | The authors argue that asking depressed patients about recent changes in their dreams is a simple clinical practice that could serve as a meaningful warning signal of suicidal crisis, citing a study in which 80% of patients altered their dreams in the months before a suicidal crisis, with a progression from bad dreams to nightmares to suicidal scenarios. |
Abstract
Nightmares are a very common experience in the general population, with approximately 35%– 45% of individuals experiencing at least one nightmare per month.1 Nightmare disorder, which is characterized by repeated nightmares causing significant distress or impairment, is less frequent but still common, affecting 2%– 8% of the general population.1 Nightmare disorders are highly comorbid with psychiatric disorders such as depressive, anxiety, trauma and psychotic disorders.1 For instance, nightmare disorder may be comorbid with 70% of patients with posttraumatic stress disorder and up to 90% of patients with depression, especially when associated with melancholic features and suicidal behaviors.1 Regarding suicidality, nightmares are one of the best clinical predictors of the risk of suicide in patients suffering from depression.1 A recent work explored the chronology and trajectories of alterations in dream contents before a suicidal crisis in depressed patients hospitalized in psychiatry after a suicide attempt or for suicidal thoughts with immediate suicidal intentions.2 Three different alterations were distinguished: bad dreams (dysphoric dreams without awakening), nightmares (dysphoric dreams with awakening), and suicidal scenarios during dreams.2 This work reported that (i) 80% of individuals alter their dreams in the months preceding a suicidal crisis; and (ii) there is a chronology and progression of this alteration of dream content: bad dreams appear 4 months before a suicide crisis, then nightmares 3 months before, and the suicide scenario is played during dreams 1.5 months before. Currently, sleep alterations are not part of the risk factors sought in the suicidal crisis, despite its recognized independent predictive value.3 We believe that questioning dreams and their recent alteration is both very simple to perform in clinical practice and represents a meaningful warning signal of the suicidal crisis. “How are you dreaming?” is a very simple question to ask depressed patients. It is also a very simple change to make for healthcare professionals to better screen for one of the leading causes of death worldwide and the foremost one in youth.