Sleep disturbance and suicidality in young transitioning inpatients
Research type
Research Study
Full title
SWAY: Sleep disturbance as an early warning sign of suicidality in young psychiatric inpatients transitioning to the community: an experience sampling methodology study
IRAS ID
280707
Contact name
Lindsay Helen Dewa
Contact email
Sponsor organisation
Imperial College London
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 6 months, 2 days
Research summary
Research Summary:
There is increasing evidence that poor sleep is a risk factor for suicidal ideation and behaviour, when controlling for depression. Young people are at particular risk of death by suicide particular when transitioning from psychiatric hospital to community and in the first few days. However, studies examining the sleep-suicide relationship in psychiatric inpatients, and in patients transitioning from acute care to the community, is lacking. Our project will examine the relationship between sleep, mental health and suicidality over time in young people transitioning from an acute psychiatric hospital to the community using experience sampling methodology. Participants will wear a wrist worn watch for up to 21 days. It will be used to measure sleep-wake activity and for participants to answer very short and quick questions about suicidal thoughts and behaviour, mood and anxiety throughout the day. We expect to see a relationship between poor sleep and suicidality, which may lead to targeting sleep interventions and digital monitoring in the first period after leaving hospital.Summary of Results:
Two hundred and twenty-four patients were assessed for eligibility either using patient records or in person. Fifty-seven were eligible and approached on the inpatient wards. Of which twenty were recruited and fifteen completed the baseline assessment. One person asked for their data to be removed from the study. Of the remaining 14 64% were male, most identified as heterosexual and half identified as minority ethnic (50%; n=7). The mean age was 26.8 (SD 6.3). Half of the 14 reported they had poor sleep before coming into the hospital. The mean PSQI and SCI scores were 9.3 (4.3) and 17.2 (7.8) respectively. Both indicate moderate sleep problems but not clinical insomnia. Seventy one percent of participants (n=10) reported having experienced suicidal ideation in their lifetime and 50% (n=7) had attempted suicide in their lifetime. Presence of suicidal ideation and attempt in the past month was 57% (n=8) and 21% (n=3) respectively. Only 8 participants used the watch before and after discharge however, data was largely missing so we were unable to analyse the data as intended.Unfortunately, we could do no more than a descriptive analysis of the questionnaire data despite team efforts. The study suffered from several limitations that prevented us from drawing meaningful conclusions. First, the sample size was too small, the attrition rate too high and there as a significantly low response rate to the ecological momentary assessment (EMA) questions, meaning that no statistical calculations could be conducted apart from descriptive ones. Researchers were faced with multiple challenges during recruitment due to limited communication between staff and the unpredictability of discharges. There are many reasons why staff were not as engaged in recruitment including inadequate knowledge of the study and its importance, the study not being a high priority, not having an incentive to recruit, and not knowing the research team (although we were as present as we could be), and not being proactive in informing the research team.
On the other hand, we were faced with multiple unplanned discharges, two watches being lost, not having enough time to give the watch back to the participants before they were discharged, or missing participants as they were discharged before we could recruit them. One patient also absconded. These challenges raise several concerns as to whether this study design is feasible and how it can be conducted.
We did have fantastic learning to share from how we co-produced the EMA study with three young people with lived experiences of sleep and suicidal ideation. Their experience was invaluable in shaping the study design, documentation, and recruitment strategy. We are currently writing both these learnings up as a reflective piece.
REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
21/WM/0128
Date of REC Opinion
25 May 2021
REC opinion
Favourable Opinion