The Effect of Sleep Problems on Suicidal Risk among Young Adults in the Presence of Depressive Symptoms and Cognitive Processes

Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents

BACKGROUND

A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor.

METHOD

Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship.

RESULTS

The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %.

LIMITATIONS

The cross-sectional study design could not prove causation.

CONCLUSIONS

There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

The pain and relief of grief: Mental pain and mental pain acceptance associations with post-loss pathologies and growth among young widows and widowers

Mental pain is a core symptom of bereavement, yet its study with grief pathologies is still scarce. Mental pain acceptance may also affect the associations between mental pain, grief pathologies, and post-loss growth (PLG). The current study aims to investigate the associations between mental pain, mental pain acceptance, and post-loss outcomes in a sample of young widow(er)s. 257 young Israeli widow(er)s completed questionnaires assessing mental pain, mental pain acceptance, depression, complicated grief (CG), suicidal risk and PLG. Paths analyses revealed that depression mediated the positive associations between mental pain and suicidal risk and CG, and mental pain acceptance moderated the positive association between mental pain and depression. Mental pain acceptance also moderated the negative association between mental pain and PLG. The study's findings highlight the crucial role of mental pain and mental pain acceptance in the associations between adverse and favorable post-loss outcomes among bereaved individuals.

Examining bidirectional relations between sleep problems and non-suicidal self-injury/suicidal behavior in adolescents: emotion regulation difficulties and externalizing problems as mediators

Based on previous empirical evidences and theoretical framework, sleep problems and non-suicidal self-injury (NSSI)/suicidal behavior may bidirectionally related to one another. However, this still needs to be examined through longitudinal research. Moreover, the mediating mechanisms accounting for their potential bidirectional relations have yet to be fully investigated. This study thus aimed to evaluate whether sleep problems and NSSI/suicidal behavior promoted each other directly or indirectly through the mediating roles of emotion regulation difficulties (ERD) and externalizing problems. A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82; Age range = 11-16 years old at T1) completed self-report measures on 3-time points across 1 year. Cross-lagged panel models were used to examine the focal longitudinal associations. Results revealed a predictive effect of sleep problems on NSSI and a positive bidirectional relation between sleep problems and suicidal behavior. Moreover, sleep problems exerted an indirect effect on NSSI through ERD, and vice versa. Additionally, both ERD and externalizing problems served as mediators in the pathway from suicidal behavior to sleep problems. This study disentangled the differential mediating roles of ERD and externalizing problems in the longitudinal associations between sleep problems and NSSI/suicidal behavior, which may help provide a more holistic theoretical framework through which to precisely identify key targets for early prevention and intervention of sleep problems and NSSI/suicidal behavior in adolescents.

The Clinical Sequelae of the COVID-19 Pandemic: Loneliness, Depression, Excessive Alcohol Use, Social Media Addiction, and Risk for Suicide Ideation

BACKGROUND

Depression, loneliness, and alcohol use disorder are associated with suicide ideation. The ongoing COVID-19 pandemic has challenged our social structures with social distancing and isolation policies implemented worldwide, severely restricting social interactions. Studies regarding the effects of the pandemic are starting to shed light on the harmful psychological effects of these policies.

AIMS

This study aims to identify whether the increase in suicidal ideation among college students (mostly young adults) during the pandemic was due to the known risk factors of loneliness, depression, alcohol use disorder, social media addiction, and other background variables.

METHOD

Nine hundred and eleven college students completed self-report questionnaires assessing suicidal risk, depressive symptoms, loneliness, excessive alcohol use, and social media use.

RESULTS

During the pandemic suicidal ideation was associated with loneliness (χ2 = 54.65, p < 0.001), depressive symptoms (χ2 = 110.82, p < 0.001), alcohol use disorder (χ2 = 10.02, P < 0.01) and social media addiction (χ2 = 13.73, P < 0.001). Being single [OR = 2.55; p < 0.01], and self-identifying as a non-heterosexual [OR = 2.55; p < 0.01] were found to constitute additional risk factors.

LIMITATIONS

The structural nature of quantitative self-report scales does not offer the flexibility of gaining a deeper understanding of causes, specific to particular circumstances that may lead participants to ideate on suicide, even briefly.

