(PS8-26) Can Sleep Disturbances Be a Treatment Target in Adolescent Psychiatric Inpatient Units? Examining Severity, Clinical Correlates Including Suicide Risk, and Informant Discrepancies

Sleep disturbances are associated with suicide outcomes for adolescents. Psychiatric inpatient units appear well suited to measure and intervene regarding sleep disturbances given their high level of monitoring. However, little is known about the severity of sleep disturbances during the vulnerable period of inpatient hospitalization and how this relates to clinical correlates and multiple informant perspectives.

Participants were a diverse group of 556 adolescents (16.4% Trans/Non-Binary, 35.4% non-white) and their caregivers, who completed standardized rating scales at intake to a psychiatric inpatient unit.  First, we determined how many adolescents experienced clinically significant sleep disturbances (2+ standard deviations above the mean on the PROMIS Sleep Disturbance Short Form). We then conducted linear regressions to examine the relation between informant reports of sleep disturbances and suicide risk (Ask Suicide-Screening Questions [ASQ]) and emotion dysregulation (Difficulties in Emotion Regulation Scale). To examine multiple informant discrepancies, we calculated Intraclass Correlations (ICCs) for each item as well as total sleep disturbance scores. We then conducted polynomial regression analyses to determine if informant discrepancies were significantly related to suicide risk and emotion dysregulation. All regression analyses controlled for internalizing symptoms using the adolescent reported internalizing subscale of the PSC-17.  

Clinically significant sleep disturbances were reported by 30.0% of adolescents and 41.1% of caregivers. Notably 58.1% of adolescents demonstrated clinically significant sleep disturbances when informant reports were combined. Linear regression analyses indicated that caregiver reported sleep disturbances were associated with caregiver reported emotion dysregulation (B = .257, p < .001), controlling for adolescent report, whereas adolescent reported sleep disturbances were associated with adolescent reported emotion dysregulation (B = .171, p < .001), controlling for caregiver report. Additionally, adolescent, but not caregiver, reported sleep disturbances were associated with higher suicide risk (B = .088, p = .019). Regarding informant discrepancies, ICCs indicated poor agreement on individual items as well as the total score for adolescent and caregiver reports of sleep disturbances (ICCs < .20, ps > .05). Polynomial regression analyses indicated that informant discrepancies related to sleep disturbances were not significantly associated with adolescent reported suicide risk, or adolescent or caregiver reported emotion dysregulation.

More than half of adolescents receiving care in psychiatric inpatient units experience clinically significant sleep disturbances, and adolescents' reports of sleep disturbances are significantly associated with emotion dysregulation and suicide risk. Although there is poor agreement between adolescents and caregivers regarding sleep disturbances, these informant discrepancies do not appear to be significantly associated with emotion regulation or self-reported suicide risk. We discuss implications for measuring and managing sleep disturbances in psychiatric inpatient units.