(PS9-A11) Sleep Variability and Its Impact on Variability of Suicidal Ideation

Suicide is the 11th leading cause of death in adults and the 2nd leading cause of death in adolescents in the U.S. (CDC, 2021). Over the last several decades, a plethora of research has identified risk factors for suicide (Fox et al., 2020); sleep disturbances have been associated with increased risk for suicidal ideation (SI), suicide attempts, and non-suicidal self-injury (NSSI), independent of diagnosis of a major depressive episode (Littlewood et al., 2016). This is of particular concern due to the high prevalence of sleep problems in healthy and clinical populations (Roth et al., 2006). In addition to evidence that inconsistent sleep is associated with adverse health outcomes (e.g., Chaput et al., 2020), research has identified that sleep variability is associated with increased risk for NSSI urges and behaviors (Burke et al., 2022) as well as SI (Bernert et al., 2017). People diagnosed with borderline personality disorder (BPD) are among those who experience high rates of SI and NSSI (Pompili et al., 2009). Additionally, meta-analyses and single research studies have found that adolescents and adults with BPD features reported several sleep disturbances (e.g., poorer subjective sleep quality, greater insomnia symptoms, and irregular sleep timing) at rates higher than a non-clinical population (Jenkins et al., 2021; Winsper et al., 2016). Given that individuals with BPD die by suicide and experience sleep problems at rates higher than the general population (Black et al., 2005), it is imperative to investigate how sleep variability impacts suicide variability in this population. To our knowledge, little to no research has been done to investigate how sleep variability may be associated with variability in SI in a sample of adults with BPD. Therefore, the present study seeks to examine how subjective measures of sleep variability impacts fluctuations in SI, particularly within the context of BPD. 

Data were collected from adults with BPD (n=18) participating in a 6-month treatment study. The study protocol also included ecological momentary assessment (EMA), which was completed one week for every month they were in treatment, as well as their last week of treatment (i.e., 7-weeks). Questions regarding sleep were delivered in the first EMA survey of the day, based on participant preference (e.g., 8am, 9am, 10am). Contrary to hypotheses, sleep variability (I.e., root mean square of successive differences in sleep quality ratings) was not related to variability in suicidal thinking (r = -0.21, p = .374) or in severity of suicidal thinking (b = -0.22, p = .648). While these are preliminary results in the context of a small sample, they suggest that the relationship between sleep and suicide is nuanced, and likely require larger samples to clarify relationships between these variables.