Researchers investigated the relationship between nightmares and suicide in war veterans and the general population. They found that although veterans report more nightmares, it did not increase their risk for suicide. Nevertheless, the authors conclude that nightmares should still be considered in suicide prevention.
Finland, one of the Nordic nations, has remained neutral with regard to military participation in armed conflict since the end of World War II. However, researchers there wondered whether that country’s veterans who experienced nightmares in the aftermath of such egregious confrontations had an increased risk of suicide than members of the general population.
Building upon existing data, the scientists utilized research from the 2001 Tanskanen study and extended the analysis to address the following:
- Identify Finnish war veterans and analyze their responses concerning whether their self-reported nightmare events, among other factors, were forecasters of suicide.
- Evaluated the veteran population separately and compare it with data generated from a greater Finnish population.
- This more recent study examined a larger participant base than the 2001 study; and continued its follow-up period by nine years beyond the original.
The researchers wanted to test for two hypotheses. They investigated if:
- War veterans’ nightmares could be utilized as predictors of suicide compared with the general population, given the fact veterans’ nightmares following war service frequently are a byproduct of various mental-health issues; and
- The link between nightmares and suicide in a general population becomes “markedly less significant” when a veteran population is excluded.
The researchers isolated data from the Finnish National FINRISK study, a series of health-related questionnaires that started in 1972 and was administered every five years. FINRISK asked random Finnish nationals various questions about their state of health and also included a physical exam. With permission, the respondents’ answers from the most recent questionnaire were uploaded to the Finn’s National Causes of Death Register, which included suicides in its roster.
The current study recruited 71,068 people, aged 25-74 years old, whose mean age was 45.6 years. Just over half, or 51.6% of participants, were women. Utilizing data from the 2001 study, which did not isolate veterans from the general population and included the years 1972-1997, the researchers incorporated four additional five-year intervals from 1997-2012 into their analyses, terminating their data follow-up on Dec. 31, 2014.
Nightmares, according to the Diagnostic and Statistical Manual of Mental Disorders, were defined as “extremely dysphoric and well-remembered dreams that usually involve efforts to avoid threats to survival, security or physical integrity.” And the researchers credited existing research citing the incident(s) of having nightmares as symptomatic of post-traumatic stress disorder (PTSD), something not uncommon among veterans.
In the study, participants self-reported their answers to questions about relationship status, smoking/drinking habits, amount of physical exercise, as well as employment status and whether that specific person had consumed antidepressants, tranquilizers or hypnotic products during the past 12 months. Also, the people answered questions concerning any degrees of insomnia or a diagnosis of depression and whether they experienced nightmares, along with their frequency.
Importantly, war veterans answered as to whether they had sustained a permanent disability, if they had become wounded or disabled at all whilst in the military.
The data analysis revealed that more male war veterans committed suicide than females, but that women experienced more nightmares than the men. Of the 69,101 people completing the study, 398 suicides were reported and 32, or approximately 10% were veterans. Of the 398 suicidal deaths, 307 or about 77% were men. Despite this, the data revealed that more women than men reported experiencing nightmares.
The veterans who committed suicide were not divided by gender in this study and accounted for less than 1% of the study population.
In conclusion, the researchers stated experiencing nightmares was not necessarily a predictor of suicide among war veterans or the general population. Scientific Reports published the findings online on March 15, 2017.
A study strength, the authors stated, lies in the fact that it builds upon existing research by isolating a veteran population experiencing nightmares. Potential limitations are the facts that a Finnish war-veteran population was limited. Also, the long time period of the study likely could have precluded responses from may Finnish war veterans who died without having their data recorded. In addition, the veterans were answering the study questionnaires 30 years after the war ended.
Written By: Susan Mercer Hinrichs, MA, MBA, CPhT