Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high-risk adolescents and young adults

Jessica L. Hamilton, Aliona Tsypes, Jamie Zelazny, Craig J.R. Sewall, Noelle Rode, John Merranko, David A. Brent, Tina R. Goldstein, Peter L. Franzen

Research output: Contribution to journalArticlepeer-review


Background: Identifying proximal risk factors for suicidal ideation that are modifiable and relevant for adolescents and young adults is critical for suicide prevention. This study used an intensive monitoring approach to examine whether objectively- and subjectively- measured sleep characteristics predict next-day suicidal ideation occurrence and intensity through affective reactivity to interpersonal events in young people at high risk for suicide. Methods: Participants included 59 (13–23 years; 76% White; 75% female) adolescents and young adults undergoing intensive outpatient program treatment for depression and suicidality. Participants completed daily ratings of suicidal ideation, sleep quality, and affective reactivity to positive and negative interpersonal events for up to 3 months (M = 56 days, SD = 24.13). Actigraphy captured behavioral sleep duration and timing. Multilevel modeling was used to evaluate within-person fluctuations in sleep and affective reactivity as predictors of suicidal ideation, and multilevel mediation tested the indirect effects of sleep on suicidal ideation via affective reactivity to interpersonal events. Results: Results indicate significant indirect effects of objectively measured sleep duration and subjective sleep quality on next-day suicidal ideation via affective reactivity to negative and positive interpersonal events, respectively. Shorter-than-usual sleep predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events. Worse sleep quality than usual predicted next-day suicidal ideation via reduced affective reactivity to positive interpersonal events. Conclusions: Affectivity reactivity is a proximal mechanism through which sleep indices may influence risk for suicidal thinking on a daily basis. Findings highlight the utility of targeting sleep and emotion regulation in suicide prevention among adolescents and young adults at high-risk for suicide.

Original languageEnglish (US)
Pages (from-to)27-38
Number of pages12
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number1
StatePublished - Jan 2023

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


  • Adolescence
  • actigraphy
  • affective reactivity
  • intensive monitoring
  • interpersonal
  • sleep
  • suicide


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