Insomnia symptoms and non‐suicidal self‐injury in adolescence: understanding temporal relations and mechanisms

Abstract

We propose a theoretical model of insomnia symptoms and non‐suicidal self‐injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; Mage = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß23 = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß12 = 0.09, p = .01; ß23 = 0.11, p < .001). In addition, depressive symptoms (ßind = 0.01, p = .02), but not impulsivity (ßind = 0.01, p = .09), mediated the path from insomnia to increased NSSI. Neither worry (ßind = 0.00, p = .59) nor rumination (ßind = 0.00, p = .96) mediated the link between NSSI and increased insomnia. We conclude that NSSI and insomnia maintain each other over time. Thus, screening adolescents for insomnia symptoms may help identify those at risk of NSSI. Although depression seems to explain why insomnia is a risk factor for NSSI, further studies should investigate why NSSI plays a role in the maintenance of insomnia. This understanding will lay the foundation for intervention.

Associations of depressive and anxiety symptoms with non-suicidal self-injury and suicidal attempt among Chinese adolescents: The mediation role of sleep quality

“…The associations between depressive symptom, anxiety symptom, sleep quality, and NSSI and SA are complex. A longitudinal study of 1,457 Swedish adolescents found that depressive symptoms could explain why insomnia was a risk for NSSI ( 49 ). Liu and colleagues also found that the association between frequent nightmares and NSSI could mediate through depressive symptoms ( 50 ).…”

Recent advances in sleep and depression

“…Recent research has also considered the role of features such as circadian preference (specifically, evening circadian preference) in the development and maintenance of depression [7,8]. Among adults with depression, sleep disturbance is associated with greater depressive symptom severity [9,10], lower rates of remission from depression [11], higher risk of depression relapse [12], and increased risk for suicidal thoughts and behaviors and nonsuicidal self-injury [13][14][15][16][17], and is the symptom most likely to persist following treatment remission [18,19].…”

A Rhesus Monkey Model of Non-suicidal Self-Injury

“…The most common forms of dysregulated sleep endorsed by individuals with NSSI were insomnia, nightmares, and poor sleep quality. Insomnia was significantly associated with NSSI in a community sample of adolescents, an effect that persisted after controlling for depressive symptoms ( Latina et al, 2021 ), and also in a survey of Norwegian adolescents ( Hysing et al, 2015 ). Insomnia symptoms were additionally linked to the recency of NSSI ( Bandel and Brausch, 2020 ).…”