USING INTENSIVE, REAL-TIME MONITORING DESIGNS TO IDENTIFY PROXIMAL RISK FACTORS FOR SUICIDAL IDEATION AMONG ADOLESCENTS

Over 1 in 5 U.S. high school students have seriously considered suicide and 1 in 10 have attempted suicide in the past year alone. Yet, suicide risk is not static; suicidal thoughts fluctuate across days and weeks, making it is critical to identify factors that predict when youth are experiencing suicidal ideation. Advancing technology makes it possible to capture suicidal thoughts when they occur in real time, thereby informing suicide prevention and targeted interventions. Intensive monitoring designs and idiographic approaches, such as ecological momentary assessment (EMA), can be used to identify risk factors that proximally predict suicidal ideation among youth. The current study leveraged such a design to examine sleep characteristics (quality, duration, timing, variability) as modifiable risk factors for suicidal ideation among adolescents. The current sample of adolescents were recruited nationwide and were unselected for current or past suicide risk. A total of 131 adolescents (Mean Age =15.9 years; 60% female; 45% White) completed a baseline clinical interview and self-reported surveys, along with two months of ecological momentary assessment (EMA) with 3 prompts per day, including morning sleep diaries and evening reports of suicidal ideation (occurrence and intensity). Adolescents wore actiwatches for two months to capture behavioral sleep metrics and installed an application for smartphone sensing to capture phone use and app patterns. Overall, 45% of adolescents endorsed lifetime active suicidal thoughts and 20% had lifetime suicidal behavior. More than 1 in 5 adolescents also reported active suicidal thoughts during the EMA period, which highlights the importance of including and asking about suicidal thoughts among adolescents in clinical research studies. Multilevel modeling was used to examine the association between sleep and next-day suicidal ideation, finding that worse sleep quality (particularly compared to one’s usual experience) was associated with next-day suicidal ideation among adolescents. Actigraphic results capturing behavioral sleep metrics will also be presented related to nextday suicidal ideation. Our study highlights the importance of evaluating suicidal ideation on a daily basis among youth to capture risk as it unfolds. Further, intensive monitoring designs can advance our understanding of modifiable risk factors, such as sleep, to inform interventions and prevent suicide.

References

Hamilton JL, Tsypes A, Zelazny J, et al. Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high-risk adolescents and young adults. J Child Psychol Psychiatry. 2023;64(1):27-38. doi:10.1111/jcpp.13651 Esposito, E. C., Duan, A. M., Kearns, J. C., Kleiman, E. M., Conwell, Y., and Glenn, C. R. (2022). Measuring adolescents’ self-injurious thoughts and behaviors: comparing ecological momentary assessment to a traditional interview. Research on child and adolescent psychopathology, 50(8), 1095-1105.