Can Sleep Problems Increase Suicide Risk in Teens?

Summary: Yes, sleep problems can increase suicide risk in teens. New research examines the impact of various sleep variables present at age 14 on an increase in suicide risk in teens at age 17. Researchers identify facts that increase risk and include suggestions for addressing those factors in order to decrease risk.

Key Points:

• Sleep quality among teens has a direct impact on mental health
• Factors common to the overall adolescent experience and developmental stage increase likelihood of poor sleep quality
• Specific sleep quality factors cause changes in specific cognitive skills
• Combined sleep factors and cognitive factors can increase suicide risk in teens

Teens, Sleep, and Mental Health

Experts on adolescent development indicate that sleep problems among adolescents – primarily lack of sleep – are caused by a variety of factors, including but not limited to:

• Early school starting times
• Late-night technology use
• Difference between week and weekend sleep schedules

Together, these factors can lead to the following negative outcomes:

• Problems falling asleep
• Problems staying asleep
• Poor sleep quality
• Daytime sleepiness

Those negative outcomes, in turn, increase risk of:

• Poor overall mental health, including
  • Depression
  • Anxiety
• Increase in suicidality, including suicide attempts

To further explore the impact of sleep on suicide attempts, a group of researchers in the United Kingdom published the paper ‘Sleep Problems, Decision-Making, and Suicide Attempts During Adolescence: A Longitudinal Birth Cohort Study” with the following research goals:

“To investigate the prospective relationship between sleep problems and subsequent suicide attempts among adolescents and examine the impact of decision-making and risk taking on the relationship between sleep problems and suicide.”

Studies on suicidality among adolescents are an essential component in improving adolescent menta health and quality of life.

The World Health Organization (WHO) reports the latest verified suicide rate and suicide rate trends among adolescents in 54 countries around the world. For the purposes of this article, we’ll report data on the U.K., the source of the study, the United States, our area of focus, and overall worldwide, for big-picture perspective.

Suicide Fatalities Among Adolescents Worldwide: Rates and Trends

Worldwide rate, suicide deaths:

• Adolescents: 3.77 per 100,000

Trends in suicide, 1990-2020:

• United Kingdom:
  • Among adolescent females: 2.5% annual increase
  • Among adolescent males; 8.5% annual increase
  • Annual suicide rate, 2020: 6.3 per 100,000
• United States:
  • Among adolescent females: 6.7% annual increase 2007-2017
  • Among adolescent males; 3.68% annual increase 2007-2017
  • Annual suicide rate, 2020: 15.5 per 100,000

Those figures clearly demonstrate the pressing need – i.e. the highly exigent circumstances – for understanding the factors that may decrease or increase suicide risk among adolescents, including whether sleep problems can increase suicide risk in teens.

Let’s return to the study we introduce above, take a look at how they designed it, and learn what they found.

Sleep Problems and Suicide Risk in Teens: About the Study

To assess whether sleep problems increase suicide risk in teens, and what factors may increase or decrease that risk, the researcher recruited 8,500 participants from the Millenium Cohort Study (UK), born between 2000 and 2002.

At age 14, each participant completed:

• A self-reported sleep surveys to measure sleep quality and variable
• The Cambridge Gambling Task to measure decision-making/risk taking qualities/tendencies

Then, at age 17, each participant answered this question:

“Have you ever hurt yourself on purpose in an attempt to end your life?”

The self-report survey included the following six questions, developed by the Millennial Cohort Study (MCS) research team. Questions included:

1. What time do you go to bed on school days?
2. What time do you go to be on non-school days?
3. When do you wake up on school days?
4. When do you wake up on non-school days?
5. Over the past month, about how long has it taken you to fall asleep?
6. Over the past month, about how many times did you wake up during the night, each night?

