Suicide Risk and Sleep in Treatment
Principal Investigator: 

Lily Brown

University of Pennsylvania

Sleep disorders are remarkably common in military service members. One out of five active duty service members has clinically significant insomnia symptoms, which are one of the most common reasons for mental health referrals in the military. Insomnia, nightmares and nocturnal wakefulness significantly increase the likelihood of suicidal ideation, suicidal attempts, and death by suicide in active duty military personnel. Leading researchers believe sleep disorders may operate as key risk factors for suicidal ideation and behavior in the military. Most prior studies on the associations among sleep disturbances and suicidal thoughts/behaviors have relied on retrospective recall. Although helpful, it does have some limitations, including, but not limited to, biased recall and averaged ratings over multiple periods of time. In recent years researchers have begun looking into ecological momentary assessment (EMA), delivered through smartphones and passive (e.g., wearable) watch devices, to measure sleep, physical activity, and heart rate. Assessments allow researchers to gather data in real time eliminating the limitations of recall.

Despite the promise of EMA, this approach has not been used for measuring risk factors for suicidal ideation and behavior for military service members in treatment. Dr. Lily Brown plans to use EMA to breakdown the complex associations among sleep disturbances and suicidal ideation and behavior in active duty military personnel receiving treatment for recent suicidal thoughts or behaviors. She will use a 28-day multidimensional assessment of military service members to explore the temporal dynamics between sleep and suicidal ideation/behavior. The aim is to characterize the influence of sleep disorders on suicidal ideation and behavior and to demonstrate critical periods of high-risk for suicide based on time-dependent sleep disturbance dynamics. These critical risk periods will inform the development and delivery of future interventions for military service members. EMA could eventually be leveraged to trigger real-time, technologically driven intervention opportunities to reduce suicide risk in service members. In addition to highlighting opportunities for stand-alone interventions, these methods may also be useful for augmenting the success of existing suicide prevention strategies.