A pilot study of sleep scholar: A single-session, internet-based insomnia intervention for college students with a history of suicide ideation

Sleep, hopelessness, and suicidal ideation: An ecological momentary assessment and actigraphy study

Recent research shows that sleep disturbances are linked to increased suicidal ideation. In the present longitudinal cohort study, we used subjective (ecological momentary assessment, EMA) and objective (actigraphy) measures to examine the effects of sleep parameters on next-day suicidal ideation. Further, we examined hopelessness as a mediator between insufficient sleep and increased suicidal ideation. Individuals with current suicidal ideation (N = 82) completed 21 days of EMA and actigraphy to estimate suicidal ideation, hopelessness and sleep parameters. Multilevel linear-mixed models were used to examine the effects of sleep parameters on next-day suicidal ideation, as well as for the mediating effect of hopelessness (in the morning) on the association between previous night's sleep and suicidal ideation levels the next day. Significant concordance existed between subjective and objective sleep measures, with moderate-to-large correlations (r = 0.44-0.58). Lower subjective sleep quality and efficiency, shorter total sleep time and increased time awake after sleep onset were significantly associated with increased next-day suicidal ideation (controlling for previous-day suicidal ideation). Actigraphy-measured sleep fragmentation was also a significant predictor of next-day ideation. Hopelessness mediated the effects of the subjective sleep parameters on suicidal ideation, but did not account for the association with sleep fragmentation. Therefore, individuals' psychological complaints (hopelessness, suicidal ideation) were better predicted by subjective sleep complaints than by objective sleep indices. Increased hopelessness following from perceived insufficient sleep appears an important explanatory factor when considering the link between sleep disturbances and suicidal ideation.

[Insomniac symptoms and suicidality-link and management]

BACKGROUND

A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention.

OBJECTIVE

We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management.

MATERIAL AND METHOD

Clinical example and selective Medline-literature research for insomnia symptoms and suicidality.

RESULTS

Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia.

CONCLUSION

patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Randomized controlled trial of cognitive refocusing versus stimulus control treatment for college insomnia: feasibility of a brief, electronic-based, and peer-led approach

OBJECTIVE

Performance of Cognitive Refocusing Treatment for Insomnia (CRT-I) relative to stimulus control treatment (SCT) remains unknown among college students. This pilot trial compared single-session, electronic-based, peer-led CRT-I to SCT, and as well as awareness-based (AC) and no-treatment (NTC) controls.

PARTICIPANTS

College students (N = 82; Mage=18.59 [SD = 0.78]; 58% female; 61% White; 16% Hispanic) with insomnia symptoms were randomly assigned to CRT-I (n = 12), SCT (n = 14), and AC (n = 14) conditions, or non-randomly recruited to NTC (n = 42).

METHODS

All participants completed baseline and one-month follow-up surveys, and reported daily task enactment (except NTC).

RESULTS

Feasibility ratings were comparable across conditions. Within-group treatment effects revealed greater improvements in (a) insomnia symptom severity among CRT-I (d = 1.13) and SCT (d = 1.66) groups relative to AC (d = 0.90) and (b) pre-sleep cognitive arousal among CRT-I (d = 0.94) and SCT (d = 1.42) groups relative to AC (d = 0.75).

CONCLUSIONS

Brief, electronic-based, peer-led CRT-I and SCT interventions appear feasible and potentially efficacious for college insomnia.