Investigating the association between sleep problems and self-harm in Scottish adolescents

Introduction: Suicidal and self-harming behaviours (SSHBs) represent a major public health concern, particularly during adolescence. As such, there is an urgent need to identify risk factors for the development of these behaviours in young people. Research has repeatedly highlighted a significantly link between sleep problems and SSHBs. However, the majority of these studies have relied upon very brief measures of global sleep that do not tap into the complexity of poor sleep. The distinctiveness of sleep disturbance subtypes, and their associated treatments, justifies a need to independently evaluate each of these subtypes in relation to SSHBs. Goals: This investigation set out to: 1.Evaluate whether distinctive subtypes of sleep disturbance can be identified within a sample of adolescents. 2.Assess the nature of the association between subtypes of sleep disturbance and SSHBs. Methodology: 15 and 16 year old volunteers (n=1046) from Scottish secondary schools completed an anonymous questionnaire battery including questions measuring self –reported self-harm (with and without suicidal intent), demographics (age gender and race), and sleep. More specifically, sleep questions assessed sleep patterns (bed-time, rise-time and total sleep duration on school days and weekends) and sleep quality (weekly sleep loss, insomnia and nightmares). Results: As predicted a priori, K-means cluster analysis identified three distinct subgroups of sleep disturbance: 1) consistently good sleepers (60.8%), 2) consistently poor sleepers (8.7%), and 3) poorer weekday/better weekend sleepers (30.45%). Cross-tabulation analysis demonstrated that rates of self-harm were highest in individuals who were consistently poor sleepers (42.2%). This was also the case with regards to suicide-attempts (18.9%). Conclusions: These findings provide novel insights into the relationship between sleep and SSHBs by examining how specific presentations of sleep disturbance could contribute to risk in adolescents. Future research in this area could inform the development of specific empirically driven sleep interventions to combat self-harm and suicide