Nightmare frequency is a risk factor for suicidal ideation during the COVID-19 pandemic

Courtney J. Bolstad*, Brigitte Holzinger, Serena Scarpelli, Luigi De Gennaro, Juliana Yordanova, Silvia Koumanova, Sérgio Mota-Rolim, Christian Benedict, Bjørn Bjorvatn, Ngan Yin Chan, Frances Chung, Yves Dauvilliers, Colin A. Espie, Yuichi Inoue, Maria Korman, Adrijana Koscec Bjelajac, Anne Marie Landtblom, Kentaro Matsui, Ilona Merikanto, Charles M. MorinMarkku Partinen, Thomas Penzel, Giuseppe Plazzi, Cátia Reis, Biserka Ross, Yun Kwok Wing, Michael R. Nadorff

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The association between nightmare frequency (NMF) and suicidal ideation (SI) is well known, yet the impact of the COVID-19 pandemic on this relation is inconsistent. This study aimed to investigate changes in NMF, SI, and their association during the COVID19 pandemic. Data were collected in 16 countries using a harmonised questionnaire. The sample included 9328 individuals (4848 women; age M[SD] = 46.85 [17.75] years), and 17.60% reported previous COVID-19. Overall, SI was significantly 2% lower during the pandemic vs. before, and this was consistent across genders and ages. Most countries/regions demonstrated decreases in SI during this pandemic, with Austria (-9.57%), Sweden (-6.18%), and Bulgaria (-5.14%) exhibiting significant declines in SI, but Italy (1.45%) and Portugal (2.45%) demonstrated non-significant increases. Suicidal ideation was more common in participants with long-COVID (21.10%) vs. short-COVID (12.40%), though SI did not vary by COVID-19 history. Nightmare frequency increased by 4.50% during the pandemic and was significantly higher in those with previous COVID-19 (14.50% vs. 10.70%), during infection (23.00% vs. 8.10%), and in those with longCOVID (18.00% vs. 8.50%). The relation between NMF and SI was not significantly stronger during the pandemic than prior (rs = 0.18 vs. 0.14; z = 2.80). Frequent nightmares during the pandemic increased the likelihood of reporting SI (OR = 1.57, 95% CI 1.20–2.05), while frequent dream recall during the pandemic served a protective effect (OR = 0.74, 95% CI 0.59–0.94). These findings have important implications for identifying those at risk of suicide and may offer a potential pathway for suicide prevention.
Original languageEnglish
Number of pages13
JournalJournal of Sleep Research
Publication statusAccepted/In press - 2024


  • PTSD
  • Anxiety
  • Depression
  • Long-COVID
  • Post-COVID
  • Suicidality


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