Nightmare distress: Mediating sleep quality and depressive symptoms in Chinese college students

This study aimed to explore the role of nightmare distress as a mediator in the relationship between sleep quality and depressive symptoms among Chinese college students. Conducted from September 2023 to October 2023, the study included 1307 students from Guangdong Province, China. Utilizing mediation analyses and bootstrapping methods, we assessed the interplay between sleep quality, depressive symptoms, and the distress caused by nightmares. Of the 1307 students who participated, 37.80 % reported inadequate sleep quality, 41.78 % exhibited depressive symptoms, and 40.63 % experienced distressing nightmares. The study found that depressive symptoms were significantly correlated with both poor sleep quality (β = 0.22, CI = 0.17-0.27) and high levels of nightmare distress (β = 0.15, 95 % CI = 0.12-0.18). Likewise, poor sleep quality was associated with higher depressive symptoms (β = 0.22, 95 % CI = 0.16-0.27) and increased nightmare distress (β = 0.16, 95 % CI = 0.14-0.19). The overall impact of nightmare distress on (sleep quality-nightmare distress-depressive symptoms) and (depressive symptoms -nightmare distress-sleep quality) were substantial, accounting for 68.83 % and 75.45 %, respectively. The differences are more pronounced in women compared to men (65.59 % vs 72.66 % and 71.66 % vs 78.73 %). These findings suggest that nightmare distress may significantly mediate the relationship between poor sleep quality and depressive symptoms. The results highlight the importance of addressing nightmare distress in clinical interventions aimed at reducing depressive symptoms and improving sleep quality among university students.