Sleep disturbances as a short-term within-person risk-factor for suicidal ideation: A systematic review and meta-analysis

BACKGROUND: Suicidal ideation is a strong predictor of suicide attempts making it a major public health concern. While long-term risk factors have been well-established, understanding short-term fluctuations in suicidal ideation is crucial for developing timely interventions. This meta-analysis examined whether sleep disturbances represent a within-person risk factor for next-day suicidal ideation among at-risk populations. METHODS: Five databases (MEDLINE, PsycINFO, CINAHL, Embase, and Web of Science) were searched from inception to November 2025 for studies using intensive longitudinal designs to assess within-person associations between sleep and suicidal ideation in at-risk populations. A correlated and hierarchical random effects meta-analysis was used to synthesize results, while cluster wild bootstrapping examined subgroup differences. RESULTS: Fifteen reports representing 12 unique studies (67 effect sizes, 959 participants) were included. A significant positive within-person association emerged between sleep disturbances and next-day suicidal ideation (r = .128, 95% CI = .075-.191, p < .001). Results were robust to publication bias. Subgroup analyses revealed no significant differences between sleep dimensions, assessment methods (self-report vs. device-based), or participant age groups (adolescents vs. adults). CONCLUSION: Sleep disturbances constitute a modest but significant short-term risk factor for suicidal ideation in at-risk populations. Though individual night-to-night effects are small, cumulative impacts over time may meaningfully contribute to suicide risk. These findings support integrating sleep monitoring into digital suicide prevention interventions and highlight the need for research examining specific within-person patterns of sleep disturbances and underlying mechanisms.