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Christopher W Drapeau, Michael R Nadorff Department of Psychology, Mississippi State University, Mississippi State, MS, USA Abstract: Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep–suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep–suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders. Keywords: sleep, suicide, suicidality, insomnia, nightmares, treatment

This study provides a decadal analysis of national suicide data over 90 years, offering a comprehensive view of long-term trends and current levels in the United States. We analyzed mean decadal suicide numbers, rates, and confidence intervals from the 1930s to the early 2020s across demographic categories including sex, race, and age. Our findings reveal that suicide rates in the 2020s are the highest since the 1930s. The data indicate significant variations across groups; the 2020s show the highest suicide rates for both Whites and Nonwhites, and individuals under 44 years of age. Conversely, men's suicide rates were slightly lower than those in the 1930s, whereas rates for women and older adults peaked during the 1930s. The results underscore the need for ongoing surveillance of suicide trends and proactive suicide prevention measures by governmental and other relevant organizations., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Disrupted sleep is associated with non-suicidal self-injury (NSSI) in young adults, but many specific features of sleep continuity and timing have yet to be examined. Additionally, the psychological mechanisms linking sleep to NSSI are unclear. The present study evaluated 14 sleep variables as classifiers of lifetime or recent NSSI and examined potential confounding and mediating factors., Methods: A sample of 885 college students provided measures of sleep continuity (e.g., duration, timing, fragmentation), nightmares, insomnia, and perceived sleep control. Lifetime and past 3-month NSSI were measured using a self-report version of the Columbia Suicide Severity Ratings Scale. Bidirectional stepwise regression identified significant sleep classifiers and subsequent models examined their associations with NSSI after adjusting for covariates and through potential psychological mediators., Results: Only absolute social jetlag was associated with recent NSSI, even after adjusting for covariates, such that each additional hour difference between weekday and weekend sleep schedules was associated with a 17% greater risk of recent NSSI. Nightmares, weekend sleep efficiency, and perceived sleep control were associated with lifetime NSSI, although only weekend sleep efficiency remained associated after adjusting for covariates. Bootstrap mediations identified negative urgency as a partial mediator for recent and lifetime NSSI, and lack of premeditation and perceived burdensomeness as partial mediators for lifetime NSSI., Conclusions: The timing and consistency of young adults' sleep schedules may be of greater importance to NSSI among college students than insomnia or insufficient sleep. Future studies of sleep and NSSI should include these measures as potential risk factors. HIGHLIGHTSDifferences between weekday/weekend sleep timing are linked to recent NSSI.Negative urgency partially mediates poor sleep on recent and lifetime NSSI.Sleep shares a multifaceted relationship with NSSI risk in college students.

Objective : To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18-25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.

Objective: The revised Willingness to Intervene against Suicide questionnaire and the Expanded Revised Facts on Suicide Quiz were employed to examine the relationship between college students' knowledge about suicide and intention to intervene. Participants: College students ( n  = 515) participated, a majority being women and Caucasian. Methods: Participants completed an online survey. Data were analyzed in SPSS. Results: College students have poor knowledge of suicide facts; however, this low level of accurate knowledge was not associated with intention to intervene with a suicidal person. Attitudes, subjective norms, perceived behavioral control, sex, and no previous suicide attempt were all significant predictors of intention to intervene. Conclusions: These results challenge the notion that one must be well-informed in order to intend to take action.

