Abstract
The year 2020 has generated profound changes in personal and working relations, and in dreams of millions of people worldwide. The aim of this study was to investigate the frequency and content of nightmares during the COVID-19 pandemic in Brazil, evaluating its associations with sociodemographic, occupational, and clinical factors. Cross-sectional exploratory study, including 1,057 participants who responded to an online survey about mental violence and nightmares during the pandemic, between May 25 and June 1, 2020. A descriptive analysis of the results was done to obtain frequency tables. McNemar's non-parametric test was used to compare the frequency of nightmares before and after the pandemic, and logistic regression models, to identify factors most strongly associated with the pandemic nightmares. Participants were from 21 Brazilian states, with a mean age of 38 ± 14 years, and 78% women. Half of them (n = 529) reported at least one nightmare episode during the pandemic, and 32.9% (n = 348) described a pandemic content. There was nearly a 3-fold increase in the occurrence of nightmares “once a week or more” during the pandemic, 9% before vs. 25% after. Prior psychiatric care, suicidal ideation, sleep medication, increased pandemic alcohol consumption, perceiving high risk of contamination, being woman, and of younger age were factors associated with having nightmares during the pandemic. Prior psychiatric care, sleep medication, and age remained significant after excluding participants without nightmares and comparing between individuals with and without a pandemic content. We conclude the COVID-19 pandemic has affected people's dreams. The increase in the frequency of nightmares, their pandemic content, and association with previous conditions are a concerning public mental health issue and should be taken into consideration by authorities and policy makers.
Highlights
Nightmares are REM parasomnias [1] defined as repeated episodes of dysphoric and wellremembered dreams, which generally involve fight to survive or for physical integrity [2]
The survey was structured with the following sections: [1] sociodemographic data—age, gender, ethnicity, marital status, state of residence, and religion; [2] occupational status and exposure to the COVID-19—professional category, occupation, exposure and threat related to coronavirus, as well as social isolation and the use of facial mask; [3] personal and clinical antecedents—health-risk behaviors, sleep, and previous medical and psychiatric conditions, including suicidal ideation related to the pandemic; and [4] nightmares assessment—frequency of nightmares before and during the pandemic (“no nightmares,” “less than once a week,” and “once a week or more”), along with specific content related to the pandemic
When pandemic-related content nightmares were regarded, only age, previous psychiatry condition, and taking sleeping pills. Another possible explanation for this result, may rely on the fact that even though the health professionals spend more time in contact with the new COVID-19 disease reality, the general population is over-exposed to real-time information of great emotional impact, especially through the media and social networks
Summary
Nightmares are REM parasomnias [1] defined as repeated episodes of dysphoric and wellremembered dreams, which generally involve fight to survive or for physical integrity [2]. The speed in which real time information travels the globe, their morbid content, the consequences and severity of this new disease without treatment, added to the experience of physical distancing, economic impact, interrupted education, changes in working and familial relations, in ways we obtain food, among others. These memories are in the making and they can modify the occurrence of mental disorders in several ways [21, 22]. In order to provide current data to healthcare organizations and policy makers, considering the need for innovative psychosocial interventions in the near future, and stressing the relevance of such threats to public mental health, we designed an online survey aimed at identifying changes in the frequency and content of nightmares and their associated factors
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