Testing the Effects of Insufficient Sleep on Suicidal Ideation Among Adolescents: Findings from the 2017 Youth Risk Behavior Surveillance System

Background and objective: Suicide is the second leading cause of death among adolescents aged 10 to 24 years in the US. Prevalence estimates shows that in 2017, about 17% of adolescents in the US seriously considered attempting suicide, 13.6% made a specific suicide plan, and 7.4% attempted suicide (Kann et al., 2018). Suicidal ideation is one of the most commonly studied factors that has been shown to have significant influence on suicide attempt and future death from suicide (Baiden & Fuller‐Thomson, 2016; Prinstein et al., 2008). Understanding potentially modifiable risk factors for suicidal ideation is therefore important in reducing future death from suicide among adolescents. Available research also shows that although sleep is vital to the physical and mental health well-being of children and adolescents, many adolescents are not getting the recommended 8 hours of sleep (Gruber et al., 2014; Owens & Adolescent Sleep Working Group, 2014; Wheaton, Jones, Cooper, & Croft, 2018). The objective of this study was to examine the effects of insufficient sleep on suicidal ideation among adolescents among adolescents aged 14-18 years.

Methods: Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,659 adolescents aged 14-18 years (51.8% female) were analyzed. The outcome variable investigated in this study was suicidal ideation and the main explanatory variable was insufficient sleep. Data analytic strategies included the use of descriptive, bivariate, and multivariate techniques. For the main analysis, we regressed suicidal ideation on insufficient sleep using binary logistic regression while controlling for the effects of demographic and other risk factors for suicidal ideation.

Results: Of the 13,659 adolescents, 2,409 representing 17.6% experienced suicidal ideation during the past 12 months and three out of four adolescents (75.2%) had insufficient sleep on an average school night. Controlling for all other predictors, odds were 1.35 times higher for adolescents who had insufficient sleep on an average school night to report experiencing suicidal ideation relative to their counterparts who had sufficient sleep on an average school night (AOR=1.35, 95% CI=1.16-1.58). Other significant predictors of suicidal ideation include female gender, sexual minority, history of traditional bullying and cyberbullying victimization, feeling sad or hopeless, being slightly or very overweight, and substance use. Physical activity had a protective effect on suicidal ideation such that adolescents who were physically active had an 11% decrease in the odds of experiencing suicidal ideation when compared to their physically inactive counterparts (AOR=0.89, 95% CI=0.79-0.99).

Conclusion: The findings of this study underscore the importance of routinely assessing for sleep problems among adolescents at risk for suicide. Interventions such as sleep hygiene, cognitive behavior therapy for insomnia, and behavioral counselling all of which aim to increase homeostatic sleep drive and normal circadian rhythms are known to be effective in treating children and adolescents with sleep problems. School counsellors, clinicians, and social work practitioners should consider sleep as an important intervention in suicide prevention.