Sleep deprivation and suicidality in adolescent males: a systematic review
Creators: name: Qureshi, Lubna J.
Publisher: name: No Publisher Supplied
Year: 2022

description: PURPOSE OF THE PROJECTThe objective of this review was to examine the prevalence of suicidality in adolescent males (13-18±1 years old) with sleep deprivation. Sleep deprivation is a risk factor and a precursor to high-risk behaviors as researchers suggest insomnia as a marker of suicide as well as an antecedent observed right before suicidal attempts and completed suicides. Examining the contributing factors associated with suicide and self-injurious behavior (SIB) is crucial in preventing suicide. METHODOLOGYThe systematic review method was used. The standard three-step search strategy of the Joanna Briggs institute was used to find eligible studies in nine different databases. This review considered experimental and epidemiological study designs including randomized and non-randomized controlled trials, prospective and retrospective cohort studies, analytical cross-sectional studies, and descriptive epidemiological study designs including population based cross-sectional surveys. Adolescent males between the ages of 13 and 18 (±1), with a diagnosed or undiagnosed depression who had engaged in self-injurious behavior (SIB); have thought of death by suicide, attempted death by suicide or have died by suicide and have also reported disturbed sleep. Studies selected for retrieval were assessed independently by two reviewers for methodological validity prior to inclusion in the review. Data were extracted and synthesized using JBI SUMARI (Joanna Briggs System for the Unified Management of the Assessment Review of Information). RESULTSThree research studies were included in this review. All included studies found a strong negative association between sleep duration and suicidal ideation and/or attempts. Of the 56 initial articles retrieved, three full-text articles meeting all inclusion criteria were selected and appraised by two independent reviewers. These included one cohort study and two analytical cross-sectional design study articles. A narrative synthesis of these three articles was performed due to the lack of quantitative data available to perform a meta-analysis. The result of this review shows negative associations between sleep duration and suicidal ideation and/or attempts in adolescent males, which helps support the need for additional efforts in highlighting suicide prevention and overall mental health for this population. The three included studies were self-reported survey based and comprised of 54,631 adolescent males of whom 22,646 (Approx. 42%) reported sleep deprivation. The data from the two included Korean studies (Jang et al., 2013; Park et al., 2019) was collected from the same web-based middle and high school surveys and were consistent in showing the negative association between number of hours of sleep or sleep duration and suicidality. Jang et al. (2013) also included the direct and indirect effect of depression with sleep duration and reported a weaker negative association between quantity of sleep and suicidal ideation or attempts. The Gong et al., (2020) was a cohort type study and collected data from 2016 to 2018, it reported a high odds ratio (OR) for suicidality (OR=2.18 95% confidence interval Cl 1.97 to 3.98, p &lt;0.05) for suicidal ideation and (OR=2.97 95% CI 1.39 to 6.38, p &lt;0.05) for suicidal attempts (OR&gt;1 exposure associated with higher odds of outcome).IMPLICATIONS FOR PRACTICEClinical Practice:This review supports the need for routine and thorough assessment for sleep disturbances and/or sleep hygiene in young adolescent males and intervene as early as possible. Providers can play a significant role in increasing public awareness and providing education to parents, and caregivers/guardians on lack of sleep and its affect a child’s mental and emotional well-being. Healthcare Policy:The prevalence reported in this review define the need for improved screening, increased education, better research and overall improved coordination of care in the community. School facilitated screening such as in the case of school-required screenings for vision or hearing. This would help minimize the gaps in screening in primary care practices or otherwise in the community.Quality/Safety:The project emphasizes the need for better detection of sleep problems to decrease related injuries and/or fatalities. Addressing insufficient sleep can affect cognitive and decision-making skills, poor lifestyle choices, self-medicating, risk taking behaviors, which may lead to often lethal or long-term health problems for these young men. Economics:Addressing sleep deprivation related suicidality has a clear fiscal incentive and doing so can save costs for the entire healthcare system. This includes not only the ED cost but also include the inpatient hospitalization and follow up, the transport or the ambulance, the autopsy or investigation, and the wages associated with it adds to the indirect cost associated with suicides or attempted suicides.