Sleep difficulties and suicidality in youth: current research and future directions

Nonlinear relationships between sleep duration, mental health, and quality of life: The dangers of less sleep versus more sleep

BACKGROUND

Recent research has found a non-linear relationship between sleep duration and mental health/quality of life. However, it is currently unclear which age group is more affected by sleep duration and what the optimal sleep duration is for each age group. Additionally, the underlying mechanisms of the non-linear relationship between sleep duration and quality of life are not well understood.

METHODS

Therefore, this study utilized questionnaire data from 20,962 participants in the Chinese PBICR-2022 database(Cross-sectional study) and constructed models to analyze the relationship between sleep duration and quality of life.

RESULTS

The results showed that the optimal sleep duration varied among different age groups: approximately 9 h for adolescents, 8 h for early/middle-aged adults, and 7 h for older adults. Compared to other age groups, less or more sleep duration had a greater impact on mental health and quality of life in adolescents. Furthermore, mental health was found to play a significant mediating role between sleep duration and quality of life in both the less sleep group and the more sleep group, but this mediating effect was not significant among the older adults in the less sleep group, whereas the mediating effect of mental health was not significant among the middle-aged adults in the more sleep group.

CONCLUSIONS

This suggests that different age groups have different optimal sleep duration, and age may be an important factor influencing the relationship between sleep duration and mental health/quality of life, with mental health playing a mediating role in the relationship between sleep duration and quality of life.

Frequency of Vigorous physical activity and sleep difficulty in adolescents: A multiply-country cross-sectional study

BACKGROUND

Sleep is an essential health behavior, and sleep difficulties are strongly associated with adolescent health, potentially leading to more severe sleep disorders. The beneficial effects of physical activity (PA) in alleviating sleep difficulties have been well-documented. Numerous investigations reveal influence in moderate to high-intensity physical activity (PA) positively influences sleep quality. Despite these findings, a gap in the literature exists, particularly regarding the association between frequency of vigorous-intensity physical activity (VPA) and sleep difficulties.

AIM

This study aims to bridge the knowledge gap by exploring the link between sleep difficulty and frequency of VPA among adolescents. Insights are derived from analyzing data accumulated from the Health Behavior in School-aged Children (HBSC) project.

METHODS

The analysis in this study utilized cross-sectional data from the HBSC (2017/2018). The study sample comprised a total of 171,233 respondents aged 11, 13, and 15 years, with males representing 51.1% of sample. Measurement instruments included a self-administered questionnaire, providing direct insight into sleep difficulty and frequency of VPA levels. Statistical analysis on the associaiton between frequency of VPA and sleep difficulties was conducted using Generalized Linear Models.

RESULTS

50.0% of adolescents reported no sleep difficulties, while 12.3% experienced sleep issues daily. Additionally, 17.1% of adolescents engaged in frequency of VPA on a daily basis, while 6.4% never participated in such activities. daily VPA was associated with fewer sleep difficulties (OR = 1.07 [1.00, 1.15]), 4-6 times a week (OR = 1.08 [1.01, 1.15]), and 2-3 times a week (OR = 1.08 [1.02, 1.16]). However, no significant association was found between sleep difficulties and frequency of VPA in girls. Furthermore, a negative association was observed between sleep difficulties and all frequencies of VPA (p < 0.05) in 11-year-old adolescents. For 13-year-olds, daily VPA was significantly associated with fewer sleep difficulties (OR = 1.10 [1.02, 1.19]), 4-6 times a week (OR = 1.15 [1.07, 1.24]), 2-3 times a week (OR = 1.19 [1.10, 1.27]), and once a week (OR = 1.13 [1.05, 1.22]). However, no significant association was found between sleep difficulties and frequency of VPA in 15-year-old adolescents.

