Abstract

Background. Because nightmares seem to be associated with depression in schizophrenia, detecting them early in therapeutic practice might be critical to ensuring effective avoidance of the development of depressive symptomatology. This helps promote well-being and improve the patient’s quality of life and illness prognosis. Therefore, the aim of this study was to examine the indirect effect of depression between nightmares and well-being in a Lebanese sample of patients with schizophrenia. Method. This monocentric cross-sectional study, conducted in July 2022, enrolled patients with chronic schizophrenia admitted to the Psychiatric Hospital of the Cross. Data were collected from a total of 148 participants through face-to-face interviews. The questionnaire included a nightmares measure, PSYRATS, Calgary depression scale for schizophrenia, PTSD checklist for DSM-5, the digit span subset, and WHO-5Well-Being Index. Results. The presence of nightmares was significantly associated with more depression, whereas higher depression was significantly associated with lower well-being. It is noteworthy that the presence of nightmares was not directly associated with well-being. Conclusion. Nightmares lead indirectly to lower well-being in schizophrenia patients, with depression serving as a mediating factor in this association. This suggests that interventions aiming at improving dream content may also have a beneficial effect in reducing depression in schizophrenia leading therefore to better well-being of the patients.

Background

Schizophrenia is one of the most severe mental disorders when it comes to its detrimental effects on various psychosocial areas and the overall quality of life of the patient [1]. Because schizophrenia causes misery and incapacity, the majority of attention has been focused on understanding and mitigating its negative effects on daily life functioning, with a rising focus on broad positive variables such as life satisfaction and subjective well-being [2]. Well-being has been widely acknowledged to entail both functioning effectively and feeling well [3]. Therefore, it is important to note that suffering from mental disorders does not imply poor well-being, and the lack of psychopathology does not guarantee a productive lifestyle [4]. Promoting well-being, on the other hand, can greatly aid recovery and improve the patient’s quality of life and illness prognosis [5]. Therefore, it is important to study factors that may affect the well-being of patients diagnosed with schizophrenia for better functioning and recovery. A variety of psychological and biological factors, such as long-term environmental influences and ongoing stressors, general cognitive abilities and personality traits, exposure to transiently traumatic life events, mental health interventions, and coping, affect the functioning and well-being of schizophrenia patients [6]. Trauma and posttraumatic stress disorder (PTSD), which are commonly prevalent among individuals with schizophrenia [7], are linked to personal well-being, which can be optimized following PTSD treatment [8]. However, the diagnosis of depression is likely the one most closely associated with a lack of well-being [4]. Patients with mental disorders, particularly those with schizophrenia, commonly experience depression [9]. Comorbid depressive symptoms, estimated in 30–۷۵% of schizophrenia patients [10], have been linked to worse long-term functioning [11] and a lower level of life quality and well-being [12]. The World Health Organization has reported that schizophrenia is the fourth most prominent cause of disability globally [13]. Individuals with schizophrenia who also suffer from depression experience a substantial level of disability [14], which impairs their ability to manage their mental and physical health, leading to a vicious cycle of deteriorating disability [15]. Moreover, it has been discovered that depression plays a partial mediator role in the connection between the severity of schizophrenia and disability [16]. Given the magnitude of negative symptoms, the impairments in functioning and well-being, and the risk of suicidality, schizophrenia patients with depressive symptoms should be monitored closely [17]. This occurrence of depressive symptoms in schizophrenia may be caused by overlapping risk factors, thereby having an impact on these patients’ general well-being.

Conclusion

Our findings demonstrate that nightmares lead to lower well-being in schizophrenia patients, with depression serving as a mediating factor in this association. As a result, the outcomes of this research may represent a first step towards emphasizing the importance of addressing patients’ distressing dreams during therapy in order to alleviate their depressive symptoms, which in turn promotes improved well-being. We support further investigation into nightmares as a potential indirect causal component of decreased well-being in schizophrenia to improve the quality of life and general subjective well-being among schizophrenia patients.