Adolescence represents a high-risk period for the onset and repetition of selfharm, and evidence suggests that an increasing number of young people are harming themselves. This is concerning as self-harm is indicative of intolerable psychological distress, and young people who harm themselves are at greater risk of suicide in the future. Responding effectively to self-harm is a key component of suicide prevention efforts. A fundamental step in reducing self-harm during adolescence is the identification of factors associated with increased self-harm risk, and clarification regarding the theoretical underpinnings of these relationships. Increased attention has been placed on adolescent sleep within this context, and research evidence supports a role for symptoms of sleep disturbance within pathways to self-harm. However, important questions about this relationship remain unanswered. This thesis aimed to target key gaps in current understanding, and had two overarching aims. The first aim of this thesis was to provide a more detailed and nuanced understanding the association between specific symptoms of sleep disturbance and future self-harm risk in order to understand which aspects of sleep are driving the relationship. The second aim was to examine the role of theoretically salient psychological factors, which underpin the relationship between disturbed sleep and self-harm in order to understand why the link exists. These aims were addressed by conducting a programme of research including a systematic review, a six-month prospective study, and a micro-longitudinal investigation. Chapter 3 synthesises and critically evaluates research examining the link between symptoms of sleep disturbance and self-harm risk during adolescence. Global assessments of sleep disturbance, symptoms of sleep disorders and problems, and specific sleep parameters, are all associated with increased vulnerability to self-harming and suicidal thoughts and behaviours. A research agenda is presented offering recommended directions for future work in the area. Chapter 4 details a six-month prospective study that examines the relationship between a wide range of symptoms of sleep disturbance and subsequent self-harm thoughts and behaviours. Clinically salient insomnia symptoms were prospectively associated with self-ham thoughts. Both insomnia symptoms and poor sleep quality predicted that a young person would engage in first time or repeat self-harm during the six-month follow up period. To establish why this link exists, Chapter 5 examined whether psychological pathways - derived from the Integrated Motivational Volitional Model of Suicidal Behaviour - explain the link between insomnia symptoms and selfharm risk. The relationship was accounted for by perceptions of defeat and internal entrapment (but not external entrapment). Chapter 6 details a micro-longitudinal
investigation that aimed to build on the insights gained from the systematic review and six-month prospective study, by examining whether symptoms of sleep disturbance and psychological factors (i.e., defeat, internal entrapment, and external
entrapment) predicted short-term self-harm risk. Specific symptoms of sleep disturbance predicted defeat (sleep quality) and internal entrapment (nightmare intensity and distress) the following day, but were not associated with next-day selfharm thoughts and behaviours. Taken together, the research presented in this thesis provides novel insights into the relationship between sleep disturbance and self-harm risk within the unique context of adolescence. This advanced understanding has implications for future research, theoretical conceptualisation of self-harm risk, and has the potential to guide policy and prevention efforts.
|Date of Award||28 Jul 2020|
- University Of Strathclyde
|Sponsors||University of Strathclyde|
|Supervisor||Susan Rasmussen (Supervisor) & Simon C. Hunter (Supervisor)|