CONCLUSION

More participations in VPA would be an effective approach to reduce sleep difficulties in adolescents. Insights gleaned from this research illustrate a discernible link between sleep difficulty and frequency of VPA, particularly notable in male and 13-year-old participants. It is also imperative to underscore the variability in the connection between sleep difficulty and frequency of VPA, distinctly influenced by factors such as gender and age. Consequently, tailoring sleep intervention methodologies to align with the specific needs dictated by these variables emerges as a pivotal recommendation.

How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: The serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury

OBJECTIVE

Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self-control, and nonsuicidal self-injury (NSSI).

METHODS

From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13-19 years) three times, 6 months apart.

RESULTS

In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one-mediator path of negative emotions, low self-control, and NSSI, respectively; two-mediator path of negative emotions via low self-control, negative emotions via NSSI, and low self-control via NSSI, and three-mediator path from negative emotions to NSSI via low self-control.

CONCLUSIONS

This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self-control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents.

Sleep disruption in adolescent inpatients: prevalence, associations with clinical outcomes, and clinician perspectives

Sleep problems are common for adolescents with psychiatric disorders, and sleep treatment may aid mental health recovery. Inpatient admissions are likely a particularly challenging time for sleep. Despite this little is known about the nature of sleep problems, and how sleep treatments could be optimised for this setting. This mixed-methods study set out to better understand sleep disturbances in adolescent inpatients. Study 1 examined the prevalence of Sleep Condition Indicator-assessed insomnia at admission and associations with psychiatric symptoms and admission length in 100 inpatients (aged 11-17 years) on one unit in Oxford. Data were gathered from admission routine measures and medical records. Associations were analysed using linear regressions. Half of the inpatients (n = 50) screened positive for insomnia at admission. Moderate-large significant associations were observed between more severe insomnia and more severe depression (β = -0.56), anxiety (β = -0.51), self-harm (β = -0.49), psychotic experiences (β = -0.32), and conduct problems (β = -0.30), but not admission length. Study 2 gained 12 clinicians' perspectives on sleep problems on the unit via a focus group and semi-structured interviews, analysed using thematic analysis. Ward staff observed insomnia and excessive daytime sleepiness in adolescent inpatients and a reciprocal relationship with mental health symptoms. Ward processes were barriers (e.g., night-time observations) and facilitators (e.g., regular routines) of sleep. Cognitive behavioural therapy for insomnia was not routinely offered but viewed as potentially helpful. Insomnia may be a common problem for adolescent inpatients, associated with greater psychopathology, but not admission length. The possible benefits of psychological sleep interventions for adolescents admitted to psychiatric units now require testing.

Maturational trend of daytime sleep propensity in adolescents

STUDY OBJECTIVES

The teenage increase in sleepiness is not simply a response to decreasing nighttime sleep duration. Daytime sleepiness increases across adolescence even when prior sleep duration is held constant. Here we determine the maturational trend in daytime sleep propensity assessed with the multiple sleep latency test (MSLT) and assess the trend's relation to pubertal maturation and changes in the sleep electroencephalogram. We also evaluate whether the relation of daytime sleep propensity to prior sleep duration changes between ages 10 and 23 years.

METHODS

Participants (n = 159) entered the study between ages 9.8 and 22.8 years and were studied annually for up to 3 years. Annually, participants kept each of three sleep schedules in their homes: 7, 8.5, and 10 hours in bed for 4 consecutive nights with polysomnography on nights 2 and 4. MSLT-measured daytime sleep propensity was assessed in the laboratory on the day following the fourth night.

RESULTS

A two-part linear spline model described the maturation of daytime sleep propensity. MSLT sleep likelihood increased steeply until age 14.3 years, after which it did not change significantly. The maturational trend was strongly associated with the adolescent decline in slow-wave (delta, 1-4 Hz) EEG power during NREM sleep and with pubertal maturation assessed with Tanner stage measurement of breast/genital development. The effect of prior sleep duration on sleep likelihood decreased with age.

