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

Teresi, Giana Isabella (2024) Rest-Activity Rhythms and Suicidal Thoughts and Behaviors in an Adolescent High-Risk Community Intensive Outpatient Sample. Master's Thesis, University of Pittsburgh. (Unpublished)

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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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Teresi, Giana Isabellagit11@pitt.edugit110000-0002-9674-3313
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairGoldstein, Tina Rgoldtr@upmc.edutrg2
Committee MemberFranzen, Peter Lfranpl@UPMC.EDUpfl4
Committee MemberChoukas-Bradley, Sophiascb.1@pitt.eduscb.1
Date: 8 May 2024
Date Type: Publication
Defense Date: 29 February 2024
Approval Date: 8 May 2024
Submission Date: 27 March 2024
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 62
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Psychology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Suicide; Sleep; Adolescence; Rest-Activity Rhythms
Date Deposited: 08 May 2024 17:45
Last Modified: 08 May 2024 17:45


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