Rest-Activity Rhythms and Suicidal Thoughts and Behaviors in an Adolescent High-Risk Community Intensive Outpatient Sample

Background: Sleep and circadian disturbances have been identified as a promising potential indicator of near-term suicide risk, with studies demonstrating prospective associations between disturbances and next-day, next-week, and next-month suicidal thoughts and behaviors (STBs) in youth populations. However, no research to date has examined the near-term associations between rest-activity rhythms (RAR), an actigraphy-based measure of circadian rhythm regularity, and STBs in youth. The current project aimed to address this gap by examining the associations between RAR and same-week and next-week STBs in adolescents attending a community intensive outpatient program (IOP) for STBs Methods: Participants are 58 adolescents (mean age 17.06; 72.4% female sex at birth) who participated in the Sleep Predicting Outcomes in Teens (SPOT) study. Participants wore an actiwatch (GT9X Link actigraph) for up to 3 months, from which RAR stability metrics—interdaily stability (IS) and intradaily variability (IV)—and daytime activity (M10) were computed on weekly intervals. Weekly ratings of depression and suicidal ideation (SI) severity were derived from the Adolescent Longitudinal Follow-Up Evaluation (ALIFE) Psychiatric Status Rating (PSR) Scales. Suicidal behaviors were not examined in analyses due to low rate of occurrence. We employed mixed level models to 1) describe the patterns of RARs over time, and to examine 2) concurrent and 3) prospective associations between weekly RARs and SI. Results: Intra-class coefficient analyses indicated significant within and between-person variability in RARs and daytime activity levels week-to-week. Lower IS was associated with higher odds of occurrence of SI with method (OR=0.61, p=.018) and more severe SI ratings (β=-0.15, p=.006) during the same week. Lower IS was also associated with higher odds of next-week SI occurrence (OR=0.52, p=.023). Moreover, within-person week-to-week decreases in IS (β=-0.13, p=.019) and M10 (β=-0.11, p=.031) were associated with more severe SI ratings during the latter week. These associations remained significant even after accounting for depression severity and previous-week SI ratings. Conclusion: Our results indicate greater 24-hour irregularity in RARs may be predictive of near-term suicide risk in adolescents. Future research may benefit from considering 24-hour circadian metrics in the study of sleep and suicide risk identification, prevention, and intervention in adolescents

Early Life Stress Predicts Depressive Symptoms in Adolescents During the COVID-19 Pandemic: The Mediating Role of Perceived Stress

Background: Exposure to early life stress (ELS) is alarmingly prevalent, and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression. Methods: We tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area (N=100; 43 male; ages 13-20 years) who had been characterized 4-7 years earlier (M=5.27, SD=0.75 years) with respect to exposure to ELS and symptoms of depression. Results: As expected, severity of ELS predicted levels of depressive symptoms during the pandemic (r(98)=0.25, p=.012), which were higher in females than in males (t(98)=-3.36, p=.001). Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic and other COVID-19-related variables. Conclusions: These findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress and isolation in high-risk youth