Sleep Problems and Suicide Risk Study

For teens, families, and clinicians who participated in our “Sleep Problems and Suicide Risk Study,” we wanted to share some of the findings with you!

Below, we have attached the four papers published from the study and describe the major findings from each. The information in the research papers is de-identified. This means that you will not see any names or information that connects you specifically to this study. We do this to make sure that the privacy of every teen, family, and clinician is protected.

If you have any questions, you can contact the Principal Investigator of the research: Dr. Cassie Glenn at (Note. Cassie has moved from the University of Rochester to Old Dominion University since this research was first conducted. Your data’s security – including identifying information – is still monitored by the same ethics committee at the University of Rochester.)

This research was funded by the American Foundation for Suicide Prevention (Grant number: YIG-1-054-16, PI Glenn). 

Paper 1. Feasibility and Acceptability of Ecological Momentary Assessment with High-Risk Suicidal Adolescents Following Acute Psychiatric Care

For this study, teens completed surveys several times a day on their smartphone for 28 days (this method is called “ecological momentary assessment” or “EMA”) and wore a Fitbit-like watch to measure their sleep. The purpose of the larger project was to help us understand risk for suicidal thoughts and behaviors among teens following hospitalization for suicide risk. But first, we wanted to see if teens would be able (find it feasible) and willing (find it acceptable) to use these methods (that is, complete EMA surveys and wear the Fitbit-like watch) for 28 days, especially after leaving the hospital. Teens who participated in the study reported: 1) an overall positive experience, 2) that they understood the study questions, and 3) that the surveys were not a big burden on their time. Clinicians (that is, therapists and counselors) who supported teens and families during the study reported that: 1) participating was not a significant burden on them (clinicians), and 2) they thought teens and families had a neutral to positive experience in the study. In sum, we found that it  is possible, acceptable, and safe for teens to use these methods during a high-risk time, such as the month after they leave the hospital.


Paper 2. Measuring Adolescents’ Self-injurious Thoughts and Behaviors: Comparing Ecological Momentary Assessment to a Traditional Interview

One reason we think methods like ecological momentary assessment (EMA; see Paper 1 summary above for definition) are useful is because they measure experiences in real time, or as they occur. Prior studies have shown that people are more accurate when they report their experiences as they happen (in real time), rather than trying to summarize over longer time periods such as days and weeks. Although we know this is true for a range of behaviors, we did not know if this was true for suicidal thoughts, suicidal behaviors, and self-injury (sometimes referred to as nonsuicidal self-injury, or self-harm) among teens. This was the purpose of this paper. In this study, teens were asked to report on their suicidal thoughts, suicidal behaviors, and self-injury over 28 days in two different ways: 1) multiple times a day, in real time (or as it was happening) using EMA on their phone and 2) in an interview over the phone at the end of the study looking back at the 28 days in total. This study found that teens were more likely to report suicidal thoughts and self-injury when asked multiple times a day (using EMA), compared to what they reported in the interview. Generally, teens did not report many suicide-related behaviors (like suicide attempts or suicide plans) during the 28-day study period. For the teens that did report suicide-related behaviors, there was no meaningful difference in how they reported them (EMA vs. Interview). This means, teens were just as likely to report a suicide-related behavior in an interview at the end as they were to report them in real time (EMA). It is important to add that some teens reported feeling uncomfortable answering questions on their phone due to concerns that someone, mainly parents, might see their answers. In sum, this study showed that EMA (multiple surveys per day) is useful for gaining accurate information about teens’ daily experiences with suicidal thoughts and nonsuicidal self-injury.


Paper 3. Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care 

This paper looks at how sleep, and sleep problems, may relate to suicidal thinking among teens, which was the primary goal of this project. We knew from prior research that sleep problems were related to suicide risk among teens over months and years. However, we wanted to know whether sleep problems were related to suicidal thoughts over shorter, and clinically important, time periods, such as the next day. Research that helps us understand how risk develops can help us create effective treatments to reduce this risk. In the current study, sleep and sleep problems were measured in two ways: (1) using daily surveys each morning (called a sleep diary) that ask questions about the quality (how “good” was their sleep) and amount of sleep the prior night (how much did they sleep), and (2) using a Fitbit-like watch to measure sleep patterns. We found that certain types of sleep problems were related to suicidal thoughts. Specifically, taking a longer time to fall asleep (called sleep onset latency), having nightmares, and ruminating before sleep (which means thinking about things from the day over and over again) were related to more suicidal thoughts the next day. This study shows that sleep problems can lead to more suicidal thoughts, even over short time periods such as the next day.

Following up on this study, we have started a sleep treatment study to see if treating teens’ sleep problems can help reduce their suicidal thoughts and the likelihood of being hospitalized for a suicidal crisis. INTERESTED IN PARTICIPATING? We are currently recruiting teens ages 14-18 for this study in Virginia. You can find out more about that study by clicking here.


Paper 4. Thwarted Belongingness Mediates Interpersonal Stress and Suicidal Thoughts: An Intensive Longitudinal Study with High-risk Adolescents

We know that stressful social situations (such as, relationship break-ups, family conflict, and bullying) can be triggers for suicidal thoughts and behaviors, especially among teens. However, what is less clear is how these events increase suicide risk. This study examined one potential link between social stress and suicide risk – social disconnection with family and friends. We found that stressful social events increased teens’ suicidal thoughts to the degree that the social stress event led to feelings of disconnection, or not belonging, with family members specifically. In other words, the more a social stress event led to feeling disconnected from family, the more likely a teen was to have suicidal thoughts. This link was not as strong for disconnection with friends. These results suggest how important family connection is for teens, particularly during times we know teens are at high risk for suicide, like the month following discharge from psychiatric hospitalization. 

Although this finding about suicidal thoughts is an important first step, we did not have enough participants in this particular study (that is, not a large enough sample) to examine how social stress events  were related to suicidal behavior. In order to take this critical next step, we have partnered with two other sites – Rutgers and Massachusetts General Hospital – to learn from teens and their parents how social stress may increase risk for suicidal behavior. INTERESTED IN PARTICIPATING? We are currently recruiting youth ages 12-18 for this study in Virginia. You can find out more about that study by clicking here