Jessica Gerner, Winner of the 2020 NIMH Three-Minute Talks Competition
Jessica Gerner: With rising suicide rates it's becoming increasingly important to identify risk factors for suicide, particularly risk factors that are modifiable and can be easily targeted and treated. Recent research has started identifying sleep disturbances as a potential risk factor for suicide.
Studies brought forth from our lab have shown that wakefulness in the early morning hours, particularly around the 4:00 a.m. hour is associated with next day suicidal ideation. Through this research it's becoming increasingly clear that linkages between sleep and suicide exist.
Ecological momentary assessment, or EMA, is a tool, is being more widely used to study the thoughts, behaviors, and patterns of individuals with a wide range of psychiatric conditions. It allows researchers to look at data as it occurs in the real world often using technology like smart phones and tablets.
It can be particularly difficult to ask explicit questions pertaining to suicidal thoughts in these platforms due to a need for quick action and monitoring.
Additionally, the fluctuating nature of suicidal ideation as well as the role that interpersonal and contextual factors play can make it difficult to incorporate EMA into suicide research.
However, I propose modifying EMA questions to include some questions based off of risk factors that are emerging in the suicide literature. In addition to straightforward questions about suicidal thoughts, we need questions that could signal risk to both the participant as well as providers. One such area of modification is sleep-related questions. While some EMA platforms do ask questions about sleep, they tend to ask about when an individual went to bed, when they awoke, and about their subjective sleep quality.
By instead asking about nocturnal wakefulness, the length of this wakefulness, and about sleep experiences we could begin to better target who is most at risk. Additionally, working with individuals to make sure that the timing of these questionnaires aligns with their sleep and wake schedules, which are often disturbed during a depressive episode can help to ensure that these questionnaires are completed.
This research can contribute to the growing body of work surrounding sleep and suicide and it can be used in conjunction with current measures such as polysomnography data, actigraphy data collection, and suicidal measures.
Individuals can also use this information to work with providers to help target and sleep disturbances that are emerging. Additionally, it can serve as a warning system to help identify when individuals are most at risk. The ultimate goal is early intervention to help target and treat symptoms of suicidal behavior as early as possible.