Nightmare frequency mediates the association between childhood trauma and suicidal ideation among youth: is it sex-specific?

Childhood trauma has been found to be associated with suicidal ideation among youth. However, the underlying processes that link childhood trauma and suicidal ideation are unclear. This study investigates the role of nightmare frequency in the association between childhood trauma and suicidal ideation, and the potential moderating effect of sex. Youths were recruited from Fujian Province, China. Childhood trauma was assessed using the Childhood Trauma Questionnaire, and the frequency of nightmares and suicidal ideation were also evaluated. Moderated mediation analyses were conducted with childhood trauma as the independent variable, suicidal ideation as the dependent variable, nightmare frequency as the mediator variable, and sex as the moderator. All statistical analyses were performed in R (version 4.2.3). A total of 3431 individuals completed all the questions assessing childhood trauma, nightmare frequency, and suicidal ideation. Among them, 28.6% reported having experienced suicidal ideation in the past 12 months. Additionally, 25.9% of participants reported frequent nightmares. The association between childhood trauma and suicidal ideation was significantly mediated by nightmare frequency, with an effect size of 0.003 (bootstrap 95%CI: 0.001, 0.005). The indirect effects accounted for approximately 4.11% of the overall effect. However, there was no statistically significant moderating effect of sex on the association between childhood trauma and nightmare frequency. The findings of this study suggest that treating nightmares may serve as a promising intervention target for addressing suicidal ideation in youth with a history of childhood trauma, irrespective of sex.