0942 The Mediating Role of Emotional and Behavioral Problems Between Nightmares and Suicidality in Adolescents

Abstract Introduction Adolescence is a transitional period that is susceptible to sleep and mental health problem. Previous research has shown that sleep problems, including both insomnia and nightmares, as well as emotional and behavioral problems, are respectively associated with the suicidal risk. However, it remained unclear whether nightmares play an independent role in this link. The present study aimed to examine the association between nightmares and suicidality, and the potential mediating role of emotional and behavioral problems in this relationship in a community-based sample of Hong Kong Chinese adolescents. Methods A total of 2475 adolescents (12–20 years; mean age 14.8 ± 1.8 years; female: 63.80%) were recruited from the local secondary schools in Hong Kong. Participants completed a battery of self-report questionnaires: nightmares were measured using a single item in the Pittsburgh Sleep Quality Index (PSQI); suicidality was measured by the suicidality item in the Patient Health Questionnaire (PHQ-9); emotional and behavioral problems were measured by the Strengths and Difficulties Questionnaire (SDQ); and insomnia severity was measured by Insomnia Severity Index (ISI). Frequent nightmares were defined as having nightmares at least once per week. Suicidality was defined by the presence of suicidal ideation over the past two weeks. Results 45.4% of the participants reported having frequent nightmares, and 29.4% of the participants reported suicidal ideation over the past two weeks. Frequent nightmares (OR =1.53, 95% CI: 1.36 - 1.71), insomnia (OR = 1.13, 95% CI: 1.10 - 1.15) and emotional and behavioral problems (OR = 1.04, 95% CI: 1.03 - 1.05), age (OR = 0.93, 95% CI: 0.88- 0.98) were all found to be significantly associated with suicidality. Path analyses revealed that emotional and behavioral problems partially mediated the relationship between frequent nightmares and suicidality among adolescents (b = .03, 95% CI = .016, .051). The meditation effect remained significant after controlling age, gender, and insomnia severity. Conclusion Psychopathology mediates the relationship between nightmares and suicidality independent of the severity of insomnia. Nightmare disturbance and psychopathology should be taken into account in suicide prevention among adolescents. Future exploration on the mechanism underlying the link between nightmares and suicidality is needed. Support (if any)