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 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 had significant mediation effects on 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.

中文翻译：

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青少年噩梦频率和噩梦困扰与自杀行为的纵向关联：抑郁症状的中介作用

研究目标 噩梦是自杀行为的重要危险因素。本研究调查了噩梦频率和痛苦与自杀念头 (ST)、自杀计划 (SP) 和自杀企图 (SA) 的纵向关联以及青少年抑郁症状的中介作用。方法 对参加山东省青少年行为与健康队列1年随访的6923名青少年进行分析。参与者在 2015 年 11 月至 12 月完成了一份自我管理的问卷，以评估噩梦、睡眠时间、失眠、抑郁症状、物质使用、先前的自杀行为和家庭人口统计。一年后，进行了一项后续调查以询问参与者报告他们的抑郁症状和自杀行为。样本的结果，26。2% 的人报告在基线时经常做噩梦（至少每月两次），10.0%、3.6% 和 2.7% 的人报告在 1 年的随访期间有 ST、SP 和 SA。随后的 ST、SP 和 SA 的发生率都随着基线噩梦频率和痛苦而显着增加。路径分析表明，在调整青少年和家庭协变量以及先前的自杀行为之前和之后，抑郁症状对频繁做噩梦和增加的噩梦痛苦与 ST、SP 和 SA 之间的关联具有显着的中介作用。结论青少年的自杀风险随着噩梦频率和痛苦的增加而增加。噩梦和自杀行为之间的关联至少部分是由抑郁症状介导的。