Introduction: Progress reducing suicide death will require randomized clinical trials (RCTs) specifically targeting suicide risk. Even large RCTs may not stipulate suicide death as the primary outcome, as suicide death is relatively uncommon. Therefore, RCTs may need to specify suicidal ideation as a proxy indicator of risk. There is no consensus on the best tool for measuring suicidal ideation within RCTs. We contrasted the psychometric performance of three suicidal ideation measures to address this need., Methods: We applied item response theory to the Beck Scale for Suicide Ideation (BSSI), the Columbia-Suicide Severity Rating Scale (C-SSRS), and the suicide item of the Hamilton Rating Scale for Depression (HRSD) for 101 outpatients with depression and suicidal ideation participating in a RCT with suicidal ideation as the primary outcome., Results: All measures of suicidal ideation were equally able to detect low and very high levels of suicidal ideation., Conclusions: The choice of the specific measure of suicidal ideation in a clinical trial may be dictated by time and financial resources versus the need for granularity in the interpretation of the scores., (© 2021 The American Association of Suicidology.)

Background: Despite alarming increases in suicide deaths among preadolescent children, knowledge of the precipitants of suicide risk and the characteristics of children who seek treatment for suicidality is limited. This study's purpose is to describe children (ages 6-12) hospitalized for suicide-related concerns and compare demographic and diagnostic differences between children and adolescent (ages 13-18) patients., Methods: This retrospective study analyzed medical records of 502 children and adolescents ages 6-18 admitted for suicide-related risk to one psychiatric inpatient hospital in southeastern United States between 2015 and 2018., Results: Patients were predominantly White (63.5%), female (64.5%), and non-Hispanic/Latino (85.1%). We conducted descriptive analyses and a series of logistic regressions comparing children and adolescents with data extracted from discharge summaries, (i.e. primary reasons for admission, environmental stressors, and diagnostic categories). Common environmental stressors included school (63.2%) and family (60.7%), and the most common diagnosis included depressive disorders. Compared to adolescents, children were more likely to be Black (OR = 1.99), male (OR = 1.94), and receive neurodevelopmental disorder (aOR = 3.0) or trauma and stress-related disorder (aOR = 2.6) diagnoses, but less likely to be diagnosed with a depressive disorder (aOR = 0.4). Across both age-groups, Black patients were more likely to be diagnosed with neurodevelopmental disorders and less likely to receive internalizing disorder diagnoses., Conclusions: Characteristics of children hospitalized for suicide-related risk are relatively similar to characteristics of children dying by suicide. Compared to adolescents, hospitalized children are more likely to be Black, male, and have a neurodevelopmental disorder diagnosis. Proactively identifying and providing strengths-based supports for Black boys and families appear critical for suicide prevention in children., (© 2021 Association for Child and Adolescent Mental Health.)

Objective: To evaluate the impact of a 6-h traumatic loss training program on organ procurement personnel attitudes, confidence, and knowledge about suicide loss and best practices in supporting survivors. Organ procurement personnel may be uniquely positioned to deliver supportive programming as they have early access to suicide loss survivors (i.e., within hours or days of a loss) and are trained in a variety of backgrounds that include skills in supportive service delivery (i.e., nursing and social work)., Method: Sixty-four personnel participated in the 6-h Traumatic Loss Support Program (TLSP) training and completed measures of attitudes, confidence, and knowledge about supporting suicide loss survivors prior to and following the training., Results: Ratings of the usefulness of the training were high and mean scores on all measures of attitudes, confidence, and knowledge increased with moderate to large effect sizes., Conclusions: Results of the current study demonstrate that the TLSP training may be an effective way of increasing suicide loss supportive services provided by organ procurement personnel; however, further research is needed to determine the extent to which these interactions influence the bereavement of those who have lost loved ones to suicide and the fidelity in which the TLSP is implemented., (© 2020 The American Association of Suicidology.)