CONCLUSIONS

Adolescent brain changes related to pubertal maturation and those reflected in the delta decline contribute to the adolescent increase in daytime sleep propensity.

Attentional Control Accounts for the Association Between Anxiety Sensitivity and Sleep Efficiency in Clinic-Referred Youth

Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.

Sleep disturbance and suicidality in psychiatrically hospitalized adolescents: The role of specific emotion regulation domains

BACKGROUND

Sleep disturbance is associated with broadband measurements of emotion regulation (ER). The linkage between ER, a multidimensional process, and suicidal ideation and suicide attempt is also documented in theoretical and empirical work. Recent research indicates that distinct profiles of ER are associated with psychiatric outcomes, including adolescent suicidal ideation and attempt. The present study examined whether specific domains of ER would explain the association between sleep disturbance, and ideation and attempt among psychiatrically hospitalized adolescents.

METHOD

The sample included 284 adolescents who completed self-report measures on sleep disturbance, ER, suicidal ideation, suicide attempt, and psychiatric symptoms upon inpatient hospitalization.

RESULTS

Findings indicated that sleep disturbance was associated with suicidal ideation. Further, a single ER domain (perceived limited access to ER strategies) fully accounted for the significant association between sleep disturbance and suicidal ideation. A reported suicide attempt in the past week was correlated with the nonacceptance of emotional responses, perceived limited access to ER strategies, and emotional clarity, but was not associated with sleep disturbance.

DISCUSSION

The current findings highlight the importance of examining narrowband ER and indicate the presence of differential associations between sleep disturbance, ER, and suicide-related outcomes. Findings further elucidate the possible role of impaired cognitive responses to emotional experiences in the co-occurrence of sleep disturbance and youth psychiatric outcomes.

Associations between sleep complaints, suicidal ideation and depressive symptoms among adolescents and young adults in Greece

Depression prevalence increases significantly during adolescence/early adulthood. Depression in youth may present suicidal ideation, while suicide represents the leading cause of death in this age group. Moreover, adolescents/young adults frequently report sleep complaints that may partially be due to depressive symptoms. Studies on the associations between depression, sleep complaints and suicidality in this age group are limited. We aimed to examine associations between depressive symptoms, sleep complaints and suicidal ideation in a large (n = 2771), representative sample of adolescents (age: 15-17 years, n = 512) and young adults (age: 18-24 years, n = 2259) from the general population in Greece. A telephone structured questionnaire was administered. Depressive symptoms were assessed using the modified Patient Health-7 questionnaire score, while presence of suicidal ideation and sleep complaints were assessed using the ninth and third question of Patient Health-9 questionnaire, respectively. Mediation logistic regression analysis revealed significant direct paths from depressive symptoms to sleep complaints (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.19-1.24; OR 1.21, 95% CI 1.18-1.24) and suicidal ideation (OR 1.18, 95% CI 1.14-1.22; OR 1.18, 95% CI 1.14-1.22), as well as sleep complaints and suicidal ideation (OR 1.82, 95% CI 1.32-2.50; OR 1.91, 95% CI 1.33-2.76) in the total group and in young adults, respectively, but not among adolescents. Moreover, we detected a significant indirect effect of depressive symptoms on suicidal ideation mediated by sleep complaints (18.8%) in young adults. These findings support the hypothesis that treatment of sleep disturbances among youth with depression may independently further reduce suicidal risk.

Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry

INTRODUCTION

Suicidality in youth is a serious public health problem. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was initiated in 2020 to create a research registry for youth with depression and/or suicidality in Texas. This report presents baseline clinical/demographic characteristics of the first 1000 participants, focusing on suicidal thoughts and behaviors.

METHODS

The registry includes 8-20-year-old youth receiving treatment for depression, or who screen positive for depression and/or suicidal ideation/behavior. Baseline data include diagnosis, depression/anxiety severity, suicidal ideation/behavior, trauma history, and measures of resilience.

