Sleep Quality and Suicide Ideation among Adolescents: Mediating Role of Rumination and Depressive Symptoms.

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

Objective Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide. Methods Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior. Results Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity. Conclusions The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk. HIGHLIGHTS We assessed the association between pain and sleep quality in suicidal patients. Sleep quality, physical and psychological pain were associated with suicide risk. Pain perception may mediate the progression to suicidal behavior.

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

ABSTRACTBackground: Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels.Methods: Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates.Results: The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes.Conclusion: The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.

The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.

Sleep disturbance and suicidal ideation among youth with depression

Changes in psychological inflexibility as a potential mediator of longitudinal links between college students’ sleep problems and depressive symptoms

BackgroundThis study was intended to investigate the correlation between depression and suicidal ideation among Chinese college students during the COVID-19 pandemic and the potential mediating roles of chronotype and sleep quality in this relationship .MethodsA sample of 4,768 college students was selected from four institutions in Anhui Province, China, and the study was conducted during the COVID-19 pandemic (November to December 2020) using a stratified, cluster, multi-stage sampling method. This study used the two-item Patient Health Questionnaire (PHQ-2) to assess depressive symptoms, the Morningness-Eveningness Questionnaire 19 (MEQ-19) to determine individual sleep chronotypes (i.e., morning or evening preference), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Participants were asked about suicidal ideation. MPLUS 8.3 software was used to analyze the mediating effect of chronotype and sleep quality on the relationship between depression and suicidal ideation.ResultsDuring the COVID-19 pandemic, the prevalence of suicidal ideation among Chinese college students was 5.4%. Depression was inversely correlated with chronotype (beta = − 0.346, P < 0.01) and positively correlated with sleep quality (beta = 0.846, P < 0.001), indicating that students experiencing depressive symptoms were more likely to have a later chronotype and poor sleep quality. A later chronotype (beta = − 0.019, P < 0.05) and poor sleep quality (beta = 0.066, P < 0.01) predicted suicidal ideation. Depression emerged as a direct and significant risk factor for suicidal ideation (effect value = 0.535, 95% confidence interval: 0.449 ~ 0.622). Chronotype and sleep quality were found to have potential mediating effects on the relationship between depression and suicidal ideation; however, the chain-mediating effect of chronotype and sleep quality was not statistically significant.ConclusionsOur findings suggest that during the COVID-19 pandemic, depression can precipitate suicidal ideation through its influence on sleep chronotype and quality. These compelling findings highlight the urgency of early intervention strategies intended to mitigate suicidal thoughts, particularly among students exhibiting depressive symptoms, who experience disrupted sleep patterns and poor sleep quality.

Time to emergence of severe suicidal ideation among psychiatric patients as a function of suicide attempt history

Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality - i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.

Future-oriented repetitive thought, depressive symptoms, and suicide ideation severity: Role of future-event fluency and depressive predictive certainty

Introduction Inadequate sleep duration and quality increases the risk and severity of depressive symptoms. Sex differences may influence these associations, but research findings are inconsistent and largely based on healthy populations. This study examined sex differences in the association between sleep and depressive symptoms in people seeking treatment primarily for sleep disorders at an outpatient clinic. Methods 1806 participants were recruited from an outpatient multidisciplinary sleep clinic (48% female; Mean-age = 43.93±16.00 years). Participants self-reported sleep duration, sleep quality (rated 1-4, higher scores represent better sleep quality), and depressive symptoms (PROMIS Short Form v1.0 - Depression 8a) prior to receiving treatment. Results Participants self-reported sleeping 6.49±1.73 hours and depressive symptoms were above population mean (55.95±10.09). Males reported more depressive symptoms than females (p &amp;lt;.001), however there were no significant sex differences in the association between sleep variables and depressive symptoms. Overall, lower sleep quality was associated with greater depressive symptoms (p &amp;lt;.001); and there was a U-shape relationship between sleep duration and depressive symptoms (p =.003), in which both shorter and longer sleep are associated with greater depressive symptoms. Conclusion This study revealed that depressive symptoms were elevated in an outpatient sleep clinic sample compared to population norm, underscoring the importance of recognising and addressing mental health symptoms that coexist with sleep problems. Associations between sleep and depressive symptoms were similar between males and females, but males reported significantly higher depressive symptoms than females. Future studies should explore biopsychosocial factors that may contribute to sex differences in depressive symptoms.

