1076 POSTTRAUMATIC STRESS DISORDER (PTSD) WITH NIGHTMARES IS ASSOCIATED WITH A SIGNIFICANTLY LOWER FREQUENCY OF SUICIDAL BEHAVIOR: RESULTS FROM A NATIONALLY REPRESENTATIVE US SAMPLE

Recurrent distressing dreams (nightmares) are one of the core symptoms of PTSD (DSM-5). Nightmares (NM) have been associated with rapid eye movement (REM) sleep. A disturbance of REM sleep is considered to be a hallmark of PTSD. It is also recognized that REM sleep plays a central role in emotional regulation. We examined the frequency of suicidal behavior (SB) and depression in PTSD patients who sought medical attention for nightmares (PTSD+NM) versus all other PTSD visits (PTSD-NM), in a nationally representative US sample. We examined an estimated±SE 27,588,109 ± 2,900,885 (unweighted count=3341) PTSD-related patient visits (mean ± SE age: 39.28 ± 0.65 years; 67.0% ±2.1%, female) from 1995–2011 in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, both nationally representative surveys of patient visits. Each patient visit is assigned up to 3 ICD-9-CM diagnoses and up to 3 ‘Reasons for Visit’ (RFV). The study variables were defined as follows: PTSD - ICD-9-CM code 309.81; Nightmares (NM)- ICD-9-CM code 307.49 or RFV ‘Nightmares’ (code 1135.3); Suicidal Behavior (SB)- ICD-9-CM supplemental E codes titled ‘Suicide and self-inflicted injury’ (E950-E959) or RFV ‘Suicide attempt’ (code 5820.0) or RFV ‘Intentional overdose’ (code 582.01); Depression- ICD-9-CM codes: 296.2, 296.3, 296.82, 311, 296.20–296.36, 300.4. There were an estimated±SE 498,169 ± 143,660 (unweighted count=57; 1.8% ±0.4% of all PTSD visits) NM visits. There were an estimated±SE 93,813 ± 40,633 SB (unweighted count=31; 0.3% ± 0.1% of all PTSD visits) visits in the PTSD sample. Interestingly, none of the PTSD patients with SB were in the PTSD+NM group (ie., all were PTSD-NM group). The odds ratio (OR) for SB in the PTSD-NM group versus all other patient visits in the 2 databases, was 6.102 (95% CI 2.56–14.57), consistent with overall increased SB in PTSD. Depression was not significantly different between the PTSD+NM versus PTSD-NM groups (OR=1.43, 95% CI 0.77–2.65). In a nationally-representative sample, PTSD patients with NM had significantly less SB but not lower depression scores. This previously unreported finding may indicate that NM (possibly through mechanisms associated with REM sleep) have a protective effect against SB. None.

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