RESULTS

We present baseline data on the first 1000 participants. Most (79.6%) of the sample had a primary depressive disorder. The sample had moderate to severe depression (Patient Health Questionnaire for Adolescents, PHQ-A; 12.9 ± 6.4) and anxiety (Generalized Anxiety Disorder, GAD-7; 11.3 ± 5.9). Nearly half reported ≥1 lifetime suicide attempts and 90% reported lifetime or current suicidal ideation. Participants with past/current suicidality (attempts and/or ideation) had greater illness severity (depression, anxiety, and suicidal thoughts/behaviors), lower resilience, and higher rates of trauma exposure than those without suicidality.

CONCLUSIONS

Baseline data indicate moderate levels of depression, anxiety, and suicidality and their correlates in this cohort. Future reports will determine trajectories of outcomes and predictors, moderators, and social determinants related to these outcomes.

Early childhood sleep problems predict increased risk for the later development of suicidal thoughts

Suicidal thoughts and behaviors in youth are an escalating and immediate public health concern. To better understand youth suicidal thoughts and behaviors, it is important to identify risk factors in early childhood that predict the later emergence of youth suicidal thoughts and behaviors. Research with adults and adolescents has identified sleep disturbances as a risk factor for suicidal thoughts and behaviors, but this has yet to be examined in early childhood. Using a prospective, 17-year longitudinal design, the current study explored the association between early childhood sleep disturbances and concurrent and later suicidal thoughts and behaviors (in separate models) across childhood and adolescence. Results indicate that sleep problems in early childhood are associated with increased probability for suicidal thoughts after age 8, even when controlling for prior and concurrent depression severity. Our findings suggest that early childhood sleep difficulties warrant increased clinical attention and management, as they may contribute to the maintenance and exacerbation of suicidal thoughts over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors Associated With Sleep Disturbance Amongst Youth With Bipolar Disorder

BACKGROUND

While sleep disturbances and their impact on functioning are well-established in adults with bipolar disorder (BD), little is known about this topic in youth.

OBJECTIVE

This study investigates the prevalence and correlates of sleep disturbance among youth with BD.

METHODS

The study included 103 youth (72 BD, 31 healthy controls [HC]), ages 14-20 years. Study measures included a semi-structured diagnostic interview and the Pittsburgh Sleep Quality Index (PSQI). PSQI yields a global score and 7 subscale scores. Analyses examined between group differences in PSQI scores, and correlates of PSQI within BD.

RESULTS

BD youth had significantly higher (worse) global sleep scores, and higher scores on 5/7 subscales (quality, latency, disturbance, sleep medication use, daytime dysfunction). In univariate analyses, poorer sleep quality was associated with higher lifetime and current depression severity, mixed mood state, self-reported affective lability, and borderline personality traits. Lifetime lithium treatment and euthymic mood state were associated with better sleep scores. In multivariate analyses, greater current depression severity and self-reported affective lability were most robustly associated with poor sleep quality.

CONCLUSIONS

Converging with data from adults, present findings indicate greater sleep disturbance among youth with BD versus HC. Also convergent with adults with BD, mood disturbance, whether depression severity or emotional lability, comprised the predominant correlates of sleep disturbance among youth with BD. Future research is warranted to better understand the temporal association between sleep disturbance and its correlates in youth with BD. Relatedly, interventions that address both mood and sleep disturbances may help improve overall functioning.

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

Background

Effective and equitable strategies to prevent youth suicidal thoughts and behaviors (STB) are an urgent public health priority. Adolescent sleep disturbances are robustly linked to STB but are rarely addressed in preventive interventions or among Black and/or Hispanic/Latinx youth for whom STB risk is increasing disproportionately. This paper describes an application of health equity-informed implementation science models and frameworks to adapt and evaluate the evidence-based Transdiagnostic Sleep and Circadian (TSC) intervention for primary care implementation with adolescents of minoritized backgrounds with depression and STB risk.

