Insomnia and nightmares as markers of risk for suicidal ideation in young people: investigating the role of defeat and entrapment

Objectives: Although converging evidence has identified sleep problems as robust predictors of suicidal ideation in young people, the psychological processes driving these associations are not yet known. The current study aimed to test predictions, informed by the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour, concerning the role of feelings of defeat and entrapment within the sleep-suicide relationship.
Methods: Fifteen and sixteen year old volunteers (n=1045) from Scottish secondary schools completed an anonymous self-report survey assessing insomnia symptoms, nightmares, suicidal ideation, depressive symptomology and feelings of defeat and entrapment.
Results: Both insomnia symptoms and nightmares were associated with an increased likelihood of reporting suicidal ideation (independent of depression). Perceptions of both defeat and entrapment were elevated in young people who reported clinically salient insomnia and/or nightmares, relative to those who did not. The relationship between insomnia and suicidal ideation was fully mediated by perceptions of defeat and entrapment, whilst nightmares were indirectly associated with suicidal ideation through perceptions of defeat and entrapment.
Conclusions: Taken together, these findings provide novel insights into the psychological mechanisms linking sleep disturbance and suicidality by highlighting the role of defeat and entrapment. Clinically, these findings have the potential to improve suicide risk assessment and prevention in young people experiencing difficulties with their sleep.