Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms

Jul 3, 2020Sleep

Nightmare frequency and distress linked to suicidal behavior in teens, with depression symptoms in between

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Abstract

26.2% of adolescents reported frequent nightmares, which may be linked to increased suicidal thoughts and behaviors.

A significant portion of adolescents experiencing frequent nightmares reported elevated rates of suicidal thoughts (10.0%), suicide plans (3.6%), and suicide attempts (2.7%) over a one-year period.
There was a notable increase in suicidal thoughts, plans, and attempts associated with higher baseline nightmare frequency and distress.
Depressive symptoms were found to significantly mediate the relationship between frequent nightmares and elevated suicidal behaviors.
These findings suggest that addressing both nightmares and depressive symptoms could be important in efforts to prevent suicidal behavior in adolescents.

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STUDY OBJECTIVES: Nightmares are a significant risk factor of suicidal behavior. This study examined the longitudinal associations of nightmare frequency and distress with suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) and mediating role of depressive symptoms in adolescents.

METHODS: A total of 6,923 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort were included for the analysis. Participants completed a self-administered questionnaire to assess nightmares, sleep duration, insomnia, depressive symptoms, substance use, prior suicidal behavior, and family demographics in November-December in 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behaviors.

RESULTS: Of the sample, 26.2% reported having frequent nightmares (at least twice/month) at baseline, and 10.0%, 3.6%, and 2.7% reported having ST, SP, and SA over 1-year follow-up. The rates of subsequent ST, SP, and SA all significantly increased with baseline nightmare frequency and distress. Path analyses showed that depressive symptoms played a significant mediating role in the associations of frequent nightmares and elevated nightmare distress with ST, SP, and SA before and after adjusting for adolescent and family covariates and prior suicidal behavior.

CONCLUSIONS: Suicidal risk increased with nightmare frequency and distress among adolescents. The association between nightmares and suicidal behavior was at least partially mediated by depressive symptoms. Assessing and intervening nightmares and depressive symptoms associated with nightmares may have important implications for preventing adolescent suicidal behavior.

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Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms

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