How Does Depression Symptomology Mediate the Relationship between Sleep Disturbance and Suicide Risk for Sexual Minority Men?

Background and Purpose: Sexual minority men (SMM; e.g. gay, bisexual, and other men who have sex with men) experience both higher rates of sleep disturbance and mental health issues (i.e., depression, and suicidal ideation), however, limited research has investigated the potential association of sleep disturbance and mental health issues for SMM. Therefore, the aims of the current study are to understand the relationships between sleep disturbance and recent suicidal ideation in a sample of SMM, and to assess mediation by depression symptoms.

Methods: In 2020, 239 SMM were recruited on geosocial networking applications (e.g., Grindr, Scruff), in the southeast US, to participate in an online cross-sectional survey. Participants answered demographic items and validated scales assessing sleep disturbance (i.e., PROMIS 8a), depression symptomology (i.e, Center for Epidemiological Study Depression), and suicidal ideation. One linear regression and two logistic regressions were conducted to test the association of sleep disturbance with suicidal ideation and mediation by depression symptoms. Mediation was assessed using the Sobel test. All analyses were controlled for by age, race/ethnicity, rurality, income, and education level.

Results: Participants were on average 34.8 years old (sd= 11.752), 47% white American, 29% living in a rural area, 30% earning more than $50,000 annually, and 84% had received at least some college education. The sample reported moderate levels of depression (M=19.0, sd=13.127), and approximately 43% of the sample reported mild to severe sleep disturbance. Approximately 50% of the sample reported ever considering suicide, 29% ever making a plan to die by suicide, and 46% reported history of a suicide attempt. Fifteen percent of the sample reported recent suicidal ideation and 10 participants reported a recent suicide attempt. Sleep disturbance and depression were both, at the bivariate level, associated with a higher odds of reporting recent suicidal ideation. A linear regression revealed that sleep disturbance was positively associated with depression symptomology (b=.900, t=9.396, p<.001). In the final binary logistic regression, sleep disturbance was not significantly associated with suicidal ideation (OR=1.068, CI= 1.000, 1.142), and depression symptomology was significant (OR=1.083, CI= 1.042, 1.124). A Sobel test indicated significant mediation of sleep disturbance by depression symptomology (ST= 3.808, p<.001).

Conclusions and Implications: Findings indicate that when SMM experience worse sleep it has an impact on their depressive symptoms and increases their suicide risk. Having reduced sleep quality and total sleep time may inhibit cognition and coping strategy generation, which could worsen mental health. Therefore, suicide risk reduction programs should prioritize implementing sleep screening and sleep interventions, in addition to providing mental health supports. Future research should investigate these relationships in a longitudinal study, as sleep disturbance and mental health may have bidirectional relationships. Further, future research should investigate the ways that coping resources and coping strategies may attenuate the impact of sleep on mental health for SMM.