Sleep loss suicidal ideation: the role of trait extraversion

Background: It is known that sleep disturbance is associated with increased suicidal thinking. Moreover, completed suicides, when adjusted for the proportion of the populace that is awake at a given time, are more probable during the late night/early morning hours. Despite these concerns, no studies have examined the role of trait-like individual differences in vulnerability to suicidal ideation during sleep deprivation or insomnia. In two separate studies, we examined whether the trait of extraversion is predictive of changes in suicidal thinking following two nights of sleep deprivation and among individuals meeting the criteria for insomnia. Methods: Study 1: Twenty-five healthy military personnel (20 males), ages 20-35 completed the NEO-PI-R Extraversion scale and the Suicidal Ideation (SUI) scale of the Personality Assessment Inventory (PAI). Participants completed 77 h of continuous sleep deprivation. After 56 h of sleep deprivation, participants completed the SUI scale a second time. We predicted a change in SUI scores from baseline extraversion. Study 2: 2,061 adults aged 18-79 (900 males) were divided into two groups based on the clinical threshold (≥ 10) on the Insomnia Severity Index (ISI) and completed measures of extraversion and depression, including the suicide item of the Patient Health Questionnaire-9 (PHQ9). Results: Study 1: After controlling for the caffeine group and changes in PAI Depression, Extraversion scores were used to predict changes in SUI scores using stepwise multiple linear regression. Higher Extraversion was significantly associated with increased non-clinical suicidal ideation following sleep loss, β = 0.463, partial r = 0.512, p = 0.013. Study 2: After controlling for depression, the effect of insomnia on suicidal ideation was moderated by trait extraversion (p < 0.0001). Overall, the presence or absence of insomnia had little effect on individuals low in trait extraversion (i.e., introverts), but insomnia was associated with significantly higher suicidal ideation among high trait extraverted individuals. Conclusions: Higher trait extraversion was associated with increased vulnerability to suicidal ideation between rested baseline and total sleep deprivation and was associated with greater suicidal ideation among those meeting criteria for clinically severe insomnia. These findings point to a potential trait-like vulnerability factor that may further our understanding of sleep disruption in the phenomenology of suicide.