Sleep problems are a modifiable risk factor for suicidal thoughts and behaviors. Yet, sparse research has examined temporal relationships between sleep disturbance, suicidal ideation, and psychological factors implicated in suicide, such as entrapment. This is the first in-the-moment investigation of relationships between suicidal ideation, objective and subjective sleep parameters, and perceptions of entrapment. Fifty-one participants with current suicidal ideation completed week-long ecological momentary assessments. An actigraph watch was worn for the duration of the study, which monitored total sleep time, sleep efficiency, and sleep latency. Daily sleep diaries captured subjective ratings of the same sleep parameters, with the addition of sleep quality. Suicidal ideation and entrapment were measured at six quasi-random time points each day. Multi-level random intercept models and moderation analyses were conducted to examine the links between sleep, entrapment, and suicidal ideation, adjusting for anxiety and depression severity. Analyses revealed a unidirectional relationship whereby short sleep duration (both objective and subjective measures), and poor sleep quality, predicted the higher severity of next-day suicidal ideation. However, there was no significant association between daytime suicidal ideation and sleep the following night. Sleep quality moderated the relationship between pre-sleep entrapment and awakening levels of suicidal ideation. This is the first study to report night-to-day relationships between sleep disturbance, suicidal ideation, and entrapment. Findings suggest that sleep quality may alter the strength of the relationship between pre-sleep entrapment and awakening suicidal ideation. Clinically, results underscore the importance of assessing and treating sleep disturbance when working with those experiencing suicidal ideation.

Suicide among college students is a challenging problem globally. Yet, the association between sleep quality, depressive symptoms, and suicidal ideation remains unclear. This study aims to understand if depressive symptoms mediate the relationship between sleep quality and suicide ideation and whether the interaction between depressive symptoms and sleep quality on suicidal ideation is additive. A total of 1182 college students were recruited, and sleep quality, depressive symptoms, and suicidal ideation were assessed using questionnaires. Univariate analysis, logistic regression analysis, linear regression models, and the Sobel test were performed. The results showed that, among college students, poor sleep quality was positively associated with suicidal ideation, and the association was mediated through depressive symptoms. Moreover, there was a significant additive interaction between poor sleep quality and depressive symptoms on suicidal ideation. These findings suggest that, in the process of preventing and treating suicidal ideation in college students with sleep disorders, we should focus on the evaluation and intervention of depressive symptoms and adopt multidisciplinary team interventions for college students with sleep disorders and depression.

Suicidal ideation is prevalent among university students and is associated with a complex interplay of psychological, interpersonal, and behavioral factors. While prior research has examined individual predictors such as sleep disturbances, depressive symptoms, and impulsivity, less is known about how these factors co-occur in clinically distinct profiles. This study aimed to identify latent profiles of suicide risk using a multidimensional model.We conducted a secondary data analysis using the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) dataset, which includes self-reported data from 971 U.S. university students aged 18 to 52 years (M = 20.10, SD = 2.41). Seven continuous variables were included as indicators: sleep quality (PSQI), insomnia severity (ISI), depressive symptoms (CES-D), suicidal ideation severity (C-SSRS), thwarted belongingness and perceived burdensomeness (INQ), and total impulsivity (UPPS-P). Latent Profile Analysis (LPA) was employed to identify subgroups, and model fit was assessed using the AIC, BIC, and entropy.Latent Profile Analysis identified five distinct profiles based on indicators of sleep, affect, interpersonal behavior, and impulsivity. These included a severely distressed profile characterized by elevated depressive symptoms, suicidal ideation, sleep disturbances, and interpersonal burden; an interpersonally burdened profile with mild affective symptoms; a moderately symptomatic profile; a psychologically resilient profile with minimal symptoms across domains; and a high impulsivity profile accompanied by emotional dysregulation.This study identified five clinically distinct profiles of suicide risk in a large sample of university students. These results may inform the development of tailored screening and intervention strategies in campus-based mental health settings.