Prediction by Insomnia to Treatment Outcomes in an Adolescent Suicide Management Program

BACKGROUND: Insomnia is the symptom most strongly associated with suicide-related thoughts and behaviors in adolescents and young adults with diverse diagnoses, even after adjusting for psychiatric conditions like depression (Goldstein, 2008). However, there is little empirical evidence that demonstrates prospectively that sleep problems are in fact a risk factor for suicide attempts (Franklin et al. 2017). OBJECTIVE: This study examines the previously unexplored relationship between insomnia and suicidal relapse in youth enrolled in an outpatient suicide prevention program. METHODS: Data were obtained from clinical records of adolescents ages 12-17 enrolled in the Suicide Prevention and Resilience at Children's Intensive Outpatient program (SPARC IOP) from January 1, 2014 through March 1, 2016 (n = 206). Patients completed measures of depressive symptoms, insomnia, and suicide risk at entry and exit. The association between insomnia, exit suicide risk, and 6-month attempts was tested with multiple regression analyses. RESULTS: Patients were mainly female (79.1%; n = 163) with a primary diagnosis of depression (89.8%; n = 185). Depression, suicide risk, and insomnia scores decreased overall. Entry insomnia was associated with exit suicide risk (CHRT) after controlling for entry risk, age, sex, time in the program, and number of previous attempts. Patients with insomnia did not show a different rate of treatment response (β = 0.257, p > .10). Entry insomnia was also associated with suicide attempts within 6 months after exiting the program when controlling for age, sex, and previous attempts. When entry and exit risk were added to the model, the association between entry insomnia and attempts within 6 months lost significance while the association between exit risk and attempts at 6 months became significant. Thus, patients with higher insomnia scores at entry had higher suicide risk scores at exit, which increased the likelihood of a suicide attempt 6 months after the program. CONCLUSION: These findings suggest that insomnia is a distal variable in the pathway to risk for suicide attempts after discharge. Entry insomnia is associated with exit risk, which has a more proximal relationship with 6-month attempts. Direct management of insomnia symptoms could reduce suicide risk at program exit, which could then reduce the probability of a suicide attempt in the 6 months following discharge. These studies could ultimately lead to new therapeutic approaches for reducing suicide attempts by treating insomnia symptoms.