Littlewood Donna L, Gooding Patricia A, Panagioti Maria, Kyle Simon D
School of Psychological Sciences, University of Manchester, UK.
Institute of Population Health, University of Manchester, UK.
J Clin Sleep Med. 2016 Mar;12(3):393-9. doi: 10.5664/jcsm.5592.
Although nightmares appear to be related to suicidal behaviors, the mechanisms which underpin this relationship are unknown. We sought to address this gap by examining a multiple mediation hypothesis whereby nightmares were predicted to have an indirect effect on suicidal behaviors through perceptions of defeat, entrapment, and hopelessness.
Data were collected from 91 participants who had experienced trauma and symptoms of posttraumatic stress disorder (PTSD). Nightmares were measured by summing the frequency and intensity ratings of relevant items on the Clinician-Administered PTSD Scale. Participants also completed questionnaire measures of suicidal behavior, hopelessness, defeat, and entrapment. Given the interrelations between insomnia, PTSD, and suicide, a measure of insomnia was included as a covariate. Furthermore, analyses were conducted with and without those participants who had comorbid depression.
Suicidal behaviors were higher in those participants who experienced nightmares (62%), in comparison to those who did not (20%). Bootstrapped analyses provided support for the hypothesized multistep mediational model. Specifically, nightmares were both directly and indirectly associated with suicidal behaviors, through perceptions of defeat, entrapment, and hopelessness, independent of comorbid insomnia and depression.
For the first time we show that the relationship between nightmares and suicidal behaviors is partially mediated by a multistep pathway via defeat, entrapment, and hopelessness. Clinically, our work highlights the importance of monitoring and targeting nightmares and perceptions of defeat, entrapment, and hopelessness when working with clients who have experienced trauma.
A commentary on this article appears in this issue on page 289.
尽管噩梦似乎与自杀行为有关，但其背后的机制尚不清楚。我们试图通过检验一个多重中介假设来填补这一空白，该假设认为噩梦会通过失败感、被困感和绝望感对自杀行为产生间接影响。
收集了91名经历过创伤和创伤后应激障碍（PTSD）症状的参与者的数据。通过对临床医生管理的PTSD量表上相关条目的频率和强度评分进行求和来测量噩梦。参与者还完成了关于自杀行为、绝望感、失败感和被困感的问卷调查。鉴于失眠、PTSD和自杀之间的相互关系，将失眠测量值作为协变量纳入。此外，对有共病抑郁症的参与者和没有共病抑郁症的参与者分别进行了分析。
与未经历噩梦的参与者（20%）相比，经历噩梦的参与者（62%）的自杀行为更多。自抽样分析为假设的多步骤中介模型提供了支持。具体而言，噩梦与自杀行为直接相关，也通过失败感、被困感和绝望感间接相关，且独立于共病的失眠和抑郁症。
我们首次表明，噩梦与自杀行为之间的关系部分是通过失败感、被困感和绝望感的多步骤途径介导的。在临床上，我们的研究突出了在治疗经历过创伤的患者时，监测和针对噩梦以及失败感、被困感和绝望感的重要性。
关于本文的一篇评论发表在本期第289页。
