title: Nightmares: Under-Reported, Undetected, and Therefore Untreated.
abstract: OBJECTIVE
  Nightmares are a robust and modifiable predictor of increased suicidality and poor psychiatric outcomes, yet nightmare screening and treatment remain rare, even in sleep centers. This paper aims to examine what proportion of nightmare sufferers have discussed nightmares with a healthcare provider, as well as possible explanations for low rates of nightmare complaints.
  
  
  METHODS
  The present study utilized a large United States community sample recruited through mTurk and a student sample recruited from a large public university in the Southeast United States. In Study 1, participants (n = 809) were asked whether they had discussed nightmares with a healthcare provider. In Study 2 participants (n = 747) were asked whether they believed nightmares were treatable in addition to whether or not they had discussed nightmares with a healthcare provider.
  
  
  RESULTS
  Of the participants in Study 1 experiencing clinically significant nightmare symptoms only 37.8% of participants reported discussing their nightmares with a healthcare professional. In Study 2 only 11.1% of participants with significant nightmares reporting having told a healthcare provider about their nightmares. Further, of these individuals with clinically significant nightmare symptoms, less than one-third believed that nightmares were treatable. Higher nightmare severity was associated with a greater likelihood of reporting nightmares to a healthcare physician as well as with lower beliefs that nightmares are treatable.
  
  
  CONCLUSIONS
  Our findings suggest that nightmares are rarely reported to healthcare providers, which may explain the underutilization of nightmare treatments. Given the poor outcomes associated with nightmares, nightmare screening is warranted.
authors.affiliation: Department of Psychology, Mississippi State University, Mississippi State, MS.|Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Nadorff
authors.affiliation: Department of Psychology, Mississippi State University, Mississippi State, MS.
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Nadorff
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D004325:Dreams / Q000502:physiology / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D020380:Needs Assessment; D058069:Neglected Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D057566:Self Report; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: nightmare disorder; nightmare screening; nightmare treatment; underreporting
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