Abstract
Introduction
Suicidal ideation is common in college-aged students, but this is limited as a risk factor because ideation rarely leads to suicide attempts. Disrupted sleep increases suicide risk, but it is unclear whether this relationship applies equally to both ideators and attempters. Therefore, the present study explored four different sleep variables as discriminators between past suicidal ideation and a past suicide attempt.
Methods
Data from N=506 respondents were collected as part of the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS) Survey in college students. The primary outcomes, lifetime history of suicidal ideation or a suicide attempt, were assessed using self-report questions derived from the Columbia Suicide Severity Rating Scale. Predictors were weekday short sleep (≤ 6h; from a retrospective sleep diary), Insomnia Severity Index (ISI) score, Brief Inventory of Sleep Control (BRISC) score, and Disturbing Dreams and Nightmares Severity Index (DDNSI) score. Binomial logistic regression models tested whether these predictors distinguished ideators from attempters. Models were unadjusted, adjusted for age, sex, race, and ethnicity, and additionally adjusted for thwarted belongingness or perceived burdensomeness from the Interpersonal Theory of Suicide.
Results
A total of N=182 (36%) respondents endorsed lifetime suicidal ideation, while N=61 (12%) reported a prior suicide attempt. Attempters tended to be slightly older (p=0.016), in worse health (p<0.001), and have more severe depression (p<0.001) and anxiety (p<0.001) than ideators. In unadjusted models, higher BRISC scores were associated with reduced odds of a suicide attempt (OR: 0.62 [0.42, 0.90]) while DDNSI scores of >=10 were associated with greater odds of a suicide attempt (OR: 4.24 [1.28, 4.24]). Adjusting for age, sex, race, ethnicity, thwarted belongingness, and perceived burdensomeness attenuated but did not eliminate these relationships. Short sleep and ISI scores did not distinguish ideators from attempters.
Conclusion
Perceived sleep control and severity of nightmares, but not insomnia or short sleep, distinguished individuals with a history of suicidal ideation from those with a history of a suicide attempt. However, longitudinal research is needed to determine if poor sleep control or nightmares are proximal predictors of a suicide attempt.
Support (if any):
Dating Violence Victimization, Interpersonal Needs, and Suicidal Ideation Among College Students
