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Sleep disturbance may portend suicidal behavior among preteens, according to a longitudinal cohort study.

A study of more than 8,000 kids found that those who reported severe sleep disturbances at age 10 had a higher odds of reporting suicidal ideation or attempt (OR 2.68, 95% CI 1.44-4.98, P=0.002) at age 12, according to Joel Stoddard, MD, MAS, of the Children's Hospital Colorado and the University of Colorado Anschutz Medical Campus in Aurora, and co-authors.

Notably, almost 1 in 3 youth who reported severe sleep disturbance at baseline also had some level of suicidal behavior during follow-up, they reported in .

Regular occurrence of nightmares was among the strongest associations with increased risk of suicidal behavior. Kids who reported daily nightmares at baseline had much higher odds of suicidal behavior 2 years later (OR 5.46, 95% CI 1.42-21.04, P=0.01) compared with kids who reported no nightmares.

"There's a nonrandom chance that sleep is associated with future suicidal thoughts or behaviors reported by the parent or child," Stoddard told MedPage Today in a phone interview at which a press person was present. "This study is beginning to look for longer term risk factors for suicidal thoughts and behaviors as opposed to more imminent risk factors."

Stoddard added that sleep, which is easily observable, has established diagnostic and treatment pathways to determine specific issues. This could mean that it may be an important risk factor easily targeted with interventions that function as secondary prevention measures for youth suicide.

"Sleep could be an opportunity. It's something that is visible [and] their parents can observe it," co-author Joshua Gowin, PhD, also of the University of Colorado Anschutz Medical Campus, said. "It's also an easier conversation since sleep is not a stigmatized thing, whereas something like depression might be."

The link between severe sleep disturbances at baseline and increased risk for suicidal behaviors in early adolescence remained even after adjusting for depression and anxiety, family history of depression, family conflict, and parental monitoring.

"If you consistently have problems where you're having trouble getting to sleep, you're not getting enough sleep, and you're frequently having disruptions like nightmares in the middle of the night, over time if that's not addressed, then it could lead to an increased risk for suicidal thoughts and behaviors," Gowin said.

To conduct the study, the authors collected data on 10,136 youths who reported no baseline suicidal ideation or behavior, using data from the Adolescent Brain Cognitive Development Study from June 2016 through January 2021.

Baseline sleep data was collected using The Sleep Disturbance Scale for Children, a 26-item parent-reported inventory, and covariates were measured using the Child Behavior Checklist Anxiety and Depression subscale and demographic variables.

In total, 8,807 youths completed the Kiddie Schedule for Affective Disorders and Schizophrenia assessment at the 2-year follow-up. Mean age was 9.9 years and just over half were boys (51.2%), while 65.6% were white, 14.5% were Black, and 2.2% were Asian.

The majority of children (91.3%) reported no suicidal behavior, while 3.6% reported passive suicidal ideation, 2.9% reported active nonspecific suicidal ideation, 1.5% reported active specific suicidal ideation, and 0.7% had a first-time suicide attempt.

The study had several limitations, including its reliance on self-reported data from parents and children for suicidal behavior and sleep information as opposed to objective measures. The authors noted that parents might not know the full extent of their child's inner thoughts. The authors also noted there was relative homogeneity for the study population, which tended to represent families with higher socioeconomic status.

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