CONCLUSIONS

Social distancing and isolation policies during the COVID-19 pandemic constitute an additional factor in the risk for suicide ideation.

Beyond sleepless nights: Unraveling the complexity of alexithymia and suicide risk among university students

BACKGROUND

There is a solid relationship between alexithymia and suicide risk. Nonetheless, the specific impact of alexithymia's distinct subscales on suicide risk has received the attention it deserves. This article presents a comprehensive exploration of suicide risk among university students, focusing on the interconnections among alexithymia, insomnia, and suicidal behavior. Three components of alexithymia including difficulties in describing emotions or feelings (DDF), difficulties in identifying emotions or feelings (DIF), and the externally oriented thinking were considered.

METHODS

The study involved 208 participants from a Persian university sample, examining the significance of incorporating both alexithymia and insomnia in suicide risk assessment and intervention planning. Insomnia was positioned as a pivotal mediator. A secure electronic link in the Telegram application was employed to collect the data. Both linear and nonlinear prediction models were used to explore potential associations among alexithymia, insomnia, and suicide risk.

RESULTS

The study revealed substantial positive correlations between alexithymia and suicide risk, as well as between insomnia and suicide risk. Additionally, specific components of alexithymia exhibited noteworthy links to suicide risk. The inclusion of insomnia scores in suicide risk predictions is critical, as it greatly enhances the precision of risk assessments and facilitates the design of targeted and effective therapeutic interventions. The association between alexithymia and suicide risk showed a significant relationship (r = .29, p < .01). Moreover, a significant correlation was observed between alexithymia and insomnia (r = .32, p < .01). Additionally, insomnia exhibited a significant positive correlation with suicide (r = .35, p < .01). Interestingly, DDF and DIF showed positive correlations with suicide (r = .28, p < .01; r = .33, p < .01).

CONCLUSION

The findings carry profound implications for suicide prevention efforts, providing valuable insights to safeguard the well-being and resilience of university students facing suicide risk challenges.

When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults

Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.

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.

Effects of sleep and impulsivity on suicidality in shift and non-shift workers

INTRODUCTION

Shift workers are known to have a higher suicide risk than non-shift workers. Sleep disturbance and impulsivity are also risk factors for suicidality. This study investigated the effects of poor sleep and impulsivity on suicidality in shift and non-shift workers.

METHODS

In total, 4572 shift workers (37.0 ± 9.84 years, 2150 males) and 2093 non-shift workers (37.8 ± 9.73 years, 999 males) participated in an online self-report survey. Suicidality was assessed using the Suicidal Behaviors Questionnaire. The Pittsburgh Sleep Quality Index was employed to explore subjective sleep quality, the Insomnia Severity Index to detect insomnia, the Epworth Sleepiness Scale (ESS) to evaluate excessive daytime sleepiness (EDS), the Center for Epidemiological Studies-Depression (CES-D) Scale to assess depressive symptoms, and the Impulsive Behavior Scale (UPPS-P) to explore impulsivity.

RESULTS

Shift workers showed poorer sleep quality, and greater impulsivity and suicidality, than non-shift workers. Impulsivity, sleep duration, sleep quality, and insomnia were significantly associated with suicidality, independent of depression. For both shift and non-shift workers, sleep quality moderated the association between impulsivity and suicidality. However, the moderating effects of sleep duration and EDS on the association between impulsivity and suicidality were apparent only in non-shift workers, while a moderating effect of insomnia was observed only in shift workers.

CONCLUSION

Shift work, sleep disturbances and impulsivity may exacerbate suicide risk. In addition, the interrelationships among insomnia, EDS, impulsivity, and suicidality may differ between shift and non-shift workers.