Methods

This multiphase study protocol uses the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, Testing (ADAPT-ITT) model to adapt and evaluate TSC for primary care implementation with adolescents who are depressed, at risk for STB, and of primarily Black and/or Hispanic/Latinx backgrounds. We integrate the Consolidated Framework for Implementation Research (CFIR) in an initial qualitative inquiry of adolescent, caregiver, and clinician perceptions of TSC. Subsequent ADAPT-ITT phases include systematically and iteratively testing adaptations based on the qualitative inquiry, with ongoing key informant input, and then evaluating the adapted TSC for feasibility, acceptability, and efficacy in a pilot randomized trial.

Anticipated results

Based on youth depression and sleep health disparities research, we expect that TSC adaptations will be needed to enhance intervention content for adolescents with depression, STB risk, and primarily Black and/or Hispanic/Latinx backgrounds. We also anticipate adaptations will be needed to align TSC delivery methods with primary care implementation.

Conclusions

Adapting evidence-based interventions with end-users and contexts in mind can help ensure that intervention strategies and delivery methods are acceptable to, and feasible with, health disparate populations. Although TSC has shown effectiveness for adolescents with sleep disturbances, we expect that additional multiphase research is necessary to optimize TSC for primary care delivery with Black and/or Hispanic/Latinx adolescents with depression and STB risk.

Sleep to Internalizing Pathway in Young Adolescents (SIPYA): A proposed neurodevelopmental model

The prevalence of internalizing disorders, i.e., anxiety and depressive disorders, spikes in adolescence and has been increasing amongst adolescents despite the existence of evidence-based treatments, highlighting the need for advancing theories on how internalizing disorders emerge. The current review presents a theoretical model, called the Sleep to Internalizing Pathway in Young Adolescents (SIPYA) Model, to explain how risk factors, namely sleep-related problems (SRPs), are prospectively associated with internalizing disorders in adolescence. Specifically, SRPs during late childhood and early adolescence, around the initiation of pubertal development, contribute to the interruption of intrinsic brain networks dynamics, both within the default mode network and between the default mode network and other networks in the brain. This interruption leaves adolescents vulnerable to repetitive negative thought, such as worry or rumination, which then increases vulnerability to internalizing symptoms and disorders later in adolescence. Sleep-related behaviors are observable, modifiable, low-stigma, and beneficial beyond treating internalizing psychopathology, highlighting the intervention potential associated with understanding the neurodevelopmental impact of SRPs around the transition to adolescence. This review details support for the SIPYA Model, as well as gaps in the literature and future directions.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Sleep Moderates Improvements in Mental Health Outcomes in Youth: Building Resilience for Healthy Kids

PURPOSE

To examine the role of sleep in a school-based resiliency intervention.

DESIGN

Single group feasibility study.

SETTING

Urban middle school Subjects: Sixth grade students Intervention: A total of 285, 11-12-year-old students (70% White, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth (n=248) completed electronic surveys at pre-post the 6-week study assessing mental health parameters and self-reported bed and wake time.

MEASURES

Students were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night.

ANALYSIS

General linear models examined differences between groups for each mental health parameters pre-post study.

RESULTS

A third of participants (28%) were classified as having insufficient sleep opportunity. Youth with insufficient sleep were more often Hispanic (27% vs 16%; p<0.001) and were more often classified with both mild to severe depression and anxiety symptoms (55% vs 35%; p=0.004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.

CONCLUSIONS

Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency interventions.

Factors of suicidal behavior among inpatients with major depressive disorder: A retrospective case series

OBJECTIVE

Previous studies indicate that more than half of those who died by suicide had a depressive disorder. When discussing the factors associated to suicidal behavior (SB) among patients with major depressive disorder (MDD), sociocultural contexts should also be carefully considered. This case series study explored the factors correlated to SB among MDD patients in Beijing, China.

