Uncovering the links between sleep struggles, substance abuse and suicidal thoughts in teens with depression

Rebecca Robbins, Ph.D., of the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital, is the senior author of a paper published in Psychiatry Research, titled "Exploring sleep difficulties, alcohol, illicit drugs, and suicidal ideation among adolescents with a history of depression."

How would you summarize your study for a lay audience?

Suicide is one of the leading causes of death for adolescents in the U.S. We know, due to previous research, that difficulty falling asleep or waking up too early as well as abuse of prescription drugs, sedatives and opioids is associated with thinking, planning or attempting suicide—otherwise known as, suicide ideation.

Using responses from the 2015 to 2020 National Surveys of Drug Use and Health (NSDUH), our team analyzed and quantified the associations between sleep difficulties and suicidal ideation among adolescents with a history of depression and how these associations were amplified by illicit drug and/or alcohol abuse/dependence.

We found significant associations between sleeping difficulties and suicide ideation among adolescents with a history of depression, and a more robust association between sleep difficulties when the person reported alcohol abuse/dependence and those that reported illicit drug abuse/dependence in the past year

What knowledge gaps does your study help to fill?

Through our analysis, we quantified the connection between sleep difficulty and substance use among adolescents with a history of depression. Our work suggests significant associations between sleep difficulties, illicit drug use and suicidal ideation in adolescents with symptoms of major depressive episodes.

How did you conduct your study?

We analyzed NSDUH survey results from 38,418 respondents between the ages of 12 to 17 over a five-year period. Questions in the surveys asked respondents about their sleep difficulties, suicide ideation symptoms, illicit drug use and depression symptoms.

From that dataset, 11.6% reported thinking about suicide, 5.7% reported planning a suicide attempt and 3.8% reported making a suicide attempt. Additionally, 16.7% reported sleeping difficulties.

Respondents who engaged in alcohol abuse had associations with sleep difficulties and attempts at suicide. Respondents who partook in illicit drug abuse had associations with sleep difficulties and thinking and attempting suicide.

What are the implications?

The findings of our work are consistent with past research connecting difficulty in sleeping with mental health concerns, such as suicide ideation. Fortunately, behavioral interventions, therapies and medications can treat patients who experience difficulties in sleeping.

There are a few limitations to our study, therefore, our results should be interpreted with caution. In the dataset, there was one question about sleeping difficulties. In addition, based on the format of the questions in the survey, it's possible sleep difficulty and suicide behavior symptoms were experienced more than one year before and alcohol and illicit drug use occurred in the year prior to the responses.

What are the next steps?

Fortunately, sleep difficulties are treatable with behavioral therapy and medication. Future research may include designing sleep health interventions that are tailored to the needs of adolescents struggling with mental health concerns and/or substance use/abuse.