Exploring suicidal ideation and its correlates among Italian adolescents: the role of sleep quality

Suicide is a leading cause of death among adolescents worldwide. Within the ideation-to-action framework, suicidal ideation (SI) is an early marker along the trajectory toward suicide. This study aimed to assess the prevalence and correlates of SI in a sample of Italian adolescents, with a specific focus on sleep quality. A total of 1402 high school students (49 % female; mean age = 16.24 ± 1.56 years) completed an online survey assessing SI, sleep quality, and several variables across three domains: sociodemographic, psychological and behavioral/relational. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Bivariate analyses compared groups with and without SI. Two hierarchical logistic regression models were performed: the first included PSQI total score, the second included the seven PSQI subdomains. The one-month prevalence of SI was 21 %. Adolescents with SI reported higher psychological distress, poorer sleep quality, and greater involvement in risky behaviors. Significant independent associations (p < .05) were observed both for PSQI total score and for its subdomains sleep disturbances and use of sleeping medication. Moreover, female gender, family history of alcohol use disorder, positive depression screening, non-suicidal self-injury, use of illicit drugs other than cannabis and video game use showed independent association to SI. Psychological distress indicators showed the strongest independent association with SI. Poor sleep quality was independently associated with SI, representing a potentially modifiable risk factor. These findings suggest the importance of school-based mental health screening incorporating sleep assessments as part of broader suicide prevention strategies.