Clinical Characteristics Of Nightmares In Adolescent Depression Patients

Objective: Nightmares are associated with a higher incidence in adolescent groups,and previous studies have shown that nightmares are independently associated with adolescent suicide risk and are associated with changes in sleep structure and cognition.In addition,adolescents with depression are at increased risk of suicide,and their sleep and cognitive function are poor.Therefore,the comorbidity nightmare may magnify the suicide risk,sleep,and cognitive problems of this clinical population.This study explores the clinical characteristics of nightmares in adolescent depression patients from three aspects: suicide risk,sleep,and cognition.This study focused on the impact of nightmares on the suicide risk of adolescent depression,and then compared the subjective and objective sleep and cognitive differences of adolescent depression patientsMethods: Subjects were 499 outpatients aged 12-18 in four large psychiatric hospitals and clinics in China,from January 2021 to October 2022.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 depression diagnoses and determination of suicide risk by a fully structured diagnostic clinical interview.In the depression group,according to the frequency of nightmares(one time/week)in the past month,they were divided into nightmare groups and non-nightmare groups(gender and age-matched)for sleep monitoring and cognitive assessment.Results: 1.There was no significant difference in gender,age,or education between the depression and control group(all p> 0.05).In the depression group,the proportion of insomnia and suicide risk was higher than in the healthy group(all p<0.001).Total Insomnia Severity Index(ISI),Chinese Adolescent Daytime Sleepiness Scale(CADSS),nightmare frequency,and Nightmare Distress Questionnaire(NDQ-CV)scores were higher in depressed patients than in healthy controls(all p <0.001);2.Among patients with depression,the severity of gender,age,frequency of the group,nightmare frequency,insomnia,drowsiness,anxiety,depression,and nightmare distress varied significantly(all p <0.05);3.The positive correlation between suicide risk,nightmare frequency,NDQ-CV,CADSS,ISI,and Patient Health Questionnaire-9(PHQ-9)scores ranged from r =0.141 to 0.669,and all coefficients were significantly correlated(all p <0.001);4.Patients with suicide risk scored scientifically higher on sleep variables,depressive and anxiety symptoms than those without the risk.Further logistic regression analysis showed that gender,grade,clinical features of depression,nightmares,worries,and depressive symptoms were significantly correlated with suicide risk.Among them,female,middle school grades,recurrent depressive episodes,severe nightmares,and severe depressive symptoms are independently and significantly associated with suicide risk(all p < 0.005);5.In terms of subjective sleep,there were significant differences in subjective sleep quality,sleep latency,sleep efficiency,sleep disorder,use of sleep drugs,daytime dysfunction,and Pittsburgh Sleep Quality Index(PSQI)total scores in the adolescent depression nightmare group(all p < 0.05).In terms of objective sleep,REM time and maximum heart rate were significantly different(all p < 0.05).;6.There were significant differences in subjective cognitive planning/attention,prospective memory,retrospective memory,and total Perceived Deficits Questionnaire for Depression(PDQ-D)scores between the nightmare group and the control group of adolescents with depression(all p < 0.001).Objective cognitive social cognitive factors were significantly different(p < 0.05).Conclusion: 1.Adolescents with depression experience more frequent nightmares and nightmares;2.Nightmare worry is a predictor of suicide in adolescent depression;3.Frequent nightmares can bring about sleep structure and cognitive changes to adolescents with depression.