مقاله انگلیسی رایگان در مورد اثر اسطه ای بی خوابی، افسردگی و اضطراب بر رابطه بین کابوس های شبانه نوجوانان – الزویر 2023

Abstract

Background

     The study explored the differences in nightmare, insomnia, depression, anxiety, and cognitive deficits among adolescents and the chain mediating effects of insomnia, depression, and anxiety on the relationship between nightmares and cognitive deficits in adolescents.

Methods

     An online survey was used to collect demographic data of 6014 adolescents and assess nightmare, insomnia, depression, anxiety, and cognitive deficits using the Chinese Version of Nightmare Distress Questionnaire, Insomnia Severity Index, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Perceived Deficits Questionnaire-Depression. Spearman correlation analysis and the SPSS function “PROCESS macro” were used for correlation and mediation analyses, respectively.

Results

     Female adolescents, senior high school, and poor academic performance had higher nightmare, insomnia, and cognitive deficit scores; those living in the city had higher depression and anxiety scores. Cognitive deficits were positively correlated with nightmares, insomnia, depression, and anxiety. Further, insomnia, depression, and anxiety had a chain mediating effect between nightmares and cognitive deficits in adolescents. Nightmares indirectly affect cognition deficits by affecting insomnia and then depression and anxiety symptoms.

Limitations

     As this was a cross-sectional study, the causal relationship between the variables could not be determined. Moreover, reporting bias and volunteer bias might be present.

Conclusions

     These findings suggest that clinicians should identify adolescents with frequent nightmares early and provide timely treatment to minimize negative outcomes and possibly limit the chronicity of nightmare disorder. It is significant to maintain the physical and mental health development of adolescents to reduce the risk of insomnia, depression, anxiety, and cognitive deficits.

Introduction

     Sleep disorders are an important issue affecting the health of adolescents. They impact important daily functions, such as behavior, emotion, learning, and so on, which has aroused widespread concern in society. Adolescents can experience several challenges that can seriously affect their sleep, including physical factors (such as internal circadian delay) and psychological development (such as school load, being ostracized by groups, parents’ divorce, etc.) (Dewald et al., 2010). The main symptoms of sleep disorders in adolescents include difficulty falling asleep, difficulty maintaining sleep, early awakening, and lack of sleep sense. Sleep disorders are diagnosed as symptoms that last for three months and occur at least three or more times a week (American Psychiatric Association, 2013). Sleep disorders are also a core symptom of many mental illnesses, such as depression, anxiety, and cognitive dysfunction. They can be a cause or a manifestation of mental illness (Alvaro et al., 2017).

     Nightmares are common among adolescents, which typically occur during REM sleep. According to statistics, 7 % of adolescents aged 12–18 years from China have had nightmares in the previous month (Chiu et al., 2012). The International Classification of Sleep Disorders, third edition (ICSD-3) defines nightmares as “coherent dream sequences that seem real and become increasingly more disturbing as they unfold. Emotions usually involve anxiety, fear or terror. The dream content most often focuses on imminent physical danger to the individual, but may also involve other distressing themes” (Mainieri et al., 2021). Evidence shows that nightmares are related to many negative health conditions, such as insomnia, drowsiness, emotional and behavioral disorders, post-traumatic stress disorder, and suicidal concept (Liu et al., 2019; Zhou et al., 2020; Liu et al., 2017; Karia et al., 2016; Russell et al., 2018). Nightmares affect daytime functioning, decrease overall well-being, increase anxiety and stress before and after sleep, and correspond to negative emotions (Schredl et al., 2021; Antunes-Alves and De Koninck, 2012; Carr et al., 2021).

Conclusion

     Studies of numerous Chinese adolescents have shown that nightmares are associated with cognitive deficits in adolescents. Furthermore, the link between nightmares and cognitive deficits was mediated mainly by insomnia, depression, and anxiety. These findings suggest that clinicians should identify adolescents with frequent nightmares early and provide timely treatment to minimize negative outcomes and possibly limit the chronicity of nightmare disorder. To reduce the risk of insomnia, depression, anxiety, and cognitive deficits, it is considerably important to maintain the physical and mental health development of adolescents.