Access Type

Open Access Dissertation

Date of Award

January 2011

Degree Type


Degree Name




First Advisor

Linda A. Lewandowski


Purpose: Exposure to trauma in youth is pervasive particularly among urban, African American teens. Nightmares are considered a hallmark symptom of Posttraumatic Stress Disorder (PTSD) and are associated with poor sleep quality and poor quality of life in adults. Research about nightmares in adolescents is lacking, and these relations have not been previously examined. The purpose of this study was to examine the relationships among nightmare frequency, nightmare distress, PTSD severity, sleep quality, and quality of life in teens.

Theory: The Roy Adaptation Model was used to conceptualize nightmares as focal stimuli reducing adaptation in teens. Nightmares may heighten memories of past trauma (contextual stimuli), and intensify PTSD. Sleep disruption impairs responses in physical and psychological adaptive modes, and impacts teen's adaptation.

Methods: A cross-sectional, predictive design with model testing was used. The sample (N=151) included African American teens, age 14 to 17, who are patients in an Adolescent Primary Health clinic in Detroit, Michigan. Data were analyzed by correlational, regression analyses, and Structural Equation Modeling was performed to examine direct and indirect paths of trauma exposure and nightmares, and mediating influences of sleep quality and PTSD symptoms on the relation between trauma, nightmares, and quality of life.

Findings: All teens in the study reported trauma exposure, and 52% had at least one nightmare in the prior month. Trauma, nightmare frequency, and nightmare distress predicted lower quality of life. Structural Equation Modeling confirmed that sleep quality mediated the relation between nightmare frequency and quality of life, and that PTSD symptomatology mediated the relation between nightmare distress and quality of life. Gender significantly influenced nightmare frequency and quality of life.

Conclusions: Use of sophisticated statistical analysis advanced study of nightmares. Understanding about the adverse outcomes of nightmares gained from this study make it clear that, in addition to vigilant assessment for nightmares, developmentally-appropriate treatments that target nightmares are needed. Nurses and health providers who work with trauma-exposed adolescents can utilize findings from this study to be the forerunners of helping reduce nightmares and improve health and quality of life for teens.

Included in

Nursing Commons