Longitudinal assessment of the sleep suicide link in Veterans: methods and study protocol

Although sleep disruption has emerged as a theoretically consistent and empirically supported suicide risk factor, the mechanistic pathways underlying the sleep-suicide link are less understood. This paper describes the methodology of a study intended to examine longitudinal mechanisms driving the link between sleep and suicide in Veterans at elevated suicide risk. Participants will be 140 Veterans hospitalized for suicide attempt or ideation with plan and intent or those identified through the Suicide Prevention Coordinator (SPC) office as being at acute risk. After study enrollment, actigraphy and ecological momentary assessment (EMA) data will be collected for 8 weeks, with follow-up assessments occurring at 2, 4, 6, 8, and 26 weeks. Participants respond to EMA questionnaires, derived from psychometrically validated assessments targeting emotional reactivity, emotion regulation, impulsivity, suicide risk, and sleep timing constructs, five times a day. First and last daily EMA target sleep parameters including sleep quantity, quality, timing, nightmares, and nocturnal awakenings. During follow-up assessments, participants will complete self-report assessments and interviews consistent with EMA constructs and the Iowa Gambling Task. The primary outcome for aim 1 is suicide ideation severity and for the primary outcome for aim 2 is suicide behavior. Findings from this study will improve our understanding of the dynamic interactions among sleep disturbance, emotion reactivity/regulation, and impulsivity to inform conceptual Veteran sleep-suicide mechanistic models. Improved models will be critical to optimizing the precision of suicide prevention efforts that aim to intervene and mitigate risk in Veteran populations, especially during a period of acute risk.

Defeat and Entrapment Mediate the Relationship Between Insomnia Symptoms and Suicidal Ideation in Young Adults

AIM

In recent years, there has been a growing interest in understanding the relationship between sleep disturbance and suicide. The current study aimed to advance understanding of the psychological processes driving these relationships by examining whether insomnia symptoms are related to suicidal ideation via perceptions of defeat and entrapment.

METHODS

Young adults (n = 259; 202 students [78.0%], 45 employed [17.4%], 12 unemployed [4.6%]) completed an anonymous self-report survey that was advertised via social media, university participant pools, and fliers. The survey was described as being related to sleep and mood/mental health. Validated measures were used to assess insomnia symptoms, chronotype, defeat, entrapment, suicidal ideation, and affective covariates.

RESULTS

Bivariate associations found insomnia severity to be related to poorer affective outcomes including severity of suicidal ideation. Insomnia and depression were significant independent variables in multiple linear regression with suidical ideation as the dependent variable. The relationship between insomnia and suicidal ideation was mediated by perceptions of defeat and entrapment.

CONCLUSION

Taken together, these findings shed light on the psychological mechanisms linking sleep disturbance and suicidal ideation by highlighting the role of defeat and entrapment. These findings have the potential to improve suicide risk assessment and prevention in young adults experiencing difficulties initiating or maintaining sleep.HighlightsDefeat and entrapment mediate relationship between insomnia and suicidal ideationEvidence for Integrated Motivational-Volitional Model of Suicidal Behavior in community sampleUses validated multi-item suicide measure.

The role of pre-sleep arousal in the connection between insomnia and suicide risk

Insomnia is a risk factor for suicidal thoughts and behaviors. The present study examined the role of pre-sleep arousal in this association. Seventy-eight adults (M_age = 24.28, 56% had recent history of suicidal thoughts and behaviors) attended two lab visits over four consecutive days. We tested if generally experienced self-reported pre-sleep arousal explained the association between self-report insomnia symptoms experienced over the past two weeks and past week-suicidal ideation. Results indicated full mediation for pre-sleep cognitive arousal, but not somatic arousal. Pre-sleep cognitive arousal could be a key variable linking insomnia symptoms to suicide risk.

Sleep and self-control: A systematic review and meta-analysis

Controlling impulses and overcoming temptations (i.e., self-control) are key aspects of living a productive life. There is a growing yet disperse literature indicating that sleep is an important predictor of self-control. The goal of this meta-analysis is to empirically integrate the findings from multiple literatures, and investigate whether sleep quality, and sleep duration predict self-control. To provide a thorough understanding of the proposed relationships, this meta-analysis also investigated potential differences between the level of analysis (between-individual vs. within-individual), research design (experiment vs. correlation; and cross-sectional vs. time-lagged), and types of measure (subjective vs. objective for sleep and self-control). A systematic review was conducted through ABI/Inform (including PsycInfo), ERIC, ProQuest Dissertation & Theses, PubMed, and Psychology Database using keywords related to self-control and sleep. Sixty-one independent studies met the inclusion criteria. The results, in general, suggest that sleep quality (between-individual 0.26, CI 0.21; 0.31; and within-individual 0.35, CI 0.24; 0.45), and sleep duration (between-individual 0.14, CI 0.07; 0.21; and within-individual 0.20, CI 0.09; 0.31) are all related to self-control. Given the impact of self-control on how individuals live productive lives, a future research agenda should include a deeper investigation in the causal process (potentially via prefrontal cortex activity) linking sleep and self-control, and an examination of the moderators (individual and contextual variables) that could impact the relationship between sleep and self-control.

