1114 Predicting Post-Trauma Insomnia and Nightmare Severity Two Weeks After Interpersonal Violence
Lily Jankowiak, Anthony N Reffi, Cameron McCray, Kanica Bhutoria, David Moore, J. Peltzer-Jones, C. Drake
SLEEPJ May 1, 2026 DOI: 10.1093/sleep/zsag091.1113 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 29 |
| Population | Patients discharged from the emergency department at an urban Level I trauma center following interpersonal violence exposure; mean age 37.3 years, 65.5% female, 75.9% Black or African American, 65.5% physical assault. |
| Duration | HMHRS completed within 72 hours of violence exposure; sleep measures completed at baseline (retrospective pre-trauma) and two weeks later (mean 13 days). |
| Measures | Insomnia Severity Index (ISI), Nightmare Disorder Index (NDI), Hospital Mental Health Risk Screen (HMHRS) |
| Topics | Dreaming |
| Key findings | The HMHRS prospectively predicted post-trauma insomnia (β = 0.36, R2 = 0.26) and nightmare severity (β = 0.22, R2 = 0.31) above pre-trauma scores, but did not predict change in insomnia (β = 0.28) or nightmares (β = 0.04) from pre- to post-trauma. The authors suggest the screen may help identify patients suitable for sleep-focused preventive treatment. |
Abstract
The Hospital Mental Health Risk Screen (HMHRS) predicts risk for negative outcomes following acute trauma, including posttraumatic stress disorder (PTSD). Insomnia and nightmares are common reactions to acute trauma and are considered modifiable risk factors for the development of PTSD. The HMHRS may be useful for detecting risk for post-trauma insomnia and nightmares, however, no studies have tested if the HMHRS predicts sleep disturbances within the acute aftermath of trauma. We tested the hypothesis that the HMHRS would predict (1) more severe insomnia and nightmares immediately after trauma, and (2) worsening of insomnia and nightmares from pre- to post-trauma. We recruited 29 patients discharged from the emergency department (ED) at an urban Level I trauma center following interpersonal violence exposure (Mage = 37.3 ± SD 14.2, 65.5% female, 75.9% Black or African American, 44.8% ≤ $20,000, 65.5% physical assault). Patients completed the HMHRS within 72 hours of violence exposure, as well as the Insomnia Severity Index (ISI) and Nightmare Disorder Index (NDI) to retrospectively report their pre-trauma insomnia and nightmare severity. Patients completed the ISI and NDI again two weeks later (Mdays = 13) to report their post-trauma insomnia and nightmare severity. We performed linear regression modeling HMHRS sum scores as a predictor of: (1) post-trauma ISI and NDI sum scores, adjusting for pre-trauma ISI and NDI, and (2) change in ISI and NDI scores from pre- to post-trauma. The HMHRS prospectively predicted post-trauma ISI (β = 0.36, p = .002, R2 = 0.26) and NDI scores (β = 0.22, p = .005, R2 = 0.31) above and beyond pre-trauma scores. The HMHRS did not predict change in pre- to post-trauma ISI (β = 0.28, p = .167) or NDI scores (β = 0.04, p = .762). These preliminary data suggest the HMHRS predicts post-trauma insomnia and nightmare severity within the acute aftermath of interpersonal violence. Patients presenting to the ED with elevated HMHRS scores following interpersonal violence may potentially be suitable for insomnia- and nightmare-focused treatments during the acute recovery period to prophylactically reduce risk of posttraumatic psychopathology, including PTSD. AASM, Strategic Research Grant (371-SR-25; Study), NIMH (K23MH134032; A.N.R).
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 |