Reduced Sleep Duration Associated With Suicide Attempts in Adolescents

In a poster presented at the SLEEP 2024 Annual Meeting in Houston, Texas, researchers found that high school students had later circadian phases and less total sleep time (TST) on weekdays when compared with the weekends.¹ This finding could have broader implications than simple sleep deprivation, as results from a second poster found a link between sleep duration and suicide attempts in adolescents.²

The first study¹ focused on the difference in circadian phases in adolescents between school nights and weekends. Later sleep times and circadian timing can cause circadian misalignment in adolescents. This mismatch has been well-documented but changes in circadian phases across the week have been less documented. The study aimed to characterize these changes in circadian phase from a weekend to a school night and determine the association between later circadian phases and other sleep characteristics.

Teenager sleeping | Image credit: Rawpixel.com - stock.adobe.com

High school students who had at least 1 standard drink of alcohol in their life were enrolled in this study. Participants used wrist actigraphy for 8 days and had 2 overnight visits to collect a melatonin sample. Social jetlag and chronotype were assessed using the Munich Chronotype Questionnaire; sleep onset latency (SOL), wake after sleep onset (WASO), TST, and midsleep timing were all collected from the actigraphy. Dim light melatonin onset (DLMO) was used to calculate circadian phase. DLMO and actigraphy measures were separated by day of the week and overall.

There were 115 high school students with a mean age of 17.3 years and who were primarily female (55.7%) and White (88.7%) included in the study. The DLMO was found to be significantly later on Sundays at a mean (SD) of 37 (41) minutes later. Longer SOL (b, 0.05), shorter WASO (b, –0.03), and shorter TST (b, –0.18) were all found with later school night DLMO. Later chronotype (b, –1.72) was also found on later school night DLMO. Longer TST (b, 0.22) was associated with later weekend DLMO. Larger weekday-weekend differences in actigraphic TST and more social jetlag were found in later DLMO on any night.

The researchers concluded that later circadian phase was associated with later chronotype, more difficulty falling asleep, and less sleep on school nights. This could have wider implications given the findings of another poster presented at the SLEEP 2024 Annual Meeting.

The second poster² focused on how sleep duration may moderate the association between bullying and suicide attempts in adolescents living in the United States. Rates of suicide have more than doubled in adolescents in the US within the past 15 years, with bullying being a significant risk factor. Sleep insufficiency has previously been linked to both bullying and suicide attempts separately, but previous studies have not focused on whether sleep duration could moderate the association between bullying and suicide attempts. This study aimed to assess what this relationship was.

The 2021 Youth Risk Behavior Surveillance System was used for this study, as it is a nationally representative sample that contains data for 17,134 participants. The relationships among bullying, sleep duration, and suicide attempts within the past year were evaluated using a multivariable logistic regression model. Sex, age, race/ethnicity, screen time, and poor mental health were all covariates for the study.

Bullying at school or electronically was found in 15% and 16% of adolescents respectively. At least 1 suicide attempt was attempted in 10.2% of adolescents and 77.3% did not follow sleep duration recommendations. A total of 29.3% reported poor mental health most of the time or always.

Adolescents who were bullied in school or electronically were more likely to attempt suicide compared with those who were not bullied (OR, 3.0; 95% CI, 2.4-3.7). Suicide was attempted twice as often in adolescents who had 4 hours of sleep or less (OR, 2.6; 95% CI, 1.5-3.0). Adolescents who were buillied had a higher likelihood of suicide attempts if they had a sleep duration of up to 6 hours or 8 or more hours. A reduced likelihood of suicide attempts was reported in participants who were not bullied and had a sleep duration of at least 7 hours.

The odds of reported suicide attempts increased with bullying, both electronic and in school, as well as short sleep duration. With the youth mental health crisis becoming more prevalent throughout the US, targeting interventions toward proper sleep could be key to addressing a personal area of improvement for mental health in adolescents aged 12 to 18 years.

"Suicide attempts, bullying, and sleep insufficiency constitute a serious public health crisis. A multi-pronged approach must involve pediatric sleep experts, public health practitioners, parents, and the school system to address this complex and multifaceted issue," said Rachelle-Marie Narcisse, research scientist at Bradley Hospital.

References
1. Hasler B, Oryshkewych N, Buysse D, et al. Circadian phase delays from school nights to weekends and relates to sleep characteristics in high school students. Presented at SLEEP 2024 Annual Meeting; June 1-June 5, 2024; Houston, TX. Abstract 0809
2. Narcisse MR, Barker D, Wolff J, Carskadon M. Sleep duration moderates the association between bullying and suicide attempts among US adolescents. Presented at SLEEP 2024 Annual Meeting; June 1-June 5, 2024; Houston, TX. Abstract 0813