When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults

Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.

Material hardship, perceived stress, and health in early adulthood

Purpose

We examined the associations between material hardship and health outcomes in early adulthood and the extent to which these associations are mediated by perceived stress.

Methods

We used wave I and IV of the National Longitudinal Study of Adolescent Health, a nationally representative survey of young adults aged 18–34 years old (n = 13,313). Multivariate logistic regression and decomposition methods were used to evaluate the associations between types and depth of material hardship (food, bill-paying, and health resource hardship), health outcomes (self-rated health, depression, sleep problems, and suicidal thoughts) in early adulthood, and the extent to which these associations were mediated by perceived stress.

Results

The adjusted odds of fair or poor health status, depression, sleep problems, and suicidal thoughts were higher among individuals with material hardship than counterparts without. A considerable proportion of the association between material hardship and health outcomes was attributable to perceived stress.

Conclusions

Material hardship is associated with adverse health outcomes in early adulthood, and these relationships are robust after accounting for various sociodemographic characteristics and family background. Perceived stress accounted for a sizable portion of the effects of material hardship on health.

Public Health Implications

Efforts to promote health equity in young adults should focus on material hardship and associated stressful conditions.

Prospective association between suicide cognitions and emotional responses to a laboratory stressor: The mediating role of nightly subjective sleep quality

BACKGROUND

Sleep is a reliable correlate of suicidal thoughts and behaviors (STBs), yet few studies have directly examined negative affect in the context of this association. The present study combined daily experience methods with a laboratory paradigm to investigate suicide cognitions as a predictor of emotional responses to environmental stressors, and tested the role of nightly sleep parameters.

METHOD

72 participants (M_age = 24.25; 41 with a recent history of suicide ideation and 31 without a history of STBs) completed a four-day study. Suicide cognitions were measured on the first day, and actigraphy-based sleep duration and fragmentation, and morning ratings of prior night subjective sleep quality (SSQ) were subsequently measured over three consecutive nights. Participants returned on the fourth day to complete the Trier Social Stress Task, where self-report changes in negative affect immediately post-task (i.e., reactivity) and five minutes post-task (i.e., recovery) were observed.

RESULTS

Regression analyses indicated that suicide cognitions predicted negative affect reactivity and recovery. Simple mediation analyses revealed that SSQ partially mediated the relation between suicide cognitions and negative affect recovery (especially shame), but not reactivity. No significant associations were observed for the actigraphy-based sleep parameters.

LIMITATIONS

Just three nights of actigraphy-based data collection. A single item was used to measure SSQ.

CONCLUSIONS

Suicide cognitions predict negative affective responses to situational stressors and SSQ may have a key role in this effect, especially the duration of negative emotional reactions. Hence, sleep and emotional reactivity may be potential targets for suicide prevention efforts.

Comparing primary insomnia to the insomnia occurring in major depression and general anxiety disorder

Apart from possibly distinguishing the different clinical causes of insomnia, this article explores the subjective and objective sleep differences amongst primary insomnia, major depression with insomnia and general anxiety disorder with insomnia. Subjective sleep and objective sleep of the participants were evaluated by using the Pittsburgh sleep quality index and polysomnography, respectively. We found that major depression with insomnia exhibited higher daytime dysfunction than primary insomnia; showed significantly higher values of rapid eye movement (REM) periods, time of REM sleep and percentage of REM stage; and presented lower percentage of non-rapid eye movement stage compared with primary insomnia and general anxiety disorder with insomnia (p < 0.05). General anxiety disorder with insomnia showed lower awakening number (AN) than primary insomnia, and other objective and subjective sleep values of general anxiety disorder with insomnia and primary insomnia showed no significant difference (p > 0.05). Our findings showed that major depression with insomnia increased active REM sleep and severe daytime function, which could alert clinicians to the risk of depression. Major depression with insomnia and primary insomnia may be categorically different. However, general anxiety disorder with insomnia and primary insomnia might be a continuum of a disease rather than be categorically distinct.

