Findings from a study published in JAMA Network Open suggested that sleep could be a visible risk factor for the study and intervention in youth suicide prevention, as parent-reported preadolescent sleep disturbances were associated with risk for suicidal ideation and attempts up to 2 years later.¹

The study, led by Joshua Gowin, PhD, of the Department of Radiology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, aimed to evaluate this relationship among children aged 9 and 10 years at that age and a 2-year follow-up.¹

Background

Gowin and colleagues noted that suicide is a leading cause of death among adolescents, a group that also demonstrate high rates of sleep disturbances. According to the study, suicide accounts for approximately 700,000 deaths globally on a yearly basis. This is far less than suicidal behaviors associated with suicide, as there are estimated to be more than 20 suicide attempts for every death by suicide.^1,2

Sleep disturbances have become as an evidence-based risk factor for suicidal behaviors, even after adjust for depressive symptoms, reason why sleep disturbances are listed as part of the top 10 warning signs of suicide by the Substance Abuse and Mental Health Services Administration.¹

"Poor sleep appears to confer risk for suicide, but longitudinal investigation of suicidal behaviors remains rare, particularly in the transition from childhood to early adolescence," Gowin and colleagues wrote.¹

Study details and results

In a cohort design, the study used data from the Adolescent Brain Cognitive Development Study, which featured children aged 9 or 10 years at baseline along with their parents or caregivers, recruited from 21 sites across the United States.

Parents completed the Sleep Disturbance Scale for Children (SDSC), a 26-item inventory at baseline. The scale generated a total score and 6 subscales. Higher scores indicated greater symptom severity and the 26 items were rated using a 1 to 5, with 5 being the most disturbed. The SDSC subscales included:¹

• Disorders of initiating and maintaining sleep (DIMS)
• Sleep-disordered breathing
• Disorders of arousal
• Sleep-wake transition disorders (SWTD)
• Disorders of excessive somnolence (DOES)
• Sleep hyperhidrosis or excessive sweating (SHY)

"The computerized Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-COMP) assessed parent- and youth-reported suicidal behaviors and outcomes (none; passive, active nonspecific, and active specific suicidal ideation; and suicide attempt) at the 2-year follow-up," said the authors. "Sleep disturbance was further grouped by symptom severity (minimal, moderate, elevated, high, and severe)."¹

In all, 8807 youth with a mean age of 9.9 years (51.2% male) completed the K-SADS-COMP assessment at the 2-year follow-up and were featured in the analysis. Follow-up revealed that 8044 had no suicidal behavior, 317 had passive suicidal ideation, 258 had active nonspecific suicidal behavior, 130 had active specific suicidal ideation, and 58 had a first-time suicide attempt.¹

At age 12 years, baseline sleep disturbance was associated with increased incidence risk for suicidal behavior (odds ratio, 2.68; 95% CI, 1.44-4.98; [P = .002]).¹

Conclusion

Disturbed sleep at age 10 years was linked to risk for suicidal thoughts and behaviors in the next 2 years, based on results from the longitudinal study. "Such findings suggest that preadolescent sleep disturbances confer near-term risk for suicidal behaviors in early adolescence, highlighting its potential importance as an intervention target," stated the investigative team. "Given its promise as a visible, non-stigmatizing, and highly treatable intervention target, we recommend additional investigation of sleep in the study and prevention of youth suicide."¹

References:

1. Gowin JL, Stoddard J, Doykos TK, Sammel MD, Bernert RA. Sleep Disturbance and Subsequent Suicidal Behaviors in Preadolescence. JAMA Netw Open. 2024;7(9):e2433734. doi:10.1001/jamanetworkopen.2024.33734

2. World Health Organization. Suicide Worldwide in 2019: Global Health Estimates. World Health Organization; 2021.