Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms
Xianchen Liu, Yanyun Yang, Zhenzhen Liu, Cun-Xian Jia
Sleep July 2, 2020 DOI: 10.1093/sleep/zsaa130 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Longitudinal Peer reviewed |
|---|---|
| Sample size | 6,923 |
| Population | Chinese adolescents in the Shandong Adolescent Behavior & Health Cohort |
| Duration | 1-year follow-up |
| Topics | Dreaming |
| Citations | 41 |
| Key findings | Suicidal thoughts, plans, and attempts increased with baseline nightmare frequency and distress over one year, and depressive symptoms partially mediated these associations after adjustment for covariates and prior suicidal behavior. The authors suggest that assessing and intervening on nightmares and related depressive symptoms may help prevent adolescent suicidal behavior. |
Abstract
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.
Comparable studies
Other observational and cohort studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lucid Dreaming: a State of Consciousness with Features of Both Waking and Non-Lucid Dreaming Student volunteers trained to become lucid and signal lucidity with horizontal eye... | 2009 | Observational study | n = 6 |
| Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Young adults with a mean age of 20 years | 2002 | Prospective observational study | n = 116 |
| Long-term effects of extreme situational stress on sleep and dreaming Survivors of traumatic events who complained of sleep disturbances, compared with... | 1987 | Case-control study | n = 11 |
| The relationship of nightmare frequency and nightmare distress to well‐being Adults who reported dreams | 2004 | Observational cohort | n = 147 |
| Dreaming in NREM Sleep: A High-Density EEG Study of Slow Waves and Spindles Healthy human subjects | 2018 | Observational cohort | n = 14 |
Citations in the library
Cited by 11
- Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder Nature and Science of Sleep September 1, 2022
- Nightmares matter: rethinking suicide risk assessment and intervention in depression Sleep April 8, 2026
- Nightmare frequency mediates the association between childhood trauma and suicidal ideation among youth: is it sex-specific? European Archives of Psychiatry and Clinical Neuroscience November 17, 2025
- Suicide and Sleep Disorders: The Role of Insomnia, Nightmares, and Circadian Disruption. Cureus July 9, 2026
- Associations between Nightmare Frequency, Nightmare Distress, and Psychopathological Problems among Chinese College Students: a Population-based Survey. Psychiatric Quarterly October 9, 2025
and 6 more in the library
Cites 8
- Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Sleep 2011
- Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Sleep 2002
- The relationship of nightmare frequency and nightmare distress to well‐being Journal of Sleep Research May 26, 2004
- Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews April 1, 2020
- Nightmare Severity Is Inversely Related to Frontal Brain Activity During Waking State Picture Viewing. Journal of Clinical Sleep Medicine February 15, 2019
and 3 more in the library