Teen Sleep & Suicidality
Sleep & Suicide: What is the relationship?
A preventable, third-leading cause of death among adolescents in the United States, the Center for Disease Control and Prevention (CDC) states that suicide accounts for between 4, 000 and 5,000 deaths per year. There are many risk factors associated with teen suicide, with some being feelings of hopelessness or worthlessness, physical or sexual abuse, family discord, and, commonly, psychiatric disorder. Several psychiatric disorders have been linked with suicidality—depression, bipolar disorder, conduct disorder, substance abuse2—and each are also strongly associated with sleep disruption. Therefore, the question is whether or not this association makes it possible that sleep may itself be a risk factor for suicidality.3 Adult studies of the relationship between sleep and suicide have resulted in insomnia becoming a strong indicator of suicide risk. In fact, the odds risks of individuals reporting sleep problems increases by 2.5 times and those with difficulty initiating sleep increased their odds of suicide by 7.5 times. While adolescence is a time where there are profound changes in sleep and circadian regulation, as well as environmental and social influences on sleep, the relationship between sleep and suicidality may be important.3 Department of Psychiatry Professor at the University of Arkansas, Caris Fitzgerald, M.D. and colleagues discuss the relationship between sleep and teen suicide in their article “Teen Sleep and Suicidality: Results from the Youth Risk Behavior Surveys of 2007 and 2009.” 3
A Study on Teen Suicide
The Youth Risk Behavior Survey is a nine to 12th grade school-based survey that is maintained by the CDC in order to monitor youth behavior that influences health. Fitzgerald and colleagues used 14,041 questionnaires from the 2007 survey and 16,410 questionnaires from the 2009 survey to base their study on.3 They established the most beneficial amount of sleep to be eight hours, no more, no less.3 Data gathered from the questionnaires revealed that 23 percent reported sleeping for eight hours per night, six percent reported sleeping for four hours or less, and two percent reported sleeping 10 hours or more.3 About 15 percent of the total sample reported suicidal ideation, 10 percent reported planned suicide, five percent had attempted suicide, and two percent reported an attempt that required treatment.3 Eighty-four percent of those who reported an attempt that required treatment reported sleeping either six hours or less or ten hours or more per night.3 Also, 34.6 percent of individuals who reported sleeping only four hours or less per night reported suicidal ideation.3
Sleep in Moderation Decreases Suicide Risk
Overall, Fitzgerald and colleagues conclude that both short and long total sleep times (TSTs) are associated with a higher risk of reporting suicidality and actual suicide attempts, as the independent samples from 2007 and 2009 both reflected those statements.3 Also, it can be said that self-reported TST is a risk factor for teen suicidality, and when routinely monitoring suicide risk, clinicians should assess sleep.3 Forty-one percent of the sample of teens reported sleeping outside a TST of seven to nine hours, which can have negative effects on judgment, concentration, affect regulation, and impulse control—all factors that are associated with risk of suicide.3 Therefore, interventions that increase an adolescent’s TST may be beneficial regarding suicidality and other neurobehavioral outcomes; however, such studies have yet to be conducted. Fitzgerald and colleagues also speculate that other sleep attributes may also affect risk of suicide.3 There have been electroencephalographic studies of sleep in patients with a history of suicide attempts that showed a decreased slow wave sleep activity in comparison to patients with no history of suicide attempts.3 Therefore, further research into this relationship is also needed.
Fitzgerald and colleagues conclude that more studies regarding the relationship between sleep and suicide should be conducted; however, both short and long total sleep times have been found to be associated with suicidality among adolescents.3 They also state that TST may also be a useful measure when screening for suicide risk among teens.3
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 Fitzgeralt, C.T.; Messias, E.; and Buysse, D.J. (2011). Teen Sleep and Suicidality: Results from the Youth Risk Behavior Surveys of 2007 and 2009. Journal of Clinical Sleep Medicine 7(4): 351-356.
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 Wojnar M, Ilgen MA, Wojnar J, McCammon RJ, Valenstein M, Brower KJ. Sleep problems and suicidality in the National Comorbidity Survey Replication. J Psychiatr Res. 2009;43:526–31. [PubMed]
 Grunbaum JA, Kann L, Kinchen SA, et al. Youth Risk Behavior Surveillance–National Alternative High School Youth Risk Behavior Survey, United States, 1998. MMWR CDC Surveill Summ. 1999;48:1–44. [PubMed] suicide.