Abstract
Sleep is a modifiable risk factor for suicidal thoughts and behaviors in adolescents, and social media use may be one factor linked to sleep outcomes. The current study examined self-reported subjective daytime and nighttime social media use (SMU) as a predictor of both subjective and objectively- captured sleep (timing, duration, and quality) among adolescents at high risk for suicide in an intensive outpatient program (IOP) for depression and suicidality. Data from two studies were used to evaluate these relationships for one month; Study 1 as part of standard clinical care among adolescents (N = 95, 75% female) and Study 2 as part of an intensive monitoring study among adolescents and young adults in the IOP (N = 30, 67% female). Multilevel modeling indicated that adolescents with more nighttime subjective SMU experienced later self-reported sleep timing and daily SMU predicted poorer sleep quality (Study 1). Both daytime and nighttime subjective SMU predicted later sleep timing as assessed by actigraphy (Study 2). Subjective SMU did not predict sleep duration or quality in Study 2. Findings suggest that SMU may be one actionable factor to improve sleep timing, which has implications for suicide prevention among individuals at high risk for suicide.
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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Ahn, S., Lobo, J. M., Logan, J. G., Kang, H., Kwon, Y., & Sohn, M.-W. (2021). A scoping review of racial/ethnic disparities in sleep. Sleep Medicine, 81, 169–179. https://doi.org/10.1016/j.sleep.2021.02.027
Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995). The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.
Åslund, L., Arnberg, F., Kanstrup, M., & Lekander, M. (2018). Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis. Journal of Clinical Sleep Medicine, 14(11), 1937–1947. https://doi.org/10.5664/jcsm.7498
Bei, B., Seeman, T. E., Carroll, J. E., & Wiley, J. F. (2017). Sleep and physiological dysregulation: A closer look at sleep intraindividual variability. Sleep, 40(9), zsx109. https://doi.org/10.1093/sleep/zsx109
Biernesser, C., Bear, T., Brent, D., Mair, C., Zelazny, J., & Trauth, J. (2022). Development of An Ecological Momentary Assessment of the Impact of Social Media Use Among Suicidal Adolescents. Archives of Suicide Research, 26(4), 1847–1861. https://doi.org/10.1080/13811118.2021.1943581
Burnell, K., George, M. J., Jensen, M., Hoyle, R. H., & Odgers, C. L. (2021). Associations Between Adolescents’ Daily Digital Technology Use and Sleep. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2021.09.033
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Carter, B., Rees, P., Hale, L., Bhattacharjee, D., & Paradkar, M. S. (2016). Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatrics, 170(12), 1202–1208. https://doi.org/10.1001/jamapediatrics.2016.2341
Charmaraman, L., Richer, A. M., Ben-Joseph, E. P., & Klerman, E. B. (2021). Quantity, Content, and Context Matter: Associations Among Social Technology Use and Sleep Habits in Early Adolescents. Journal of Adolescent Health, 69(1), 162–165. https://doi.org/10.1016/j.jadohealth.2020.09.035
Chu, C., Hom, M. A., Rogers, M. L., Ringer, F. B., Hames, J. L., Suh, S., & Joiner, T. E. (2016). Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 12(5), 647–652. https://doi.org/10.5664/jcsm.5784
Cook, B. L., Trinh, N.-H., Li, Z., Hou, S.S.-Y., & Progovac, A. M. (2017). Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004–2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453
Das-Friebel, A., Lenneis, A., Realo, A., Sanborn, A., Tang, N. K. Y., Wolke, D., von Mühlenen, A., & Lemola, S. (2020). Bedtime social media use, sleep, and affective wellbeing in young adults: An experience sampling study. Journal of Child Psychology and Psychiatry, 61(10), 1138–1149. https://doi.org/10.1111/jcpp.13326
Dolsen, E. A., Byers, A. L., Flentje, A., Goulet, J. L., Jasuja, G. K., Lynch, K. E., Maguen, S., & Neylan, T. C. (2022). Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiology of Stress, 21, 100488. https://doi.org/10.1016/j.ynstr.2022.100488