METHODS

The patient information sheets were retrieved from an electronic database that comprised patient medical information. Three forms of binary logistic regression equations were conducted to explore the factors associated to SB among patients with MDD. For the inconsistent variables produced by the three regression models, the propensity score matching (PSM) analysis was done for further verification.

RESULTS

In this retrospective study, 1,091 depressed cases were enrolled. The difference between the SB group and non-SB group in gender, impulsivity, the severity of depression, history of major mental trauma, and family history of suicide were statistically significant in univariate comparisons (P < 0.05); the binary logistic regression analysis and the PSM analysis showed that female gender, history of major mental trauma, impulsivity, family history of suicide and severity of depression were factors correlated to SB among patients with MDD (odds ratios >1).

CONCLUSIONS

Female gender, the history of major mental trauma, impulsivity, the severity of depression, and family history of suicide were independently associated with the appearance of SB among MDD patients in Beijing, China. Inevitably, these findings should be viewed with particular caution due to the inherent drawbacks of a retrospective nature. More prospective longitudinal research should be conducted to examine those dynamic alterations in the corresponding confounders.

Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

Sleep problems and emotional dysregulation mediate the relationship between childhood emotional abuse and suicidal behaviors: A three-wave longitudinal study

BACKGROUND

Suicide is a major public health safety concern among youth. Childhood emotional abuse is one of the most widely recognized risk factors for suicidal behaviors. However, little is known about the role of sleep problems and emotion dysregulation in this relationship.

METHODS

This study is part of a large-scale health-related cohort among Chinese college students. A total of 7434 participants who completed the first three waves of data collection were used for data analysis. All participants completed questionnaires regarding childhood emotional abuse (Wave 1), sleep problems and emotional dysregulation (Wave 2), and suicidal behaviors (Wave 3). Mediation analyses with bootstrapping were conducted to investigate the mediating role of sleep problems and emotional dysregulation in the relationship between childhood emotional abuse and suicidal behaviors.

RESULTS

The results showed that the prevalence of childhood emotional abuse and suicidal behaviors were 8.7% and 5.9%, respectively. Findings from mediation analysis showed that sleep problems and emotional dysregulation served both parallel and sequential mediating roles in the relationship between childhood emotional abuse and suicidal behaviors.

LIMITATIONS

All measures were based on self-report instead of objective assessments or clinical diagnostic evaluations.

CONCLUSIONS

Psychological interventions aimed at developing healthy sleep habits and emotion regulation skills may be helpful in decreasing the risk of suicidal behaviors, especially for suicide ideators with childhood emotional abuse.

Longitudinal predictors of suicidal ideation: Emerging to early adulthood

Few studies have examined the longitudinal trajectory of suicidal ideation (SI) in community samples, particularly during emerging adulthood. Additionally, there is scant data on predictors of longer-term course of SI across this period. We examined multiple domains of adolescent psychosocial and clinical functioning as predictors of SI trajectory and explored whether biological sex moderates those associations. The data came from the Oregon Adolescent Depression Project. Participants completed self-reports of psychosocial and clinical functioning and interviews assessing psychopathology in mid-late adolescence. SI was assessed using up to seven annual mailer assessments spanning ages 19-31. Multilevel growth models found that SI declined across emerging adulthood. Multiple indices of adolescent functioning were associated with higher levels of SI three years later. Few adolescent functioning constructs predicted faster reductions in SI, and no constructs predicted slower longitudinal reductions (or increases) in SI. Similar associations were found when controlling for adolescent SI. Lastly, we found little evidence for sex differences in these associations. This work shows that adolescent functioning is largely associated with initial and enduring levels of SI. Moreover, associations were similar between sexes. Given the modest associations found across long periods of time, future research should focus on proximal risk factors for SI.

