Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high‐risk adolescents and young adults

Abstract

Background: Identifying proximal risk factors for suicidal ideation that are modifiable and relevant for adolescents and young adults is critical for suicide prevention. This study used an intensive monitoring approach to examine whether objectively-and subjectively-measured sleep characteristics predict next-day suicidal ideation occurrence and intensity through affective reactivity to interpersonal events in young people at high risk for suicide. Methods: Participants included 59 (13-23 years; 76% White; 75% female) adolescents and young adults undergoing intensive outpatient program treatment for depression and suicidality. Participants completed daily ratings of suicidal ideation, sleep quality, and affective reactivity to positive and negative interpersonal events for up to 3 months (M = 56 days, SD = 24.13). Actigraphy captured behavioral sleep duration and timing. Multilevel modeling was used to evaluate within-person fluctuations in sleep and affective reactivity as predictors of suicidal ideation, and multilevel mediation tested the indirect effects of sleep on suicidal ideation via affective reactivity to interpersonal events. Results: Results indicate significant indirect effects of objectively measured sleep duration and subjective sleep quality on next-day suicidal ideation via affective reactivity to negative and positive interpersonal events, respectively. Shorter-than-usual sleep predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events. Worse sleep quality than usual predicted next-day suicidal ideation via reduced affective reactivity to positive interpersonal events. Conclusions: Affectivity reactivity is a proximal mechanism through which sleep indices may influence risk for suicidal thinking on a daily basis. Findings highlight the utility of targeting sleep and emotion regulation in suicide prevention among adolescents and young adults at high-risk for suicide.

Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments

“…Although there is no direct evidence that sleep problems influence an individual's self-regulatory behavior or diminish their capacity for self-control during a suicidal crisis, recent EMA research has shown that poor sleep quality and short sleep duration were temporally associated with suicidal ideation (74). Furthermore, an EMA study (75) with high-risk adolescents has found that shorter-than-usual sleep duration predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events, a finding in line with the DSMS. According to its assumptions, when a person has depleted self-regulatory resources to sleep deprivation they are not able to downregulate negative affect via effective emotion-regulation strategies and that results in affective dysregulation.…”

A protocol for applying health equity-informed implementation science models and frameworks to adapt a sleep intervention for adolescents at risk for suicidal thoughts and behaviors

“…These items will be deployed using links to a web-based form sent via SMS texts or emails, as in the sleep diary implementation. These items will be assessed in the evening and will include ratings of adolescents' mood; experiences of racism, discrimination, and victimization ( 101 ); and affective and behavioral regulation (impulsivity and reactivity to the day's most positive and negative event as in our prior work) ( 102 ).…”

Commentary: The potential of sleep research to contribute to our understanding on antisocial behaviour – a reflection on Brown, Beardslee, Frick, Steinberg and Cauffman (2022)

“…Here, I learnt about Hamilton et al. (2022)'s study that tests the relationship of sleep quality and duration with suicide ideation using exactly this sort of intensive monitoring design.…”

“…As I was writing this commentary, Journal of Child Psychology and Psychiatry's Early View Alert landed in my inbox. Here, I learnt about Hamilton et al (2022)'s study that tests the relationship of sleep quality and duration with suicide ideation using exactly this sort of intensive monitoring design.…”