Dong, L., Dolsen, M. R., Martinez, A. J., Notsu, H., & Harvey, A. G. (2020). A transdiagnostic sleep and circadian intervention for adolescents: Six-month follow-up of a randomized controlled trial. Journal of Child Psychology and Psychiatry, 61(6), 653–661. https://doi.org/10.1111/jcpp.13154
Fobian, A. D., Avis, K., & Schwebel, D. C. (2016). The Impact of Media Use on Adolescent Sleep Efficiency. Journal of Developmental and Behavioral Pediatrics : JDBP, 37(1), 9–14. https://doi.org/10.1097/DBP.0000000000000239
Goldstein, T. R., & Franzen, P. L. (2022). A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions. Current Sleep Medicine Reports, 8(1), 1–19. https://doi.org/10.1007/s40675-022-00222-9
Goldstein, T. R., Bridge, J. A., & Brent, D. A. (2008). Sleep disturbance preceding completed suicide in adolescents. Journal of Consulting and Clinical Psychology, 76(1), 84–91. https://doi.org/10.1037/0022-006X.76.1.84
Griggs, S., Conley, S., Batten, J., & Grey, M. (2020). A systematic review and meta-analysis of behavioral sleep interventions for adolescents and emerging adults. Sleep Medicine Reviews, 54, 101356. https://doi.org/10.1016/j.smrv.2020.101356
Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58. https://doi.org/10.1016/j.smrv.2014.07.007
Hale, L., Kirschen, G. W., LeBourgeois, M. K., Gradisar, M., Garrison, M. M., Montgomery-Downs, H., Kirschen, H., McHale, S. M., Chang, A. M., & Buxton, O. M. (2018). Youth screen media habits and sleep: Sleep-friendly screen behavior recommendations for clinicians, educators, and parents. Child and Adolescent Psychiatric Clinics of North America, 27(2), 229–245. https://doi.org/10.1016/j.chc.2017.11.014
Hamilton, J. L., & Lee, W. (2021). Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample. JMIR Mental Health, 8(9), e26273. https://doi.org/10.2196/26273
Hamilton, J. L., Biernesser, C., Moreno, M. A., Porta, G., Hamilton, E., Johnson, K., Poling, K. D., Sakolsky, D., Brent, D. A., & Goldstein, T. G. (2021). Social media use and prospective suicidal thoughts and behaviors among adolescents at high risk for suicide. Suicide and Life-Threatening Behavior, 51(6), 1203–1212. https://doi.org/10.1111/sltb.12801
Hamilton, J. L., Chand, S., Reinhardt, L., Ladouceur, C. D., Silk, J. S., Moreno, M., Franzen, P. L., & Bylsma, L. M. (2020a). Social media use predicts later sleep timing and greater sleep variability: An ecological momentary assessment study of youth at high and low familial risk for depression. Journal of Adolescence, 83, 122–130. https://doi.org/10.1016/j.adolescence.2020.07.009
Hamilton, J. L., Coulter, R. W. S., & Radovic, A. (2020b). Mental health benefits and opportunities. In Technology and Adolescent Health (305–345). Elsevier https://doi.org/10.1016/B978-0-12-817319-0.00013-X
Hamilton, J. L., Hutchinson, E., Evankovich, M. R., Ladouceur, C. D., & Silk, J. S. (2022). Daily and average associations of physical activity, social media use, and sleep among adolescent girls during the COVID-19 pandemic. Journal of Sleep Research, n/a(n/a), e13611 https://doi.org/10.1111/jsr.13611
Hamilton, J. L., Tsypes, A., Zelazny, J., Sewall, C. J. R., Rode, N., Merranko, J., Brent, D. A., Goldstein, T. R., & Franzen, P. L. (2023). Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high-risk adolescents and young adults. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 64(1), 27–38. https://doi.org/10.1111/jcpp.13651
Harbard, E., Allen, N. B., Trinder, J., & Bei, B. (2016). What’s Keeping Teenagers Up? Prebedtime Behaviors and Actigraphy-Assessed Sleep Over School and Vacation. Journal of Adolescent Health, 58(4), 426–432. https://doi.org/10.1016/j.jadohealth.2015.12.011
Hom, M. A., Hames, J. L., Bodell, L. P., Buchman-Schmitt, J. M., Chu, C., Rogers, M. L., Chiurliza, B., Michaels, M. S., Ribeiro, J. D., Nadorff, M. R., Winer, E. S., Lim, I. C., Rudd, M. D., & Joiner, T. E. (2017). Investigating insomnia as a cross-sectional and longitudinal predictor of loneliness: Findings from six samples. Psychiatry Research, 253, 116–128. https://doi.org/10.1016/j.psychres.2017.03.046
Johnson, D. A., Reiss, B., Cheng, P., & Jackson, C. L. (2022). Understanding the role of structural racism in sleep disparities: A call to action and methodological considerations. Sleep, 45(10), zsac200. https://doi.org/10.1093/sleep/zsac200
