Multidimensional sleep health and suicide risk in older depressed adults

A variety of sleep dimensions are associated with suicidal thoughts and behavior in late life. However, sleep is not experienced as a singular dimension. This study examined associations of multidimensional sleep health with life-time suicide attempt and current suicidal desire in older depressed adults.

Participants (N = 72, mean age: 60.5 ± 5.6 years; 60% women; 22% nonwhite; with 32 past suicide attempters and 40 non-attempters) completed a 3-week protocol involving ecological momentary assessment and wrist actigraphy. Multidimensional sleep health was quantified using actigraphic measures of sleep efficiency, timing, duration, and regularity, and sleep diary measures of satisfaction. Each component was dichotomized and then summed to create a composite score (0-6); higher values indicated worse sleep health. Participants completed weekly clinical assessments of suicidal ideation. Separate regression models tested associations of multidimensional sleep health and its individual components with current suicidal desire and life-time suicide attempt adjusting for covariates.

A 1-point change in worse multidimensional sleep health was associated with 2.0 times greater odds of current suicidal ideation (OR: 1.990; 95% CI: 1.146 - 3.456; p = 0.015). Among its components, greater irregularity of sleep duration and sleep timing were associated with current suicidal desire . After adjusting for depression severity, the association between multidimensional sleep health and suicidal desire was attenuated by 56%.

Multidimensional sleep health is associated with current suicidal desire but not lifetime suicide attempt in older depressed adults. Future research should determine whether regularity of sleep duration and timing is an intervention target for reducing current suicidal ideation.