Objective: Suicidal behavior is stigmatized, and suicide attempt survivors often keep their experiences secret. Although secrecy can protect from discrimination, research from related fields suggests that both the experience of stigma and secrecy can contribute to suicidality. Although suicide attempt survivors are at high risk for reattempt, research investigating the link between suicide stigma and suicidality among this group is rare., Method: A community sample of 159 suicide attempt survivors participated in an online survey in the US. We used multiple linear regression models to test the association between anticipated suicide stigma and current suicidality, as well as a path model to test the mediating effect of secrecy., Results: After controlling for age, sex, number of lifetime suicide attempts, and time since the most recent suicide attempt, anticipated suicide stigma was significantly associated with increased suicidality. In a controlled path model, this link was partially mediated by increased secrecy., Conclusion: These results provide initial support that anticipated suicide stigma, and secrecy can contribute to suicidality among suicide attempt survivors. Therefore, programs to support suicide attempt survivors in coping with suicide stigma and secrecy, as well as interventions to reduce harmful aspects of public suicide stigma, could contribute to suicide prevention., (© 2020 The Authors. Suicide and Life-Threatening Behavior published by Wiley Periodicals, Inc. on behalf of American Association of Suicidology.)

It is important to explore factors that could help or hinder one's wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of covariance (MANCOVA) to test the relationship between disclosure, PTG, and posttraumatic depreciation among suicide attempt survivors when controlling for time since attempt and to test whether these effects remained after controlling for quality of support from family and friends. Suicide attempt survivors ( n = 159) completed an online survey about their experiences. Increases in disclosure to family and friends but not to healthcare providers predicted changes in PTG. The effects of family disclosure remained even after controlling for quality of support. Disclosure to healthcare providers demonstrated some statistical effects on PTG, yet in the opposite direction and only after controlling for quality of support. The control variables-time since attempt and quality of support-were the only variables that predicted a change in posttraumatic depreciation. These findings suggest there is value in disclosing one's personal story to family regardless of whether one receives supportive responses and that social support can impact one's PTG.

Outpatient visits for sleep-related difficulties and the rate of suicide in the United States have both increased by more than 20% since 1999. Research suggests that anywhere from 75% to 91% of suicide decedents had contact with a physician within the year prior to fatally attempting suicide. Although the prevalence of such contacts among sleep clinicians is unknown, it is important to note that sleep disturbances in general are both a risk factor and potential warning sign for suicide. Screening for suicide risk among sleep patients is recommended, especially among those with a history of psychiatric and chronic medical conditions. Using evidence-based screening tools, such as the Columbia suicide severity rating scale, when screening patients for suicide risk is recommended despite the need for more research on the efficacy of suicide screening. For sleep clinic professionals who do not have the time to comprehensively assess and manage suicide risk, they are encouraged to implement suicide prevention policies within their departments and clinics and to follow the best available evidence to inform these policies. A protocol for screening for suicide risk in sleep clinics is outlined along with triage and documentation recommendations., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Although suicide loss has been associated with several negative outcomes, numerous studies have shown that loss survivors can experience posttraumatic growth (PTG) following the suicide loss of a significant other. However, few studies have explored the mechanisms of such growth. Aims: The aim of this study was to identify predictors of PTG among a sample of adult suicide loss survivors and to explore whether the amount of time since the suicide loss moderated the relation between self-reported coping and PTG. Method: Suicide-bereaved adults ( n = 307) completed online questionnaires measuring personality, coping, help-seeking attitudes, social support, and PTG. Results: Hierarchical regression analyses showed five independent associations with PTG: time since loss, perceived closeness, help-seeking attitudes, social support, and problem-focused coping. Time since loss did not moderate the relation between any of the self-reported coping styles and PTG. Limitations: The limitations of this study include a cross-sectional design, potential selection bias, no comparison or control group, and unrepresentative sample demographics of suicide loss survivors. Conclusion: Problem-focused coping showed the strongest association with PTG, independent of time since loss, suggesting that this coping style may facilitate growth throughout the grief trajectory.

