The dynamic relationship between alcohol and suicidal ideation: Between-person associations and overnight inertia

This study examined within- and between-person relationships between alcohol consumption and suicidal ideation (SI), including whether alcohol moderates the overnight persistence of SI, and explored whether sleep quality mediates the relationship between alcohol consumption and SI.

70 participants with recent SI (35.2 ± 10.9 years old, 70% identified as female, 17.1% as non-white, 8.6% as Hispanic, and 50% as non-heterosexual) completed six daily surveys for 28 days, assessing: intensity of SI across severities (passive SI, active SI, and suicide desire), sleep quality, and alcohol consumption. Bayesian multilevel models examined the relationship between alcohol consumption and next-day SI, including alcohol's moderation of the overnight inertia of SI, and between daily average SI and next-day drinking, at within- and between-person levels. Two-level dynamic structural equation modelling investigated whether sleep quality accounted for the association between alcohol consumption and next-day SI.

Between-person alcohol consumption was associated with more intense SI across severities. All between-person SI severities were associated with a greater likelihood of alcohol consumption. Within-person alcohol consumption was associated with greater overnight inertia of SI at all severities. We did not detect evidence that sleep rating mediated the relationship between alcohol consumption and next-day SI.

This study suggests that those who consume more alcohol may experience more SI, and those with elevated SI may be more likely to drink. The morning following alcohol consumption may be associated with heightened risk for SI, highlighting a potential need to develop safety plans and coping skills for this critical period.