Trauma-related nightmares among U.S. veterans: Findings from a nationally representative study

Study objectives: Trauma-exposed veterans may be at an increased risk for nightmares. To date, however, no known study has examined the prevalence, risk factors, and comorbidities of nightmares in a nationally representative sample of veterans.

Methods: A nationally representative sample of 4069 US military veterans completed a survey that assessed trauma-related nightmares, health histories, and functioning. Multivariable analyses examined the association between trauma-related nightmares, and sociodemographic, military, and trauma characteristics, and psychiatric and functioning measures.

Results: Lifetime trauma-related nightmares were endorsed by 15.0 % of the sample, with 6.4 % endorsing nightmares in the past month. Sociodemographic factors, exposure to adverse childhood events, number of deployments, and index trauma type were all associated with trauma-related nightmares. In addition, nightmares were associated with elevated odds of psychiatric conditions, worse health and psychosocial functioning, and suicidal ideation and future suicidal intent. A "dose-response" association was observed between nightmare severity and suicidal ideation, even after controlling for sociodemographic characteristics, trauma exposure, and psychiatric and medical conditions.

Conclusions: Nearly 1-in-6 veterans experience trauma-related nightmares in their lifetime, which is associated with adverse mental health, functional difficulties, and increased suicide risk. Results underscore the importance of transdiagnostic assessment, monitoring, and treatment of trauma-related nightmares in this population.