Implicit Identification with Death and Adolescent Self-Injurious Thoughts and Behaviors: Sleep Quality as a Moderator

Dual-process theory suggests that implicit identification with death more strongly predicts self-injurious thoughts and behaviors under certain conditions. As reliance on implicit heuristics to guide behavior may increase in the context of poor sleep, the current study evaluated whether implicit identification with death alone, or in combination with self-reported sleep quality, predicted future levels of suicidal ideation and self-harm.

The sample consisted of 100 adolescents (M_age = 16.62; SD = 1.83, 91.0% females; 26.0% racial minority; 25.0% Hispanic/Latino/a/x) with histories of suicidal episodes and repeat self-harm behavior. Implicit identification with death and sleep quality were assessed at baseline. Outcomes (i.e. suicidal ideation and self-harm levels) were assessed at baseline, 6-, and 12-months. Multilevel structural equations were used to assess relations among study variables.

At high and/or moderate levels of poor sleep quality, greater implicit identification with death positively predicted suicidal ideation and self-harm levels. Importantly, similar results were found with suicide attempts and non-suicidal self-injury as separate outcomes. As main effects, implicit identification with death and poor sleep quality only positively predicted suicidal ideation and suicide attempts, respectively.

The interaction between implicit identification with death and sleep quality may be an important predictor of future adolescent suicidal ideation and self-harm. Assessment of an adolescent's implicit identification with death and sleep quality may help identify those at greatest future risk.