Sleep in youth with repeated self-harm and high suicidality: Does sleep predict self-harm risk?

Joan Rosenbaum Asarnow, Sunhye Bai, Kalina N. Babeva, Molly Adrian, Michele S. Berk, Lauren D. Asarnow, Damla Senturk, Marsha M. Linehan, Elizabeth McCauley

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Objective: To elucidate processes contributing to continuing self-harm in youth at very high risk for suicide, focusing on sleep disturbance, a putative warning sign of imminent suicide risk. Method: 101 youth (ages 12–18) selected for high risk of suicide/suicide attempts based on suicidal episodes plus repeated self-harm (suicide attempts and/or nonsuicidal self-injury [NSSI]). Youth were assessed at baseline, 6-, and 12-month follow-ups on measures of self-harm, suicidality, sleep, and depression. Results: Youth showed high rates of baseline sleep disturbance: 81.2% scored in the clinical range on the Pittsburgh Sleep Quality Index (PSQI); 81.2% reported an evening (night owl) circadian preference. PSQI score was associated with elevated levels of self-harm (suicide attempts and NSSI) contemporaneously and predicted future self-harm within 30 days. Rates of self-harm were high during follow-up: 45.0% and 33.7% at 6 and 12 months, respectively. Conclusions: Results underscore the need to move beyond an acute treatment model to prevent recurrent and potentially deadly self-harm, the importance of clarifying mechanisms contributing to elevated suicide/self-harm risk, and the potential promise of engaging sleep as a therapeutic target for optimizing treatment and elucidating mechanistic processes.

Original languageEnglish (US)
Pages (from-to)1189-1197
Number of pages9
JournalSuicide and Life-Threatening Behavior
Issue number6
StatePublished - Dec 2020

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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