Evidence of sleep duration and weekend sleep recovery impact on suicidal ideation in adolescents with allergic rhinitis

STUDY OBJECTIVES

Sleep problems are common in allergic rhinitis (AR) and are a modifiable risk factor for suicidal ideation. However, the effect of sleep duration and weekend catch-up sleep (WCUS)-sleep time on weekends that exceeds sleep time on weekdays-on suicidal ideation for adolescents with AR is unknown. The objective of this study was to explore whether sleep duration and WCUS have an impact on suicidal ideation among adolescents with AR.

METHODS

From the annual Korean Youth Risk Behavior Web-Based Surveys (completed from 2013-2017), data were obtained from a stratified, multistage, clustered sample. Using self-reported questionnaires, students provided doctor-diagnosed AR and sleep time.

RESULTS

Among 134,417 and 262,653 adolescents with and without AR, respectively, those with AR compared with those without AR had more sleep dissatisfaction (46.6% vs 40.8%), slept less (sleep duration: 6.71 ± 1.37 hours vs 7.01 ± 1.48 hours), and had longer WCUS (3.46 ± 0.11 hours vs 2.11 ± 0.14 hours). After adjustment, the odds ratio of patients with sleep dissatisfaction was a 1.22 (95% confidence interval, 1.17-1.28) times higher risk of suicidal ideation than in those with sleep satisfaction. For average sleep duration (defining 7-8 hours as the reference), the odds ratio of short sleep (≤ 5 hours) was 1.45 (95% confidence interval, 1.32-1.53). Notably, long WCUS (≥ 2 hours) was significantly associated with decreased suicidal ideation (odds ratio, 0.85; 95% confidence interval, 0.81-0.92).

CONCLUSIONS

Although further research is needed to clarify this association, under the condition of sleep deprivation, WCUS at a certain extent may be associated with a low risk for suicidal ideation in adolescents with AR.

CITATION

Kim CW, Jeong SC, Hwang SW, Jo SH, Kim SH. Evidence of sleep duration and weekend sleep recovery impact on suicidal ideation in adolescents with allergic rhinitis. J Clin Sleep Med. 2021;17(8):1521-1532.

Prevalence, risk factors and clinical correlates of suicidal ideation in adolescent patients with depression in a large sample of Chinese

BACKGROUND

Suicidal ideation (SI) has a high risk in adolescents and is now a significant concern due to its problematic outcome. However, few systemic studies of suicidal ideation have been conducted in adolescent patients. Therefore, the current study was aimed to assess the prevalence and its clinical correlate of suicidal ideation among adolescent patients with depression.

METHODS

A total of 1635 adolescent patients (748 males/ 887 females) with depression were recruited in this study. The clinical and demographic data were collected by a self-administered questionnaire. Suicidal ideation was assessed by interview. Children's Depression Inventory (CDI) was used to evaluate depressive symptoms, Adolescent Self-Rating Life Events Check List (ASLEC) was used to assess the stressful life events.

RESULTS

The study showed that the prevalence of suicidal ideation in adolescent depression patients was 38.2% (625/1635). Compared to the non-SI patients, SI patients had greater scores on CDI and ASLEC, had inadequate sleeping time, and were more likely to be females. Further logistic regression analysis indicated that suicidal ideation in adolescent patients with depression was significantly associated with females, inadequate sleeping time, the severity of depression, and higher learning pressure.

LIMITATIONS

No causal relationship could be drawn due to the cross-sectional design.

CONCLUSIONS

Our results suggest a high prevalence of suicidal ideation in adolescents with depression. Moreover, the severity of depression, sex, sleep time, and learning pressure are all related to suicidal ideation. Early recognition and treatment of suicidal ideation can effectively prevent the occurrence of suicide among adolescent patients.

The prospective associations between different types of sleep disturbance and suicidal behavior in a large sample of chinese college students

BACKGROUND

Sleep disturbance can be an important predictor associated with suicide behaviors. However, to date, few studies have examined the prospective relationships between different types of sleep disturbance and suicidal behaviors. The current study examined which sleep disturbance types were independent risk factors for subsequent suicidal behaviors in a large sample of Chinese college students.

