Investigating the Interaction Between Sleep Symptoms of Arousal and Acquired Capability in Predicting Suicidality

Heightened arousal significantly interacts with acquired capability to predict suicidality. We explore this interaction with insomnia and nightmares independently of waking state arousal symptoms, and test predictions of the Interpersonal Theory of Suicide (IPTS) and Escape Theory in relation to these sleep arousal symptoms. Findings from our e‐survey (n = 540) supported the IPTS over models of Suicide as Escape. Sleep‐specific measurements of arousal (insomnia and nightmares) showed no main effect, yet interacted with acquired capability to predict increased suicidality. The explained variance in suicidality by the interaction (1%–2%) using sleep‐specific measures was comparable to variance explained by interactions previously reported in the literature using measurements composed of a mix of waking and sleep state arousal symptoms. Similarly, when entrapment (inability to escape) was included in models, main effects of sleep symptoms arousal were not detected yet interacted with entrapment to predict suicidality. We discuss findings in relation to treatment options suggesting that sleep‐specific interventions be considered for the long‐term management of at‐risk individuals.     

Exploring Thematic Nightmare Content and Associated Self‐Harm Risk

Nightmares have been shown to be robust predictors of self‐harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self‐harm risk. This study explored associations of thematic nightmare content with history of self‐harm, and risk of self‐harm phenomena the morning following a nightmare. A mixed‐method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi‐square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self‐harm history, and risk of self‐harm phenomena following a nightmare. “ Powerlessness to Change Behavior” was associated with a history of self‐harm engagement, whereas “Financial Hardship” indicated reduced risk. Themes were not significantly associated with increased risk of self‐harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self‐harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self‐harm risk is presently lacking. Replication with increased power is recommended.