Kearns, J. C., Coppersmith, D. D. L., Santee, A. C., Insel, C., Pigeon, W. R., & Glenn, C. R. (2020). Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. General Hospital Psychiatry, 63, 141–151. https://doi.org/10.1016/j.genhosppsych.2018.09.011
LeBourgeois, M. K., Hale, L., Chang, A.-M., Akacem, L. D., Montgomery-Downs, H. E., & Buxton, O. M. (2017). Digital Media and Sleep in Childhood and Adolescence. Pediatrics, 140(Suppl 2), S92–S96. https://doi.org/10.1542/peds.2016-1758J
Levenson, J. C., Shensa, A., Sidani, J. E., Colditz, J. B., & Primack, B. A. (2016). The association between social media use and sleep disturbance among young adults. Preventive Medicine, 85, 36–41. https://doi.org/10.1016/j.ypmed.2016.01.001
Levenson, J. C., Shensa, A., Sidani, J. E., Colditz, J. B., & Primack, B. A. (2017). Social Media Use Before Bed and Sleep Disturbance Among Young Adults in the United States: A Nationally Representative Study. Sleep, 40(9), zsx113. https://doi.org/10.1093/sleep/zsx113
Liu, R. T., Steele, S. J., Hamilton, J. L., Do, Q. B. P., Furbish, K., Burke, T. A., Martinez, A. P., & Gerlus, N. (2020). Sleep and suicide: A systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review, 81, 101895. https://doi.org/10.1016/j.cpr.2020.101895
Liu, X. (2004). Sleep and adolescent suicidal behavior. Sleep, 27(7), 1351–1358. https://doi.org/10.1093/sleep/27.7.1351
Matthews, T., Danese, A., Gregory, A. M., Caspi, A., Moffitt, T. E., & Arseneault, L. (2017). Sleeping with one eye open: Loneliness and sleep quality in young adults. Psychological Medicine, 47(12), 2177–2186. https://doi.org/10.1017/S0033291717000629
McCall, W. V. (2022). Targeting insomnia symptoms as a path to reduction of suicide risk: The role of cognitive behavioral therapy for insomnia (CBT-I). Sleep, 45(12), zsac260. https://doi.org/10.1093/sleep/zsac260
Meltzer, L. J., Montgomery-Downs, H. E., Insana, S. P., & Walsh, C. M. (2012). Use of actigraphy for assessment in pediatric sleep research. Sleep Medicine Reviews, 16(5), 463–475. https://doi.org/10.1016/j.smrv.2011.10.002
Monk, T. H., Reynolds, C. F., Kupfer, D. J., Buysse, D. J., Coble, P. A., Hayes, A. J., MacHen, M. A., Petrie, S. R., & Ritenour, A. M. (1994). The Pittsburgh Sleep Diary. Journal of Sleep Research, 3, 111–120.
Nesi, J., Burke, T. A., Lawrence, H. R., MacPherson, H. A., Spirito, A., & Wolff, J. C. (2021a). Online Self-Injury Activities among Psychiatrically Hospitalized Adolescents: Prevalence, Functions, and Perceived Consequences. Research on Child and Adolescent Psychopathology, 49(4), 519–531. https://doi.org/10.1007/s10802-020-00734-4
Nesi, J., Rothenberg, W. A., Bettis, A. H., Massing-Schaffer, M., Fox, K. A., Telzer, E. H., Lindquist, K. A., & Prinstein, M. J. (2021b). Emotional Responses to Social Media Experiences Among Adolescents: Longitudinal Associations with Depressive Symptoms. Journal of Clinical Child & Adolescent Psychology, 1–16. https://doi.org/10.1080/15374416.2021.1955370
Orben, A., & Przybylski, A. K. (2020). Teenage sleep and technology engagement across the week. PeerJ, 8, e8427. https://doi.org/10.7717/peerj.8427
Orzech, K. M., Grandner, M. A., Roane, B. M., & Carskadon, M. A. (2016). Digital media use in the 2 h before bedtime is associated with sleep variables in university students. Computers in Human Behavior, 55, 43–50. https://doi.org/10.1016/j.chb.2015.08.049
Parry, D. A., Davidson, B. I., Sewall, C. J. R., Fisher, J. T., Mieczkowski, H., & Quintana, D. S. (2021). A systematic review and meta-analysis of discrepancies between logged and self-reported digital media use. Nature Human Behaviour, 5(11), 1535–1547. https://doi.org/10.1038/s41562-021-01117-5
Parry, D. A., Fisher, J. T., Mieczkowski, H., Sewall, C. J. R., & Davidson, B. I. (2022). Social media and well-being: A methodological perspective. Current Opinion in Psychology, 45, 101285. https://doi.org/10.1016/j.copsyc.2021.11.005
Perlis, M. L., Grandner, M. A., Chakravorty, S., Bernert, R. A., Brown, G. K., & Thase, M. E. (2016). Suicide and sleep: Is it a bad thing to be awake when reason sleeps? Sleep Medicine Reviews, 29, 101–107. https://doi.org/10.1016/j.smrv.2015.10.003
Ploderl, M. (2021). Suicide risk over the course of the day, week, and life. Psychiatria Danubina, 33(3), 438–445. https://doi.org/10.24869/psyd.2021.438. Scopus.