Based on answers to these questions, researchers created five sleep variables for the study:

1. Total time in bed on school nights
2. Total time in bed on non-school nights
3. Social jetlag, defined as the difference, or conflict, between sleeping patterns and daily commitments/responsibilities
4. Sleep onset latency
5. Frequency of night awakenings

The Cambridge Gambling Test (CGT) is designed to assess risk taking in controlled risk-taking situations, i.e. gambling and placing bets, and measures the following areas of cognitive function in adolescents:

• Rational decision-making skills: assesses rational decision-making skills, based on betting choices
• Risk-taking: assesses likelihood of taking risks, based on betting choices
• Risk-adjustment: assesses ability to adjust bets/bet choices based on various factors associated with betting choices
• Deliberation time: period spent deciding to make a bet
• Delay aversion: assesses difference in betting choice when betting amounts are presented in descending or ascending order, wherein teens with trait impulsivity are more likely to bet more when presented amount choices in descending order

After collecting survey data and CGT data at participant age 14, and reviewing responses to the single question on suicidality at participant age 17, researchers assessed the impact of sleep patterns on suicidality, and analyzed the effect of decision-making/risk taking outcomes on the impact sleep patterns may have on suicidality.

Let’s take a look at what they found.

Sleep Problems and Suicide Risk in Teens: Outcomes

Here are the top-line outcomes identified by the researchers:

• Lower total time in bed on school nights at age 14 was associated with increased risk of suicide attempt at age 17.
• Higher number of wake-ups during school nights at age 14 was associated with increased risk of suicide attempt at age 17

Those results are clear. Reduced sleep time and frequent wake-ups, called sleep fragmentation, increased risk of suicide. However, the research team did not stop there: the second part of the study was designed to assess whether cognitive factors measured by the CGT, such as decision-making skills or risk propensity, had any effect on suicidality among participants who reported lower sleep time and/or frequent nighttime wakeups.

Factors measured in the CGT that influenced – i.e. increased or decreased – risk of suicide included:

• Rational decision-making skills:
  • Lower scores on rational decision-making skill metrics indicated increased risk of suicide among teens with a higher number of nighttime wakeups
  • Higher scores on rational decision-making skill metrics indicated decreased risk of suicide among teens with a higher number of nighttime wakeups
• Risk-taking: no impact on suicidality
• Risk-adjustment: no impact on suicidality
• Deliberation time: no impact on suicidality
• Delay aversion: no impact on suicidality

Those data are also clear. With regards to risk, impulsivity, and decision-making skills, the ability to make rational decisions based on changing circumstances reduced risk of suicide among participants who reported a high number of nighttime wakeups.

Here’s how the study authors describe these findings:

[These results] suggest that the protective buffer of rational decision-making weakens as sleep fragmentation [i.e. nighttime wakeups] becomes more frequent, and other types of executive dysfunction, or even emotion regulation, may implicate this relationship.”

We’ll discuss these outcomes below.

How This Information Helps Us Help Teens

Viewed holistically, the results reported in the study imply at least three specific target areas to address that can reduce suicide risk among teens with sleep problems:

1. Sleep deprivation:

• • • • We can work to improve sleep among teens by improving basic sleep hygiene
      • We can work to improve sleep among teens by improving daily habits that promote healthy sleep, i.e. exercise, healthy eating, reducing late night technology use

2. Sleep fragmentation:

• • • • We can work to reduce nighttime wakeups by improving basic bedroom-centered sleep hygiene
      • Blackout curtains, white noise generators, cool temperature, and absence of screen tech after bedtime can all reduce nighttime wakeups

3. Rational decision-making

• • • • We can work to improve rational decision-making skills in teens by helping them increase coping skills in several areas
      • Areas that improve rational decision-making skills include emotion regulation skills, distress tolerance skills, and stress management skills

It’s possible to help teens improve in all three of these areas, thereby reducing the extent to which sleep problems increase suicide risk in teens. Improving the first two factors can occur at home, through the collaborative efforts of parents, teens, and experts in sleep hygiene. Improving the third factor – rational decision-making skills – can occur at home and with professional mental health support, also through the collaborative efforts of parents, teens, and experienced psychiatrists, therapists, or counselors.

Our final takeaway for parents is this: if your teen shows signs of sleep deprivation, it’s important to address those signs immediately. Sleep problems can increase suicide risk in teens, but with timely identification and intervention, evidence indicates it’s possible to decrease risk of suicide associated with sleep problems.

We’ll close with this reminder:

The sooner a teen who needs professional support for mental and/or behavioral health issues gets the professional support they need – including support for sleep problems – the better the outcome.