by Leiden University

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A restless night aggravates symptoms in those experiencing suicidal thoughts, as psychologists have found in their study on the short-term risk factors of suicide. They argue that targeting sleep could thus be essential for suicide prevention.

To better prevent suicides, researchers are attempting to build reliable models to predict when someone might consider suicide. However, this proves incredibly challenging, explain Niki Antypa and Liia Kivelä from the Department of Clinical Psychology.

“Most research examines long-term data, where participants are often followed over years. This helps identify general suicide risk factors like gender and socioeconomic status, but it reveals little about the timing of these risks,” says Kivelä.

Antypa adds, “We wanted to understand what happens in the short term among those experiencing suicidal thoughts—what specific circumstances and emotions coincide with suicidal ideation.”

Their results stem from the SAFE study: Suicidal ideation Assessment: Fluctuation monitoring with Ecological momentary assessment. The researchers identified which factors can exacerbate or reduce suicidal ideation. They have published three papers from this study, in the Journal of Psychiatric Research, Acta Psychiatrica Scandinavica and Psychological Medicine.

Real-time tracking

For three weeks, 82 participants used an app to record their emotional and mental state as well as their sleep four times daily. Kivelä explains, “We chose this timeframe as it was manageable for participants, yet long enough to capture a detailed view of their lives.”

Participants were either recruited online or were clients at the LUBEC or LUMC. “All struggled with suicidal thoughts and various diagnoses, such as depression, anxiety, autism, or PTSD. Many had had negative past experiences with mental health care and wanted to contribute to a better understanding of their condition. Others were on waitlists for psychological treatment and sought to do something constructive in the meantime.”

Disturbed sleep worsens symptoms

One significant conclusion from the data is that disturbed sleep plays a major role in exacerbating suicidal thoughts. “A broken night’s sleep was associated with heightened suicidality the next day. This association was evident both in objective measurements from a sleep tracker and in subjective assessments of sleep characteristics,” says Antypa.

She was unsurprised by these results. “Sleep is a basic need, and when it is disrupted, issues can arise, especially for someone already struggling.” She notes, however, that the critical impact of sleep on mental health is still often overlooked in clinical settings.

“There remains a lack of integrated understanding; many clinicians work within their specialized focus areas. In cases of suicidality, the emphasis is primarily on addressing thoughts and feelings, while sleep often takes a back seat. This study shows that poor sleep may act as a warning sign and suggests that improving sleep could be a valuable intervention.”

The heavy role of shame

Besides sleep, the researchers also mapped participants’ thoughts and feelings related to suicide, distinguishing between passive and active suicidal thoughts. “Passive thoughts involve a vague desire to escape distress, while active thoughts reflect concrete plans to take action,” Antypa explains.

Their analysis showed that feelings of shame were particularly linked with active suicidal thoughts. “Shame is often accompanied by a sense that something is inherently wrong with oneself. This feeling can be so heavy that those who experience it wish to escape it.”

Although psychological treatments specifically addressing shame exist, they are generally targeted towards patients with PTSD, where shame is also prevalent. Kivelä says, “These treatments targeting shame could also be applied to those experiencing suicidal thoughts, as they could be effective for this group as well.”

Risky research

Researching suicidal thoughts can be risky, but the researchers found that their study proceeded smoothly. Clear communication was key. “Participants knew in advance that this was not a treatment study and that we would only monitor their responses. They were also pre-screened to ensure stability for participation, and each had a personalized safety plan detailing who they could reach out to in a crisis,” Antypa explains.

At the study’s end, participants received a tailored report outlining insights into their symptoms and factors that influenced their thoughts, both positively and negatively. Kivelä adds, “For many, this report was a motivating factor for participating; they received something concrete in return for their involvement.”

More information: Liia M.M. Kivelä et al, Sleep, hopelessness, and suicidal ideation: An ecological momentary assessment and actigraphy study, Journal of Psychiatric Research (2024). DOI: 10.1016/j.jpsychires.2024.06.039

L. M. M. Kivelä et al, Digital phenotypes of real‐time suicidal ideation: Correlates and consequences, Acta Psychiatrica Scandinavica (2024). DOI: 10.1111/acps.13750

Liia M. M. Kivelä et al, Examining contemporaneous and temporal associations of real-time suicidal ideation using network analysis, Psychological Medicine (2024). DOI: 10.1017/S003329172400151X

Journal information:Journal of Psychiatric Research , Psychological Medicine

Provided by Leiden University