Background: Sleep has emerged as an important factor in elevated risk for suicide and suicidal behaviors; however, the mechanisms accounting for this relationship are poorly understood. Emotion regulation is a well-established correlate of self-injurious behaviors; however, the broad construct has recently been shown to provide limited predictive utility. More nuanced investigations into the processes involved in emotion regulation may address this gap. This study sought to examine the mediating role of emotion regulation between sleep disturbances and suicide risk, as well as to evaluate a moderated mediation model in which down- and up-regulation of emotions would moderate this mediation., Methods: Participants were 972 adults recruited from a crowdsourcing website (Amazon's Mechanical Turk) who completed self-report questionnaires regarding nightmares, suicide risk, and emotion regulation., Results: Emotion regulation mediated the direct effect of nightmares on suicide risk and suicide attempts. Downregulation of negative affect moderated the mediation of nightmares on suicide risk more clearly than upregulation of positive affect, and neither component of emotion regulation exhibited moderated mediation in the suicide attempt model., Limitations: Generalizability of our findings from an online community sample will need to be established with replication in other samples. Additionally, we used cross-sectional measures in our mediation models., Conclusions: Downregulation of negative emotions may be particularly salient in relation to the severity of suicide risk and, as a result, relative deficits in this area should be considered when making risk determinations., (Copyright © 2018. Published by Elsevier B.V.)

The suicide rate in the United States has climbed each year for more than a decade, highlighting the need for greater understanding of, and prevention strategies for suicidal behavior. Nightmares have been shown to be associated with suicidal behavior independent of several psychiatric risk factors for suicide, such as symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The specific role of nightmares in contributing to suicide remains unclear due to the difficulty in delineating causal factors. However, the reporting, screening and treatment of nightmares continues to remain rare making progress difficult. Research is beginning to make some progress in uncovering the mechanisms by which nightmares increase suicide risk providing opportunities for intervention and prediction of suicidal behaviors., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Study Objectives: Although nightmares have been associated with suicidal behavior beyond well-known risk factors, the association between nightmares and multiple suicide attempts remains largely unexplored. This study addressed this gap in the literature by examining whether nightmares differentiated between individuals who reported single versus multiple suicide attempts. The individual contributions of nightmare frequency, distress/severity, and chronicity were also investigated to determine which variable contributed the most variance., Methods: Participants (n = 225) were recruited as part of a larger data collection through Amazon Mechanical Turk, an online crowdsourcing venue. Participants reported attempting suicide once (n = 107 individuals), multiple times (n = 118), or never (n = 791). Nightmare frequency, distress, and chronicity were assessed with the Disturbing Dreams and Nightmares Severity Index., Results: Nightmare frequency differentiated multiple from single suicide attempters, even after controlling for symptoms of depression, posttraumatic stress disorder, insomnia, nightmare severity/distress, nightmare chronicity, and age ( P = .019). Comparison participants, those not reporting suicide attempts, reported a significantly lower level of nightmare frequency than those reporting single or multiple suicide attempts., Conclusions: Inconsistent with past research, this study showed that nightmare frequency, and not nightmare chronicity or severity/distress, differentiated between single and multiple suicide attempters. This outcome suggests that the number of nightmares experienced may be more pertinent in predicting repeat suicide attempts than their duration or perceived severity. Study limitations include a cross-sectional design, a convenience sampling approach, a lack of control for previous treatment or length of time since last attempt, and a retrospective nightmare measure., (© 2018 American Academy of Sleep Medicine.)

This article reviews the literature examining the association between sleep disorders and psychopathology among older adults. Similar to the younger adult literature, the authors found that sleep disorders are robustly associated with anxiety, depression, dementia, and suicidal behavior in late life. Clinical implications and opportunities for intervention are discussed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This study examined the impact of personality, coping, and perceived closeness on help-seeking attitudes in suicide bereaved adults. Participants (n = 418; mean age = 49.50; 90% women, 89.7% Caucasian) completed measures of personality (neuroticism, extraversion, openness, conscientiousness, and agreeableness), coping, and attitudes toward seeking mental health services. Regression analyses revealed neuroticism as the strongest predictor of help-seeking attitudes. Relatively neurotic adult women bereaved by suicide may be at-risk for developing unhealthy coping styles, low stigma indifference, and more negative help-seeking attitudes.

Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.