Sleep Problems Alter Proximal Risk of Negative Self‐Perceptions on Suicide Risk

INTRODUCTION: Perceiving oneself as a burden and self-hate are core drivers of suicidal thoughts and behaviors. Sleep problems also contribute to elevated risk for suicide. These factors are often studied in isolation and the impact of sleep problems on the risk conferred by negative self-perceptions to suicide is unclear. The current study evaluated how sleep problems interact with state- and trait-level self-hate and perceived burdensomeness in predicting suicide intent. METHODS: Data came from 25 adult outpatients with recent suicide ideation who completed a 21-day EMA protocol including three daily prompts assessing prior night hours slept, sleep problems, burdensomeness, self-hate, and suicide urges (n observations = 1092). Bayesian multilevel cumulative ordinal models with random intercepts were run. RESULTS: All variables except sleep hours had significant within-person effects on suicide urges. There were significant negative interactions between within-person burdensomeness and between-person sleep problems, as well as a within-person self-hate and between-person sleep problems. Among those with more sleep problems, the association between burdensomeness or self-hate and suicide urges was less positive, suggesting sleep problems may override the risk-related effects of negative self-perceptions. CONCLUSION: These findings underscore the complexity of suicide risk and suggest that interventions focusing on improving sleep may reduce near-term risk for suicide.