A qualitative systematic review of suicide behavior using the cognitive systems domain of the research domain criteria (RDoC) framework

Neurocognitive deficits are associated with both suicide behavior (SB) and psychiatric disorders. Application of a transdiagnostic framework to identify neurocognitive commonalities of SB may clarify important risk factors of SB across psychiatric disorders. The aim of this study was to conduct a qualitative systematic literature review of SB using the Research Domain Criteria (RDoC) Cognitive Systems framework to determine if cognitive deficits exist independently of psychiatric disorders in SB. The following six constructs that encompass the Cognitive Systems domain were assessed: 1) Attention, 2) Cognitive Control, 3) Declarative Memory, 4) Language, 5) Perception, and 6) Working Memory. A total of 1386 abstracts were identified and 74 studies met the inclusion criteria for this review. The majority of studies reviewed (65%) had significant differences in cognition between individuals with and without SB. Seventy-nine percent of studies with a patient control group showed significant cognitive deficits in SB groups. Deficits in cognitive control were associated with SB and had the greatest percentage of studies with significant main findings. Use of the RDoC cognitive systems framework to evaluate SB revealed that cognitive deficits may be a transdiagnostic risk factor for SB, especially alterations in cognitive control.

Rumination in relation to suicide risk, ideation, and attempts: Exacerbation by poor sleep quality?

BACKGROUND

Rumination, particularly brooding rumination, is associated with suicide risk, ideation and attempts; however, findings are inconsistent with respect to reflective rumination. Recent research suggests reflective rumination might be associated with increased suicide risk specifically among vulnerable individuals. Poor sleep quality is related to both suicide risk and rumination, yet no research has examined whether reflective rumination and sleep quality interact in relation to suicidal risk. This study, therefore, examined whether sleep quality moderates the link between ruminative subtypes and (a) suicide risk overall, and (b) suicidal ideation and (c) history of suicide attempts, specifically.

METHODS

Participants were 1696 college students (ages 18-29 years; 65% female) who completed measures assessing rumination, sleep, and suicidal ideation and behavior. Hierarchical linear and logistic regressions were performed regressing overall suicide risk (linear), suicidal ideation (linear) and history of attempts (logistic) on ruminative subtypes controlling for demographics. Sleep quality was examined as a moderator of the rumination-suicide risk/ideation/attempts link.

RESULTS

Brooding rumination was significantly associated with increased suicide risk, ideation, and attempts but these associations were not moderated by sleep quality. Sleep quality exacerbated the association of reflective rumination with overall suicide risk and suicidal ideation specifically. Reflective rumination was not itself, or in interaction with sleep quality, significantly associated with a history of suicide attempts.

LIMITATIONS

The study is cross-sectional and utilizes a college student sample.

CONCLUSIONS

This study adds to the literature that suggests reflective rumination is associated with suicide risk and ideation in certain cases, such as in individuals with lower sleep quality. In addition, the study adds continued support for an association between brooding rumination and suicidal behaviors. More studies that examine the relations between ruminative subtypes and attempts are needed. Interventions that target sleep problems and rumination may be beneficial for suicide prevention and intervention.

Adolescent insomnia, suicide risk, and the interpersonal theory of suicide

Although insomnia has been repeatedly linked with suicide ideation, the reason for the linkage is not clear. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that three core variables (thwarted belongingness, perceived burdensomeness, and acquired capability) are the final common pathway for all risk factors for suicide ideation and behavior. Recent research has suggested that insomnia may be associated with suicide ideation independently of the IPTS. We examined cross-sectional data from 151 psychiatric inpatients (ages 12-17) to determine if the association between insomnia symptoms and a continuous measure of suicide risk (measured as increasingly severe ideation and plan) was explained by the framework of the IPTS. When all IPTS variables and depressive symptoms were included in the model, insomnia symptoms did not contribute unique variance to suicide risk. Perceived burdensomeness and depressive symptoms were found to explain the relationship between insomnia symptoms and suicide risk. Our findings suggest that improved sleep might reduce suicide risk, that management of interpersonal need cognitions might reduce risk in the presence of insomnia symptoms, and reinforce the independent role of depressive symptoms in suicide risk in clinical samples of adolescents.

