Associations Between Frequent Nightmares,Nightmare Distress And Depressive Symptoms In Adolescent Psychiatric Patients

Objective:The present study was divided into study 1 and study 2.(1)Study 1:To evaluate the psychometric properties of Chinese version of nightmare distress questionnaire(NDQ-CV)in adolescent psychiatric patients.(2)Study 2:To explore the associations between frequent nightmares,nightmare distress and depressive symptoms in adolescent psychiatric patients.Method:A total of 536 adolescent psychiatric patients with age of 10-19 years old were recruited from Shandong Mental Health Center in China to complete the questionnaire,and 408 patients completed the section measuring depressive symptoms.(1)Study 1:SPSS 25.0 was used to describe the sample characteristics,to analyze NDQ-CV items,to measure internal consistency reliability,convergent validity and discriminate validity of NDQ-CV and its subscales.Confirmatory factor analysis was performed to assess the two-factor structure of NDQ-CV in adolescent psychiatric patients using Mplus 8.(2)Study 2:SPSS 25.0 was used to describe sample characteristics.Independent t test and chi-square test were performed to analyze the gender difference between variables and the variable differences between patients with and without frequent nightmares.Linear regressions and mediation analysis were performed to examine the associations between frequent nightmares,nightmare distress and depressive symptoms.Results:(1)Study 1:The mean age of our participants was 15.30± 1.95,and 61%of them were girls.There were 52%participants diagnosed with depressive disorder.In adolescent psychiatric patients,the mean and median NDQ-CV score were 29.92±13.22 and 27.Two factor model was suitable to interpret the structure of NDQ-CV(χ2=324.73,df=76,p<.01,RMSEA=0.078,CFI=0.973,SRMR=0.040).Internal consistency reliability coefficient of NDQ-CV and its subscales was 0.94,0.93 and 0.79.The NDQ-CV score and its subscales were moderately and highly correlated with nightmare frequency,sleep duration,insomnia,daytime sleepiness,and depressive symptoms,and lowly correlated with sleep duration on weekdays.There were significantly different NDQ-CV scores between psychiatric adolescents and general ones.(2)Study 2:The mean age of our participants was 15.31±1.88,and 62.7%of them were girls.There were 53.2%participants diagnosed with depressive disorder.49.3%adolescent patients reported weekly nightmares.Girls reported more frequent nightmares and had significant higher scores of depressive symptoms and nightmare distress than boys.Patients with frequent nightmares had higher scores of nightmare distress and depressive symptoms.Frequent nightmares and nightmare distress were significantly associated with depressive symptoms.Nightmare distress had a full mediating effect on the correlation between frequent nightmares and depressive symptoms.Conclusion:(1)The NDQ-CV has satisfactory reliability and validity and is applicable to assess nightmare distress in adolescent psychiatric patients.(2)Frequent nightmares are common in adolescent psychiatric patients.There was gender difference in frequent nightmares,nightmare distress and depressive symptoms in adolescent psychiatric patients.Nightmare distress was a mediator between frequent nightmares and depressive symptoms in adolescent psychiatric patients.