Radovic, A., Gmelin, T., Stein, B. D., & Miller, E. (2017). Depressed adolescents’ positive and negative use of social media. Journal of Adolescence, 55, 5–15. https://doi.org/10.1016/j.adolescence.2016.12.002
Ramchand, R., Gordon, J. A., & Pearson, J. L. (2021). Trends in Suicide Rates by Race and Ethnicity in the United States. JAMA Network Open, 4(5), e2111563. https://doi.org/10.1001/jamanetworkopen.2021.11563
Roberts, R. E., Roberts, C. R., & Duong, H. T. (2009). Sleepless in adolescence: Prospective data on sleep deprivation, health and functioning. Journal of Adolescence, 32(5), 1045–1057. https://doi.org/10.1016/j.adolescence.2009.03.007
Sampasa-Kanyinga, H., Hamilton, H. A., & Chaput, J.-P. (2018). Use of social media is associated with short sleep duration in a dose-response manner in students aged 11 to 20 years. Acta Paediatrica (Oslo, Norway: 1992), 107(4), 694–700. https://doi.org/10.1111/apa.14210
Scott, H., & Woods, H. C. (2018). Fear of missing out and sleep: Cognitive behavioural factors in adolescents’ nighttime social media use. Journal of Adolescence, 68, 61–65. https://doi.org/10.1016/j.adolescence.2018.07.009
Scott, H., & Woods, H. C. (2019). Understanding Links Between Social Media Use, Sleep and Mental Health: Recent Progress and Current Challenges. Current Sleep Medicine Reports, 5(3), 141–149. https://doi.org/10.1007/s40675-019-00148-9
Sewall, C. J. R., Bear, T. M., Merranko, J., & Rosen, D. (2020). How psychosocial well-being and usage amount predict inaccuracies in retrospective estimates of digital technology use. Mobile Media & Communication, 8(3), 379–399. https://doi.org/10.1177/2050157920902830
Takano, K., & Tanno, Y. (2011). Diurnal variation in rumination. Emotion, 11(5), 1046–1058. https://doi.org/10.1037/a0022757
Tandon, A., Kaur, P., Dhir, A., & Mäntymäki, M. (2020). Sleepless due to social media? Investigating problematic sleep due to social media and social media sleep hygiene. Computers in Human Behavior, 113, 106487. https://doi.org/10.1016/j.chb.2020.106487
The Trevor Project National Survey. (2021). Retrieved January 11, 2022, from https://www.TheTrevorProject.org/survey-2021/
Tubbs, A. S., Fernandez, F.-X., Johnson, D. A., Perlis, M. L., & Grandner, M. A. (2021). Nocturnal and Morning Wakefulness Are Differentially Associated With Suicidal Ideation in a Nationally Representative Sample. The Journal of Clinical Psychiatry, 82(6), 36963. https://doi.org/10.4088/JCP.20m13820
Vernon, L., Modecki, K. L., & Barber, B. L. (2017). Tracking Effects of Problematic Social Networking on Adolescent Psychopathology: The Mediating Role of Sleep Disruptions. Journal of Clinical Child & Adolescent Psychology, 46(2), 269–283. https://doi.org/10.1080/15374416.2016.1188702
Vogels, E., Gelles-Watnick, R., & Massarat, N. (2022, August 10). Teens, Social Media and Technology 2022. Pew Research Center: Internet, Science & Tech. https://www.pewresearch.org/internet/2022/08/10/teens-social-media-and-technology-2022/
Acknowledgements
Dr. Hamilton and Dr. Biernesser were supported by NIMH, including a K01MH121584 (Hamilton), L30MH117642 (Hamilton), and T32MH018951 (Biernesser). This research was supported in part by grants awarded to Drs. Goldstein and Franzen from the American Foundation for Suicide Prevention grant and a pilot award from the University of Pittsburgh Clinical and Translational Science Institute (UL1 TR001857). We acknowledge with gratitude Dr. David Brent’s Endowed Chair in Suicide Studies, as well as the Pennsylvania Legislature for their support of the STAR-Center and for supporting the electronic data collection and management. We are grateful to the youth and families who provided their data. We thank the STAR-Center team, including assessors, therapists, nurses, psychiatrists, data staff, student workers, and volunteers for their work and dedication.
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Hamilton, J.L., Jorgensen, S.L., Crichlow, Z. et al. Social Media Use and Sleep Outcomes among Adolescents at High Risk for Suicide. J Cogn Ther 17, 53–71 (2024). https://doi.org/10.1007/s41811-023-00177-x
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DOI: https://doi.org/10.1007/s41811-023-00177-x