Nightmare distress as a mediator between frequent nightmares and depressive symptoms in Chinese adolescents

Abstract Background : Frequent nightmares are related to depressive symptoms in adolescents. Little is known about pathways from frequent nightmares to depressive symptoms. This study aimed to examine the mediation effect of nightmare distress in the association between frequent nightmares and depressive symptoms in a large sample of Chinese adolescents. Methods : A total of 11831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. A self-administered questionnaire was used to measure nightmare frequency, nightmare distress, depressive symptoms, sleep duration, insomnia, and demographic characteristics. Linear regressions and mediation analyses were performed to examine the associations between frequent nightmares, nightmare distress and depressive symptoms. Results : Of 11831 participates, 50.9% were males and the mean age was 14.97. Adolescents with frequent nightmares scored significantly higher on nightmare distress (t=29.87, P Limitation : No causality could be made from the cross-sectional data and possible information bias due to self-report. Conclusions : The association between frequent nightmares and depressive symptoms appears to be substantially mediated by nightmare distress. Assessing and intervening distress associated with frequent nightmares may have important clinical implications for reducing the risk of depression in adolescents.