(PS9-31) Sleep Quality Moderates Attentional Bias and Aversion to Self-Harm in Suicidal Ideation and NSSI

Abstract Text: Sleep quality is recognized as an important factor in the development and worsening of suicidal ideation and NSSI (Littlewood et al., 2018; Liu et al., 2016). Additionally, suicide theories emphasize acquired capability as increasing suicide risk through habituation, where there is a diminished fear of and aversion to pain and death (Brackman et al., 2016; Smith et al., 2016). Studies also demonstrate that attentional bias toward suicide and NSSI stimuli may be associated with future acts of NSSI and attempts(Brüdern et al., 2024; Powers, Brausch, & Muehlenkamp, 2021). Poor sleep quality has been associated with a higher rate of negative biases (Gobin et al., 2015), however its association with attentional bias to, or aversion for, suicide is unexamined. Despite the existing research on sleep and habituation variables in suicide and NSSI, few have examined how they work together to influence short-term ideation and related behaviors like NSSI. The current study addresses this gap by testing the hypothesis that sleep quality will interact with attentional bias and aversion to self-harm, increasing same- and next-day suicidal intent and NSSI behavior.
Participants included 132 college students with past-month NSSI and suicide ideation (Mage =19.44; 69.7% Female; 87.9% White; 49.2% in counseling) who completed a 28-day, daily diary protocol. Participants responded to items assessing subjective sleep problems, aversion and cognitive bias to self-harm, NSSI acts, and suicide intent each evening at an agreed-upon time.
Data collection recently completed, so preliminary moderation analyses using the PROCESS macro for SPSS with bootstrapping are described. The interaction between sleep and self-harm aversion was significant (b = -0.036, t = -7.39, p < .01) such that the effect of aversion on suicide intent was weakened at low levels of sleep problems. A similar pattern was observed for the sleep x cognitive bias (b = 0.030, t = 6.71, p <.01), with the relationship between cognitive bias and suicide becoming non-significant at low sleep problems. For NSSI, there was a significant interaction between sleep and aversion (b = -0.017, t = -4.74, p < .01) such that high and average sleep problems increased the strength of the association between aversion and NSSI. The sleep x cognitive bias interaction effect on NSSI acts was non-significant (b = .001, t = 0.21, p > .80). We will conduct multi-level path moderation analyses with latent variable centering, which allows for simultaneous estimates of between and within-person effects, for the final presentation.
These results suggest that sleep problems may affect how risk factors such as attentional bias and self-harm aversion relate to, or impact risk for, suicide intent and NSSI. Integrating cognitive behavioral sleep-focused interventions with those addressing cognitive biases and processes could be important in reducing suicide risk and NSSI behaviors.