Sleep Problems Predict Next-Day Suicidal Thoughts Among Adolescents: A Multimodal Real-time Monitoring Study

• In Event: Using Developmental Science to Identify Mechanisms and Reduce Adolescent Suicidal Thoughts and Behaviors

Abstract

Suicidal thoughts and behaviors (STBs) are major public health concerns in youth (CDC, 2019). STBs initially begin during adolescence and rates increase drastically during this developmental period. Although previous research has helped identify which youth may be at risk for STBs, far less is known about when youth are at greatest risk and how risk is conferred over shorter time periods (i.e., hours and days). Sleep problems may be a particularly promising short-term risk factor for STBs in youth because they are transdiagnostic, time-varying, and treatment-targetable (Kearns et al., 2020). Though sleep problems have been linked with increased suicide risk over longer time periods (weeks and months) in research primarily conducted with adults, much less is known about the short-term associations between sleep problems and STBs, particularly in youth. Given the key developmental changes in sleep patterns in this age group (e.g., increased biological need for sleep), adolescents may be particularly sensitive to the negative effects of disrupted sleep. To examine short-term associations between sleep problems and STBs in youth, temporally sensitive methods, such as real-time monitoring techniques (Russell & Gajos, 2020; Trull & Ebner-Priemer, 2013) including ecological momentary assessment (EMA) and wrist-worn sensors (e.g., wrist actigraphy), are needed.

The current presentation will discuss findings from a recently completed real-time monitoring study that intensely monitored high-risk adolescents (n=53; 12-18 years old) for 28 days following discharge from acute psychiatric care for suicide risk (Glenn et al., 2020). A multimodal assessment of sleep problems was employed: Sleep quality and quantity were self-reported using daily sleep diaries (via smartphone-based EMA) and measured objectively using wrist-worn sensors (via wrist actigraphy). Suicidal thoughts (e.g., suicide ideation, suicide intent) were self-reported daily via smartphone-based EMA. We hypothesized that greater sleep problems (e.g., shorter sleep duration, presence of nightmares) would predict greater suicidal thoughts (e.g., desire for suicide, suicide intent) the next day.

Results indicated that poorer sleep quality and quantity, assessed among a range of sleep diary and actigraphy variables, predicted greater next-day suicidal thoughts. Specifically, the following sleep variables predicted next-day increases in suicidal thoughts: shorter sleep duration (assessed via sleep diary and actigraphy), poorer sleep efficiency (% of time spent asleep out of time in bed; actigraphy), presence of nightmares (sleep diary), and ruminative thoughts before bed (sleep diary). Findings from this study provide novel information about the temporal association between sleep problems and suicidal thoughts in adolescents during high-risk periods (such as following discharge from acute psychiatric care). This study represents a significant step toward improving our understanding of the development, short-term prediction, and ultimate prevention of STBs in youth. Study limitations include the small sample and limited power to detect individual differences or to predict suicidal behavior (a low base rate event). Future research is needed to examine the mechanisms linking sleep problems to increased STBs and to test whether sleep problems are a casual risk factor, and effective treatment target, for STBs in youth.

Authors

• Catherine R. Glenn, Old Dominion University
  Presenting Author

• Evan M. Kleiman, Rutgers University
  Non-Presenting Author

• Jaclyn C. Kearns, University of Rochester
  Non-Presenting Author

• Yeates Conwell, University of Rochester Medical Center
  Non-Presenting Author

• Linda J. Alpert-Gillis, University of Rochester Medical Center
  Non-Presenting Author

• Wilfred R. Pigeon, University of Rochester Medical Center
  Non-Presenting Author