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.

Keywords: Adolescence; actigraphy; affective reactivity; intensive monitoring; interpersonal; sleep; suicide.

Figure 1

Direct effects of sleep, affective reactivity to negative and positive events, and probability of suicidal ideation. (A) Shorter sleep compared to an individual's usual amount predicted higher levels of next‐day affective reactivity to negative interpersonal events. (B) Later‐than‐usual sleep timing predicted lower levels of next‐day affective reactivity to positive interpersonal events. (C) Poorer‐than‐usual sleep quality predicted lower levels of next‐day affective reactivity to positive interpersonal events. (D) Higher levels of affective reactivity to negative interpersonal events relative to an individual's mean significantly predicted days on which they reported having suicidal ideation. (E) Lower levels of affective reactivity to positive interpersonal events relative to an individual's mean significantly predicted days on which they reported having suicidal ideation

Figure 2

Indirect pathways linking sleep, affective reactivity, and suicidal ideation. All multilevel mediation of indirect pathways were conducted with within‐person variables, with sleep and affective reactivity reflecting within‐person fluctuations compared to each person's own mean. Solid lines reflect significant paths and dashed lines reflect non‐significant paths. Sleep duration and sleep timing reflect actigraphy‐derived measures, whereas sleep quality was self‐reported on the daily surveys in the morning