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Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness.
J Clin Sleep Med. 2016 Mar; 12(3):393-9.JC

Abstract

STUDY OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

COMMENTARY

A commentary on this article appears in this issue on page 289.

Authors+Show Affiliations

School of Psychological Sciences, University of Manchester, UK.School of Psychological Sciences, University of Manchester, UK.Institute of Population Health, University of Manchester, UK.Sleep and Circadian Neuroscience Institute, University of Oxford, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26564386

Citation

Littlewood, Donna L., et al. "Nightmares and Suicide in Posttraumatic Stress Disorder: the Mediating Role of Defeat, Entrapment, and Hopelessness." Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, vol. 12, no. 3, 2016, pp. 393-9.
Littlewood DL, Gooding PA, Panagioti M, et al. Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness. J Clin Sleep Med. 2016;12(3):393-9.
Littlewood, D. L., Gooding, P. A., Panagioti, M., & Kyle, S. D. (2016). Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 12(3), 393-9. https://doi.org/10.5664/jcsm.5592
Littlewood DL, et al. Nightmares and Suicide in Posttraumatic Stress Disorder: the Mediating Role of Defeat, Entrapment, and Hopelessness. J Clin Sleep Med. 2016;12(3):393-9. PubMed PMID: 26564386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness. AU - Littlewood,Donna L, AU - Gooding,Patricia A, AU - Panagioti,Maria, AU - Kyle,Simon D, PY - 2015/09/10/received PY - 2015/10/15/accepted PY - 2015/11/14/entrez PY - 2015/11/14/pubmed PY - 2017/1/12/medline KW - defeat KW - depression KW - entrapment KW - hopelessness KW - insomnia KW - nightmares KW - posttraumatic stress disorder KW - suicidal ideation SP - 393 EP - 9 JF - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine JO - J Clin Sleep Med VL - 12 IS - 3 N2 - STUDY OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. COMMENTARY: A commentary on this article appears in this issue on page 289. SN - 1550-9397 UR - https://www.unboundmedicine.com/medline/citation/26564386/Nightmares_and_Suicide_in_Posttraumatic_Stress_Disorder:_The_Mediating_Role_of_Defeat_Entrapment_and_Hopelessness_ L2 - https://doi.org/10.5664/jcsm.5592 DB - PRIME DP - Unbound Medicine ER -