Sleep and Next-Day Negative Affect and Suicidal Ideation in Borderline Personality Disorder

Abstract

Sleep disturbance is associated with elevated suicidal ideation and negative affect. To date, however, no study has investigated the temporal relationship between sleep and suicidality among those diagnosed with borderline personality disorder (BPD). This preregistered (https://osf.io/4vugk) study tested whether nightly sleep (self-reported sleep duration, sleep onset latency, and subjective leep quality) represents a (within-person) short-term risk factor for affective dysregulation and increases in suicide risk from day-to-day, as well as whether between-person differences in sleep, negative affect, and suicidality were associated. We used a 21-day ecological momentary assessment protocol in a sample of 142 people diagnosed with BPD, 98 of which had a history of serious suicide attempts, and 52 healthy controls. We found a within-person association between better subjective sleep quality and greater next day negative affect. At the between-person level, we found positive relationships between sleep latency and suicidal ideation, and a negative association between subjective sleep quality and negative affect. BPD severity did not significantly moderate the strength of any within-person associations, although BPD was positively associated with average levels of suicidal ideation, sleep latency, and negative affect, and negatively related to subjective sleep quality. These findings suggest that the association of sleep with suicidal ideation and BPD exists largely at the between-persons rather than the within-person level. Disturbed sleep, therefore, seems to largely coincide, rather than specifically contribute to the exacerbation of suicidal crises in BPD.

Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research

“…Most reports failed to establish independent temporal predictors of suicidal ideation severity: of twelve articles fitting temporal prediction models (47, 51, 52, 55-57, 60, 73, 74, 76, 77), four failed to establish significant predictors after accounting for ideation at the previous time point (47,52,55), and five did not control for prior ideation (51,60,73,74,76). Across studies, prior suicidal ideation therefore remained the strongest (or only) predictor of subsequent ideation (i.e., suicidal ideation at T significantly predicting ideation at T+1).…”

“…One study indicated that active coping reduced the intensity of ideation at the subsequent assessment 2 h later (77). Between days, short sleep duration (both objective and subjective), poor subjective sleep quality and increased sleep latency (i.e., time to fall asleep) predicted (mean) next-day suicidal ideation (51,74). Negative interpersonal events were also associated with increased next-day suicidal ideation (73).…”