Sleep Disturbances May Increase Suicide Risk in Young Adults

Disturbed sleep is a short-term indicator of worsening suicide risk in young adults, according to a study published online June 28 in the Journal of Clinical Psychiatry.

“Sleep disturbances stand apart from other risk factors because they are visible as a warning sign, yet non-stigmatizing and highly treatable using brief, fast-acting interventions,” said lead author Rebecca Bernert, Ph.D., an assistant professor of psychiatry and behavioral sciences at Stanford University, in a press release. “That’s why we believe it may represent an important treatment target in suicide prevention.”

The study collected both objective and self-reported sleep characteristics from 50 young adults aged 18 to 23 with a history of suicide attempts or recent suicidal ideation. They were recruited from among almost 5,000 undergraduate students enrolled in a university research pool.

Findings showed that sleep disturbances (insomnia, nightmares, and sleep-onset variability) predicted acute suicidal ideation symptom changes, even when controlled for the severity of participants’ depression, substance use, and the severity of their suicidal symptoms at the start of the study.

“Sleep is a barometer of our well-being and directly impacts how we feel the next day. We believe poor sleep may fail to provide an emotional respite during times of distress, impacting how we regulate our mood, and thereby lowering the threshold for suicidal behaviors,” said Bernert.

At the start of the study, and 7 and 21 days later, participants completed questionnaires to measure the severity of their suicidal symptoms, insomnia, nightmares, depression, and alcohol use. Researchers evaluated both actigraphic and subjective sleep parameters as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation) and used hierarchical regression analyses to predict residual change scores.

They assessed participants’ sleep objectively for one week, during which participants wore watch-like devices containing an accelerometer to measure wrist movements while sleeping or trying to sleep. The device had been validated as an accurate way to distinguish sleep-wake patterns and generate a variety of sleep metrics.

A total of 96 percent of participants (n=48) endorsed a suicide-attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78 percent endorsed clinically significant insomnia and nightmares, according to the study. Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation, the study found.

Falling asleep at very different times each night and waking at different times in the morning were especially predictive of an increase in suicidal symptoms at the 7- and 21-day marks. Participants with substantial variation in falling asleep times also reported more insomnia and nightmares, which independently predicted more suicidal behaviors, according to the study.

The findings suggest the potential use of sleep as a biomarker of suicide risk and a therapeutic target. Bernert’s team is currently conducting two clinical trials to test a brief, nonmedication insomnia treatment for suicidal behaviors.

The study was supported by the John Simon Guggenheim Foundation and National Institutes of Health. ■