Examining the role of psychological factors in the relationship between sleep problems and suicide

We sought to conduct the first systematic review of empirical evidence investigating the role of psychological factors in the relationship between sleep problems and suicidal thoughts and behaviours. Twelve studies were identified which examined psychological factors grouped into four categories of cognitive appraisals, psychosocial factors, emotion regulation strategies, and risk behaviours. Although there was substantial heterogeneity across studies with respect to measurement, sampling, and analysis, preliminary evidence indicated that negative cognitive appraisals, perceived social isolation, and unhelpful emotion regulation strategies may contribute to the association between sleep problems and suicidal thoughts and behaviours. Given that findings in this area are currently restricted to studies with cross-sectional designs, the directionality of the interrelationships between these psychological factors, sleep problems and suicidality, remains unclear. We integrate the findings of our review with contemporary psychological models of suicidal behaviour to develop a clear research agenda. Identified pathways should now be tested with longitudinal and experimental designs. In addition, a more thorough investigation of the complexities of sleep, psychological factors, and suicidal thoughts and behaviours is crucial for the development of targeted psychological interventions.

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Systematic review of the role of psychological factors in sleep/suicide relationships

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Review findings integrated with suicide theory to define a clear research agenda.

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Reliance on cross-sectional designs limits interpretation of directionality of pathways.

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Identified pathways should be investigated with longitudinal and experimental designs.

Association between sleep duration, suicidal ideation, and suicidal attempts among Chinese adolescents: The moderating role of depressive symptoms

BACKGROUND

Suicidal ideation and attempts are still currently serious problems among adolescents worldwide, and there is evidence that sleep problem may be associated with increased rates of mental disorder. This study aimed to examine the associations between sleep duration and suicidal ideation and attempts among adolescents and to test whether depressive symptoms have moderating effects on the associations.

METHODS

A 3-stage, stratified cluster, random sampling method was used to collect data from 20,130 high school students in southeast China.

RESULTS

The weighted prevalence of short sleep among Chinese adolescents was 5.6% (95% CI, 5.3-6.0%), and the weighted prevalence of long sleep was 2.7% (95% CI, 2.5-3.0%). The final results demonstrated that short sleep was positively associated with suicidal ideation (AOR=2.28, 95% CI=1.96-2.66) and suicidal attempts (AOR=3.20, 95% CI=2.46-4.16), and long sleep was only significantly associated with suicidal attempts (AOR=2.47, 95% CI=1.70-3.58). Stratification analyses conducted separately for students with and without depressive symptoms demonstrated that depressive symptoms may have moderating effects on the associations between sleep duration and suicidality.

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Sleep duration was associated with suicidal ideation and attempts, and the association between sleep duration and suicidal attempts was U-shaped. These findings support that proper treatments services with the potential to restore adolescent normal sleep would be helpful in preventing suicidality among adolescents.

Understanding the role of sleep in suicide risk: qualitative interview study

OBJECTIVE

Sleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours.

DESIGN

Qualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis.

PARTICIPANTS

A maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours.

SETTING

Primary care, North West England.

RESULTS

Respondents emphasised the importance of sleep for recovery and management of their mental well-being. Moreover, three inter-related pathways were identified, whereby beliefs about sleep contributed to suicidal thoughts and behaviours. First, being awake during the biological night heightened risk of suicidal behaviours, as this was perceived to be an opportune time for a suicide attempt due to the decreased chances that a friend of family member would intervene during a suicide attempt. Additionally, the reduction in available support at night added to suicide risk. Second, failure to achieve good sleep was perceived to make life harder through contributing to core features of depression, such as negative thinking, attention difficulties and inactivity. Third, sleep acted as an alternative to suicide, by providing an escape from problems, including mental health problems, in waking life. However, this desire to sleep to escape was associated with excessive daytime sleeping, which subsequently may reinforce disturbed sleeping patterns.

CONCLUSIONS

Sleep problems should be an important treatment target when working with suicidal clients. More broadly, night-time service provision should be considered when developing suicide prevention initiatives.