Investigating the Interaction Between Sleep Symptoms of Arousal and Acquired Capability in Predicting Suicidality

Abstract

Heightened arousal significantly interacts with acquired capability to predict suicidality. We explore this interaction with insomnia and nightmares independently of waking state arousal symptoms, and test predictions of the Interpersonal Theory of Suicide (IPTS) and Escape Theory in relation to these sleep arousal symptoms. Findings from our e-survey (n = 540) supported the IPTS over models of Suicide as Escape. Sleep-specific measurements of arousal (insomnia and nightmares) showed no main effect, yet interacted with acquired capability to predict increased suicidality. The explained variance in suicidality by the interaction (1%-2%) using sleep-specific measures was comparable to variance explained by interactions previously reported in the literature using measurements composed of a mix of waking and sleep state arousal symptoms. Similarly, when entrapment (inability to escape) was included in models, main effects of sleep symptoms arousal were not detected yet interacted with entrapment to predict suicidality. We discuss findings in relation to treatment options suggesting that sleep-specific interventions be considered for the long-term management of at-risk individuals.

Examining the role of psychological factors in the relationship between sleep problems and suicide

“…The fifth study took an alternative approach to show that the interaction between sleep problems and acquired capability predicted increased suicidal thoughts (Hochard et al, 2016). Although the quality of this evidence was rated as moderate (Zschoche & Schlarb, 2015) to high (Golding et al, 2015, Nadorff et al, 2014), given that this divergent evidence is based on a small number of studies all of which were conducted with non-clinical samples, it would be inappropriate to discount the role of risk behaviours at this point.…”

“…); Nightmares (DDNSI); Nightmares duration (single item from DDNSI)Suicidality (SBQ)Acquired capability (ACSS-FAD); Perceived burdensomeness and thwarted belongingness (INQ)Multiple linear regressionDuration of nightmares was associated with suicidality, independent of acquired capability for suicide, perceived burdensomeness, thwarted belongingness, current insomnia symptoms, and current nightmares. However, duration of insomnia symptoms was not significantly associated with suicidality independent of acquired capability for suicide, perceived burdensomeness, thwarted belongingness, current insomnia symptoms, current nightmares and duration of nightmares.7Hochard et al (2016)540 adults M age = 24.2 (7.9), 74.3% femaleCross-sectionalInsomnia (ISI); Nightmares (DDNSI)Suicidal thoughts (DSI-SS)Acquired capability (mod-DSHI)Entrapment (Entrapment scale)Multiple linear regressionAcquired capability interacted with both insomnia and nightmares to significantly predict suicidal thoughts. Entrapment interacted with both insomnia and nightmares to significantly predict suicidal thoughts.7Littlewood, Gooding, Kyle, et al (2016)18 individuals with experience of depression and suicidality.…”

Perceptions of Past Parenting and Adult Attachment as Vulnerability Factors for Suicidal Ideation in the Context of the Integrated Motivational–Volitional Model of Suicidal Behavior

“…Respondents indicate on a 5‐point rating scale how much each statement represents them (from “Not at all like me” to “Extremely like me”). This measure has been commonly used within suicide and self‐harm research (Dhingra et al, ; Hochard et al, ; Wetherall et al, ) and displayed high internal reliability in the current study (ω = 0.961, SE = 0.002, CI = 0.957–0.966, N = 700).…”

Exploring Thematic Nightmare Content and Associated Self‐Harm Risk

“…This study followed operational definitions of self-harm set out by Hawton et al (2003) as intentional self-injury or self-poisoning, regardless of motivation or suicidal intent and with a nonfatal outcome. To measure self-harm, the modified-Deliberate Self-Harm Inventory (mod-DSHI; Lundh, Karim, & Quilisch, 2007) was employed.…”

“…However, findings regarding the role of acquired capability for suicide have been equivocal (Golding et al., ; Hochard, Heym, & Townsend, ; Nadorff et al., ) and warrant further research. Variables from the Cry of Pain model (Williams, ) — namely defeat (Littlewood, Gooding, Kyle, Pratt, & Peters, ), entrapment (Hochard et al., ; Littlewood, Gooding, Panagioti, & Kyle, ), and hopelessness (Littlewood, Gooding, Panagioti, et al., ) — have also been shown to account for some of the variance explained in the nightmare to suicidality relationship. This has been further reinforced by qualitative data (Littlewood, Gooding, Kyle, et al., ) suggesting participants viewed sleep as a temporary escape, as previously hypothesized by Shneidman ().…”