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Tian-He Song,1,2,* Ting-Ting Wang,2,3,* Yun-Yue Zhuang,1,2 Hua Zhang,4 Jun-Hui Feng,5 Tang-Ren Luo,6 Shuang-Jiang Zhou,2 Jing-Xu Chen2 1Department of Psychology, Chengde Medical University, Chengde, Hebei, People’s Republic of China; 2Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China; 3School of Mental Health, Bengbu Medical College, Bengbu, Anhui, People’s Republic of China; 4Dongying People’s Hospital, Dongying, Shandong, People’s Republic of China; 5Jining Psychiatric Hospital, Jining, Shandong, People’s Republic of China; 6The Third Hospital of Longyan, Longyan, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shuang-Jiang Zhou; Jing-Xu Chen, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 10096, People’s Republic of China, Tel +86 13466401377 ; +86 13681394260, Email zhoushuangjiang@126.com; chenjx1110@163.comPurpose: Nightmare is common and is also independently implicated in suicide risk among the adolescent population. Adolescents with major depressive disorder (MDD) are at an increased risk of suicide. Therefore, comorbid nightmares may amplify suicide risk among this clinical population. This study aimed to explore the effects of nightmares on suicide risk among adolescents with MDD.Patients and Methods: Subjects were 499 outpatients aged 12– 18 in four large psychiatric hospitals clinic of China, from January 1 to October 31, 2021. Simultaneously, we matched 499 healthy controls according to gender and age. All participants underwent affective state (depressive and anxiety symptoms) and sleep variable (nightmare frequency/distress, insomnia symptoms, and daytime sleepiness) evaluation as well as MDD diagnoses and determination of suicide risk by a fully structured diagnostic clinical interview.Results: Adolescents with MDD reported a higher incidence of frequent nightmares (at least one night per week) and level of nightmare distress than healthy controls (22.0% vs 6.1%; 28.85 ± 11.92 vs 17.30 ± 5.61). Over half of the patients with suicide risk (51.6%) experienced frequent nightmares compared with approximately one-third of those at a risk for suicide (30.7%). Patients with suicide risk scored scientifically higher on sleep variables, depressive and anxiety symptoms than those without the risk. Further logistic regression analysis indicated that female gender, junior grade, recurrent depressive episode, severe nightmare distress and severe depressive symptoms were independently and significantly associated with suicide risk.Conclusion: Our study provided evidence that adolescents with MDD experienced a higher prevalence of frequent nightmares and suffered more nightmare distress. Nightmare distress is an independent risk factor for suicide risk.Keywords: major depressive disorder, sleep problems, nightmare, suicide risk, adolescent |