METHODS

Data came from a large-scale health-related cohort study in Guangdong, China. Participants were 11,740 college students initially assessed in March and April in 2019 and reassessed six month later. Self-administered structured questionnaires were used to assess suicidal behaviors, insomnia, nightmares, sleep disordered breathing (SDB) symptoms, restless legs syndrome (RLS) symptoms, depression, substance abuse and demographic characteristics. A series of logistic regression analyses were conducted to examine the associations between different types of sleep disturbance and suicidal behaviors.

RESULTS

Overall, 12.2% and 1.2% of college students reported suicidal ideation and attempts at baseline, and 8.6% and 2.4% reported similar behavior at follow-up. After adjustment for key covariates and prior suicidal behaviors, frequent nightmares (AORs = 1.35-1.69) and RLS symptoms (AOR = 1.37) at baseline predicted subsequent suicidal ideation, and only frequent nightmares (AOR = 2.40) at baseline predicted subsequent suicidal attempts.

LIMITATIONS

All measures were based on self-report instead of objective assessments or clinical diagnostic evaluations.

CONCLUSIONS

Frequent nightmares and RLS symptoms were independently associated subsequent suicidal ideation or attempts. Screening and managing sleep disturbance may be helpful for reducing the risk of suicidal behaviors among college students.

Identification of influencing factors for suicidal ideation and suicide attempts among adolescents: 11-year national data analysis for 788,411 participants

Suicide is one of the most common causes of death in adolescents. This study identified trends in the prevalence of and factors influencing suicidal ideation and attempts among Korean adolescents. Data were drawn from the third through the thirteenth (2007-2017) annual Korean Youth Risk Behavior Web-based Surveys. Participants included stratified, multistage clustered samples selected from 400 middle schools and 400 high schools annually. Depression, suicidal ideation, and suicide attempts were binary dependent variables (requiring answers of yes or no). A total of 818,684 adolescents were targeted and 788,411 adolescents completed the survey. The prevalence rates of both suicidal ideation and attempts gradually decreased from 23.7% and 5.8%, respectively, in 2007 to 12.1% and 2.6%, respectively, in 2017. Overall, 16.8% of participants had suicidal ideation and 3.9% had suicide attempts during the survey period. During logistic regression analysis, depression was most strongly associated with suicidal ideation (adjusted odds ratio: 5.78 [95% confidence interval: 5.64-5.88]) and suicide attempts (adjusted odds ratio: 5.56, [95% confidence interval: 5.22-5.83]). Despite decreasing trends, the high rate of suicidal behaviors remains a critical public health problem. Depression most strongly predicts suicidal behaviors. Early interventions are essential to treat depression and reduce or prevent suicide.

Allergic Disease, Short Sleep Duration, and Suicidal Ideation and Plans Among Korean Adolescents

The purpose of the study is to identify the relationships between allergic disease, suicidal ideation, and plans among Korean adolescents. Additionally, we examined the mediating role of short sleep duration. We analyzed nationally representative cross-sectional data from the 12th to 14th Korea Youth Risk Behavior Web-Based Survey; the final sample included 164,725 middle school-aged and high school-aged adolescents (mean age = 15.17 years, standard deviation = .13; 51.1% male). Allergic disease was a statistically significant risk factor for suicidal ideation (crude odds ratio [COR] = 1.284, 95% confidence interval [CI] = [1.246, 1.323]) and suicide plans (COR = 1.165, 95% CI = [1.108, 1.224]). Short sleep duration was a statistically significant mediator (p < .001). We advised school nurses to assess warning signs of poor sleep-including irritability, depression, sleep problems, poor concentration, and poor academic achievement-and that programs be created to improve sleep and mental health in adolescents with allergic disease.