Department of Psychology, Rutgers University, New Brunswick, NJ, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
J Child Psychol Psychiatry. 2023 Jan;64(1):27-38. doi: 10.1111/jcpp.13651. Epub 2022 Jul 2.
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.
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 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.
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.
识别与青少年和年轻人有关且可改变的自杀意念近端风险因素对于预防自杀至关重要。本研究采用密集监测方法，通过对处于自杀高风险的年轻人的人际事件的情绪反应，来检验客观和主观测量的睡眠特征是否通过情绪反应预测次日自杀意念的发生和强度。
参与者包括 59 名（13-23 岁；76%为白人；75%为女性）正在接受门诊强化治疗抑郁和自杀倾向的青少年和年轻人。参与者每天要对自杀意念、睡眠质量和对积极与消极人际事件的情绪反应进行评分，持续时间最多为 3 个月（M=56 天，SD=24.13）。活动记录仪记录了行为睡眠时间和时间。使用多层次模型评估睡眠和情绪反应的个体内波动作为自杀意念的预测因子，并通过多层次中介检验睡眠通过对人际事件的情绪反应对自杀意念的间接影响。
结果表明，客观测量的睡眠时间和主观睡眠质量通过对消极和积极人际事件的情绪反应对次日自杀意念具有显著的间接影响。比平时短的睡眠时间通过对消极人际事件的情绪反应增加预测次日自杀意念的出现和强度。比平时差的睡眠质量通过对积极人际事件的情绪反应降低预测次日自杀意念。
情绪反应是睡眠指标可能影响每日自杀思维风险的近端机制。研究结果强调了针对青少年和年轻人的睡眠和情绪调节在预防自杀中的实用性，这些人处于自杀的高风险中。
