Dysfunctional Beliefs About Sleep in Suicidal Adolescents: Associations and Treatment Implications

Cognitive behavior therapy for insomnia has shown increasing promise in reducing suicidality in adults and may be effective in reducing suicidality in adolescents. Dysfunctional beliefs about sleep (DBs) are a primary target of such interventions. However, there are few studies of DBs in adolescents, let alone suicidal adolescents. Our study (1) assessed the sleep and suicide-related correlates of DBs, and (2) examined if change in DBs was associated with change in sleep, in a sample of acutely suicidal adolescents aged 12-18 years in an intensive cognitive behavior therapy-informed treatment program that did not target sleep. Measures of DBs (using the 16-item Dysfunctional Beliefs About Sleep Scale's (DBAS) total score and four subscale scores: Consequences, Helplessness, Expectations, and Medications), sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation were administered at program admission and discharge. Total DBs were concurrently associated (all ps < .05) with sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation, and reduction of DBs was associated with improvement in sleep over treatment. There was some variability in the association between types of DBAS and variables of interest, with the Helplessness subscale showing the strongest and most consistent associations. Limitations include subjective measurements only, a lack of specific insomnia symptom measures, and a nondiverse sample. DBs show promise as a target in the management of suicidal adolescents. Our findings also suggest that the development of an adolescent-specific scale could enhance construct measurement validity.